Commentary: Cholera in Krishnapur

Abstract

Some years ago, when I was writing my doctoral thesis on medicine in British India, my supervisor directed me towards J.G. Farrell’s remarkable novel about the Mutiny of 1857—The Siege of Krishnapur. I was glad that she did, for the book not only provides a compelling narrative of these tumultuous events but also offers deep insights into the murky waters of Victorian medical theory. Farrell succeeds brilliantly in bringing to life the panic induced by that great scourge of the British in India—cholera, as well the bitter factionalism revealed by medical debates over its causation and treatment. The subject matter of these disputes is rather abstruse but it is made to seem as relevant to the reader as it must have been to denizens of the besieged residencies during the Mutiny. For them, cholera was a reminder of fragility of British rule and many came to believe that the uprising had been timed deliberately to coincide with the cholera season. That was almost certainly untrue, but cholera stalked the British throughout the summer of 1857, adding to their miseries and compromizing their military response. The medical part of the story revolves around two characters: the dutiful Scotsman Dr McNab and the more flamboyant Dr Dunstaple. Both represent types that would have been familiar to contemporaries. Scottish doctors were exceedingly well represented in the medical services of the East India Company and the middle years of the 19th century marked the peak of their influence. They had a reputation for seriousness and high learning, albeit with dogmatic tendencies. Dunstaple represents a less serious type, more attracted to India by the prospect of sport and adventure than by the opportunity for original research. The besieged Residency at Krishnapur becomes the arena for a showdown between these two characters and the viewpoints they represent. One of their main points of contention was the water-borne theory of cholera as propounded in 1854 by the London physician, John Snow. McNab expertly defends Snow’s position, whereas Dunstaple represents what was then the dominant view of the Anglo-Indian medical establishment—that the disease was miasmatic in origin and spread atmospherically. Snow’s theory was still regarded as unproven—even in Britain— and was not finally accepted by the majority of the medical profession until the mid-1860s. In India, the controversy raged for several years afterwards and there was great antipathy to the idea that cholera could be transmitted on anything other than monsoonal air currents. This was the view that would become official doctrine following the appointment of Dr James McNab Cuningham as Sanitary Commissioner with the Government of India, in 1868. Remaining in office until 1884, Cuningham came to be identified with views which were the opposite of his fictional namesake’s, sometimes punishing those who dared to oppose him. The water-borne theory of cholera was ultimately accepted in India, but medical officials tried their best to downgrade the importance of the newly discovered cholera bacillus in the causation of disease. The row sparked by Robert Koch’s identification of the bacillus in a Calcutta reservoir in 1884 was just as bitter as that which preceded it. One of his greatest antagonists was the German hygienist Max von Pettenkofer, who was lauded by Anglo-Indian officials such as Cuningham. In an act of reckless selfconfidence, equalled only by Dr Dunstaple in Farrell’s novel, Pettenkofer consumed a ‘cocktail’ containing cholera germs obtained from Koch himself. Unlike Dr Dunstaple, however, he survived. But more was at stake here than professional reputations. The question of what caused cholera had implications for how best to protect the beleaguered residencies and the military columns sent to suppress the rebellion. In the wake of the Mutiny, the ravages of this disease also began to attract the attention of the government at home. In 1859 a Commission on the Sanitary State of the Army in India was appointed, with a similar brief to the one established a few years earlier after the debacle in the Crimea. Reporting in 1863, the Commission recommended sweeping reforms of military stations and their environs. The campaign to clean up these barracks—and India more generally—received the enthusiastic support of none other than Florence Nightingale, who made Indian sanitary reform the focus of much of her work after the Crimea. But the main reason for the Published by Oxford University Press on behalf of the International Epidemiological Association