Description

INDIA – MEDICINE – EPIDEMIOLOGY / THEMATIC CARTOGRAPHY / PROVINCIAL INDIAN IMPRINT:

Stephen Chapman TOWNSEND (1826 – 1901).

[Nagpur, 1870].

 

4° (30 x 20 cm): [1 f.], 3 pp., [1 f.], v pp., 2 large folding hand coloured lithographed maps, 85 pp., [9 ff. of tables (2 folding)], bound in modern marbled paper wrappers (Very Good, text remarkably clean, some slight restoration to blank gutter of last leaf, second map with small loss to the left margin but scarcely affecting image due to publisher’s binding error but otherwise with lovely vibrant wash colours).

 

Cholera is a highly contagious gastrointestinal disease, incubated in pools of warm, contaminated water and spread by human contact.  It had its origins in India’s Ganges Delta, where it had been a recurrent epidemic since ancient times.  Traditionally, the disease’s spread had been limited to the Indian Subcontinent, and to areas that were densely populated, with a moist, tropical climate, where sanitary conditions were lax.

However, during the First Cholera Pandemic (1817-24), the scourge, which originated in Jessore, Bengal, near Calcutta, within seven years spread to infect hundreds of thousands of people from the Mediterranean to China.

The Second Cholera Pandemic (1827-35) was a global crisis that brought the disease to the forefront of European consciousness for the first time.  It killed 7,000 in London, while 100,000 died in France, before it spread to attack Canada and northeastern United States.

The Third Pandemic (1839-56) affected Europe, North Africa and the Americas.  This proved especially lethal as over 1 million people died in Russia, while 150,000 perished in North America.

The first significant breakthrough in combatting cholera did not occur until 1854, when Dr. John Snow made the connection between contaminated water and the disease.  His research caused many European and North American cities, such as New York, Munich and Montreal to bury fetid rivers, canals and sewers, improvements that were the genesis of modern urban sewage/drainage systems.  That same year, the Italian scientist Filippo Pacini correctly identified the bacteria Vibrio cholera as the cause of the disease; however, he failed to adequately publicise his discovery.  It was not until 1883, when the German scientist Robert Koch re-identified and widely publicised Vibrio cholera that effective medical solutions to the cholera crisis were developed.

Cholera led to the first corpus of truly sophisticated printed medical cartography, of which Map #2 of the present work is one of the most impressive to have been issued in India during the 19^th century and is all the more remarkable for having been published by a provincial press.

 

The 1868 Central Provinces-Berar Cholera Epidemic

The Central Provinces, created in 1861, from former pieces of the Maratha Empire, was a vast region of central India under direct British crown rule, that covered portions of today’s Madhya Pradesh, Maharashtra and Chhattisgarh; its capital was ‘Nagpoor’ (Nagpur, Maharashtra).  The province of Berar (capital: Akola), to its southwest, was a de jure part of Hyderabad, but since 1853, it was de facto under British rule.  For some administrative functions, it was governed jointly with the Central Provinces, while the two entities would be merged in 1903.

While the lands comprising the Central Provinces and Berar had august histories, by the midpoint of the 19th century, the region was something of a backwater, being one of the poorest parts and of the Indian Subcontinent, remote from major travel corridors and commercial centres.

However, from the mid-1860s, transformative change came to the heat of the Central Provinces, being the Nagpur-Jubbulpore (Jabalpur) corridor.  The first rapid connection traversing India was progressing towards completion, as the Great Indian Peninsular Railway (GIPR), working inland for Bombay, and the East India Railway (EIR), being built inland from Calcutta were set to meet at Jubbulpore.  This ‘Golden Spike’ moment would occur in 1870, an achievement which not only revolutionized transportation in India, but changed global logistics, being one of the events that inspired Jules Verne’s Around the World in Eighty Days (1872).

The railways would transform the Nagpur-Jubbulpore corridor from being a backwater into a great nexus of commerce and human movement, while Nagpur would become one of India’s great modern industrial centres.

With regards to cholera, the disease was traditionally not much of problem in the Central Provinces and Berar.  This was since cholera epidemics did not easily spread to region, due to its relatively isolated state, while it generally dry climate and elevated, rocky terrain was thought to hinder cholera’s progress.

However, from 1860 to 1866, “no year passed by in which cholera did not become epidemic” in the Central Provinces.  The disease was carried to the region from other parts of India by pilgrims travelling from holy sites such as Puri and the Mahadeo Cave.  The colonial authorities prevented a cholera epidemic from afflicting the region in 1867 only because they successfully imposed strict quarantine measures.  These polices were repeated the following year, but the result was tragically different.

In April 1868, the authorities received reports of isolated cholera cases of the area south of Jubbulpore, along the ‘Northern Road’, the critical 164-mile-long route that ran from Nagpur north to Jubbulpore, that was soon to host the final section of the Great Indian Peninsular Railway.  By early May, it was clear that a cholera epidemic had broken out along Northern Road between Seonee (Seoni) and Jubbulpore, as well as places to the immediate east and west, yet there were no reports of cholera in Jubbulpore city (which, in 1867, had been connected the EIR, creating a potential entry point for cholera into the region).  Moreover, most of the affected areas lay within the geological region of the Deccan Traps, an area of dry exposed bedrock, not thought conducive to the spread of cholera.  Over the coming weeks, cholera spread to Jubbulpore and beyond, and then all the way down to Nagpur, killing hundreds of people.  Yet, it was clear that the area between Jubbulpore and Seoni was the “ground zero” of the epidemic, and that railways and pilgrims were not the source of the scourge.

 

Enter Dr. Stephen Townsend:  Solving the Mystery of the 1868 Cholera Epidemic

During the 1868 epidemic, Dr. Stephen Townsend arrived in Nagpur, to serve as the ‘Sanitary Commissioner, Central Provinces and Berars’, essentially the region’s chief epidemic fighter.  He bought with him vast and diverse experience combatting infectious diseases in Bengal and Burma, in both military and civilian environments.  Upon entering his new post, Townsend soon realized that while the Central Provinces and Berar Cholera Epidemic of 1868 was not remarkable in terms of its death toll (indeed such scourges in Bengal often killed exponentially more people), it was unusual in its circumstances, so was worth studying exhaustively, to gain grander insights into epidemics across India and beyond.

Townsend spent months painstakingly gathering statistics and eyewitness testimonies to fully understand the nature of the 1868 epidemic.  The present work is his official report on the endeavour, and its quality and significance far transcended that normally found in provincial epidemiological reports.

Townsend’s report was predicated upon an exhaustive gathering and analysis of statistics from the field, a sophisticated topographical-geological study of the terrain of the affected region (namely the Nagpur-Jubbulpore corridor), as well as a careful record of the meteorological situation.  The text is augmented by the accompaniment of the 9 detailed statistical charts, as well as two large folding thematic maps custom made for the report, of which the second map is one of the most sophisticated and impressive epidemiolocal maps made in India during to era.

Fundamentally, Townsend found that the death rates from cholera were remarkably higher in the villages located within the geological zone of the Deccan Traps, along the Northern Road between Nagpur and Jubbulpore, a dry region of exposed rock, totally different from the swampy, heavily populated environment traditionally associated with cholera.  Notably, it was through this region that in the spring of 1868, “8,394 coolies” were working on the Northern Road.  Their presence and interaction with the locals, as well as the use of wells of diseased water, were primarily blamed for the proliferation of the epidemic, which spread to other areas, although the death rates there were not as high.

With all this in mind, Townsend drew five basic conclusions.  First, that to produce cholera two conditions are necessary, the presence of a special contagion, and a susceptibility to its influence on the part of the person to whom the contagion is applied.  Second, that with respect to the origin of the epidemic of 1868, the evidence is in favour of the contagion having been brought from elsewhere rather than that it was generated in the localities where the disease first broke out.  Third, that the subsequent diffusion of the contagion was affected solely by means of human intercourse (namely by the workers on the Northern Road).  Fourth, that a high temperature and extreme dryness are no obstacles to the diffusion of the contagion.  Fifth, that with respect to the general population of the country the imbibition of water containing animal organic impurities is the most common means by which personal susceptibility to the effects of the contagion is induced.

Dailing down on the origins of the 1868 epidemic in the Central Provinces, Townsend wrote:

The fact of the first manifestations of the disease having occurred in bodies of men located close by a road daily thronged with passengers from a part of the country in which the disease had previously appeared, afforded strong support to the supposition that the infecting matter may have been imported rather than generated locally; and the account given of the subsequent spread of the disease, and of its appearance in the different towns and villages scattered over the epidemic area, appears to me to favour the opinion that the choleraic influence is diffused by means of human intercourse, and by that means alone … a water supply containing organic impurities is the chief, if not the sole, condition under which cholera manifests itself [and that] cholera will not prevail epidemically among a population when the water supply is abundant and fairly protected from pollution…

Highlights of the work are the two large folding thematic maps, custom made by Townsend, and printed in Nagpur; they are as follows:

 

[1]

[Stephen TOWNSEND].

Map of the Central Provinces, to illustrate Sanitary Report 1868-9.

Nagpur: Lithographed at the Curator’s Press Nagpoor, [1869].

Lithograph with yellow wash colour, 57 x 84 cm.

This large map, “Lithographed at the Curator’s Press Nagpoor”, covers a great expanse of central and eastern India, from the Mouths of the Krishna River, in the south; up to Allahabad (Uttar Pradesh), in the north; Aurangabad (Maharashtra), in the west; and Calcutta in in the east.  It is centred upon the area affected by the Central Provinces-Berar Cholera Epidemic of 1868, which is here shaded in yellow.  The affected area extends in roughly a crescent shape, from Bhoaslawal, just west of Akola, in Berar, in the southwest, up to Moorwara, just northeast of Jubbulpore.  The affected area generally follows the main transport corridors, including the unfinished lines of the Comrawutee and Jubbulpore Branches of the Great Indian Peninsular Railway, as well as, importantly, the Northern Road, between Nagpur and Jubbulpore (which was the epicentre of the epidemic).  Notably, all major towns in the yellow zone are labelled with the dates by when the cholera arrived there.  For instance, cholera appeared in ‘Gunneshgunj’ [Ganeshganj] (thought to be the first village to be affected) on April 16 [1868], and arrived at Jubbulpore on May 15, at Nagpur on June 1 and at Akola, Berar, on July 1.

 

[2]

[Stephen TOWNSEND].

Map of the Central Provinces, to illustrate Report on Epidemic Cholera of 1868.

Nagpur: Lithographed at the Curator’s Press Nagpoor, [1869].

Lithograph with wash colours, 75 x 52 cm.

This is one of the most sophisticated and impressive thematic maps issued in India during the 19^th century and is all the more remarkable for having been published by a provincial press.  It is a geological-epidemiological map focusing upon the heartland of the Central Provinces-Berar Cholera Epidemic of 1868, being the area anchored by Jubbulpore, running for 100 miles (east-northwest) along the railways, and then extending 50 miles south and east through the Deccan Traps down just beyond Seonee.

The ‘Index’, in the upper left corner, identifies the geological zones which are colour coded in bright wash hues, being: 1. Nerbudda Alluvium (Yellow); 2. Overflowing Trap of the Deccan (Green); 3. Mahadeva Lameta and Jubbulpore beds (Brown); 4. Vindhyan (Orange);

5. Metamorphic, Schists, Laterite, &c. (Ligh Pink); and 6. Granite (Dark Pink).

 

Importantly, each district of the region is accompanied by a circle divided into in quarters, each of which contains data.  In the upper left quarter of the circles it is noted the date upon which the district was first attacked by cholera; in the upper right, is the population of the district per square mile; lower left, is the number of villages attacked as a “p.c.” [as  a percentage] of the total villages in the district; lower right, the mortality as a percentage of the population attacked.

Thus, the map brilliantly illustrates that cholera could defy geology, showing that during the Central Provinces-Berar Cholera Epidemic of 1868, the worst outbreaks occurred in the villages in ‘Zone 2. Overflowing Trap of the Deccan (Green)’, being a high and dry area of exposed rock (as opposed to the swampy lowland areas traditionally associated with cholera, ex. central Bengal).  For instance, in the Deccan Traps region, which featured the Northern Road, the construction workers upon which were the main source of the spread of the scourge, the mortality rates of the infected population were over 4%, being more than double that in the other zones (the ultra-unlucky town of Ramgurh, in the east, had a death rate of 14.7%!).

 

Legacy

Townsend’s present report attracted international attention due to his findings in relation to the geographically unusual nature of the Central Provinces-Berar Cholera Epidemic of 1868.

Notably, an article in The London Lancet, perhaps the world’s most prestigious medical journal, read:

From a Report on the Cholera Epidemic of 1868, by Dr. S. C. Townsend, Sanitary Commissioner for the Central Provinces and Berars, we gather that numerous villages, built upon hard, impervious rock, bare of soil, and where no such thing as subsoil water existed, suffered greatly from cholera; indeed, on reference to Table 6 [i.e., Statement VI: ‘Showing mortality from Cholera in proportion to population in each Circe within the epidemic area of 1868’], and the map of his report [i.e., Map #2], it would appear that the highest rate of mortality occurred on the trap formation. The conditions of site, soil, substrata, and water-supply that surround the various towns and villages differ considerably in different situations. In the trap formation the villages are situated on the tops of rocky ridges, or on high open plateaus on bare rock and, in fact, Dr. Townsend adds, more dry, healthy sites could scarcely be found anywhere. The conditions of moisture and subsoil water supposed to be necessary to the development of the infecting matter of cholera, are wanting, and the theory of their connexion derives no support from the study of cholera as it prevails in the Provinces of India under report.

All things considered, Dr. Townsend thinks that the doctrine which regards the use of polluted water as the principal condition under which cholera manifests itself, receives very strong confirmation, from the facts which he has been able to collect regarding the spread of cholera in the towns and villages of this part of India.

With regard the different forms of water supply, and their liability to pollution, the open springs and small surface wells, so common in the trap formation, are undoubtedly the worst. The most fatal outbreaks of cholera occurred in villages dependent on this form of water-supply. Dr. Townsend’s Report is a very able one, and we may probably return to it.

 

Dr. Stephen Townsend: Leading Public Health Officer and Epidemiologist in India

Stephen Chapman Townsend (1826 – 1901) was for over thirty years one of the leading public medical officers and epidemiologists in British India.  A native of Devon, England, the son of an Anglican reverend from a family with ties to nobility, Townsend qualified as a doctor in 1851, becoming a member of the Royal College of Surgeons.  The following year, he moved to India, where he joined the Bengal Medical Department, with the rank of Assistant Surgeon.  He was soon seconded to military service, participating in the Second Anglo-Burmese War (1852-3).  For the next generation, Townsend served in various senior posts as part of the Indian Medical Service, notably as Sanitary Commissioner of the Central Provinces 1868-78, whereupon he was the point man during the 1868 cholera epidemic in the Central Provinces and Berar, resulting in the present work.

In 1878, Townsend was made the Surgeon-General of Punjab, but took leave to serve as the

Principal Medical Officer of the Kuram Field Force during the Second Anglo-Afghan War 1878-9, whereupon he was severely wounded.  He recovered and, in 1880, returned to his post in Punjab, serving until 1883.  He retired in 1884 but remained academically active as a fellow of the University of Calcutta.  His son, Stephen Frank Townsend (1857 – 1941) became one of the top railway engineers in South Africa and Rhodesia, as well as renowned amateur botanist.

 

A Note on Rarity

The present work is very rare, consistent with all 19th century provincial Indian imprints.  We can trace examples held by 6 institutions, including the British Library (2 examples); University of Oxford Library; University of Liverpool Library; National Library of Scotland; Wellcome Library; and the National Library of Medicine (Bethesda, Md.).  Moreover, we are not aware of any sales records for any other examples.

 

References: British Library (2 examples): I.S.C.P.35/4. and W 4090; University of Oxford Library: (IND) IB. C.Prov. Yb. 1 Ref.; University of Liverpool Library: STM CS.C.18/C; National Library of Scotland: IP/19/PI.2; Wellcome Library: WC262 1868M25r; National Library of Medicine (Bethesda, Md.): HMD Collection: WCB C397rj 1869; OCLC: 14547809, 316460760; The British and Foreign Medico-chirurgical Review or Quarterly Journal of Practical Medicine and Surgery, vol. 47 (January-April, 1871), pp. 135-6; The Half-yearly Abstract of the Medical Sciences: Being a Digest of British and Continental Medicine, and of the Progress of Medicine and the Collateral Sciences, vols. 52-53 (1871), pp. 31-2; The London Lancet. …For the Year 1871 (1871), p. 213.