?Distribution of Leprosy. 93
earth and air charged with decaying animal and vegetable
matters. Life under such conditions must be unstable, and the
quickly matured man must in every stage of his growth and
decadence, even under the most happy circumstances, maintain
a state of health perilously liable to become one of disease."26
Cholera and fever are the chief causes of mortality amongst
the inhabitants of Bengal. "Insanitary conditions abound
throughout rural Bengal, and have been only partially dealt
with in the better class of towns. The dwellings of the poor,
sessile on damp ground, are crowded, and if perchance clean
within are surrounded by dirt-heaps and dirt-pools. Clothing
is deficient, often dirty; the food is largely composed of un-
wholesome material, and too generally is insufficient for the
needs of the body, and the water is impure. Want, ignorance,
and carelessness, or fatalism result in neglect of precautions
against disease "27 Dr. Coates describes the population as
"poor, ill, and insufficiently clad, badly fed, debilitated, and
broken down in constitution."28 In the Chittagong Division
the people are, for Bengal, an healthy and able-bodied race,
thrifty and industrious, and in a condition of considerable pro-
sperity, and here the smallest leper ratio of any Bengal division
is found. Again in Rungpore the tracts where leprosy is
extremely prevalent are characterised by marshy and uncul-
tivable land, the people being of lazy habits and living in
wretchedly built mat or grass huts, and miserably clothed.
On the other hand, the areas of comparative immunity are
extensive local plains covered with paddy, the inhabitants
given to other pursuits besides agriculture. Trade here is
pretty active, rice crops being abundant and exported to a
great extent, while the people themselves are more civilised,
feed and clothe themselves better.29
(26) F. N. Macnamara. "Himalayan India, its Climate and Diseases," page
127.
(27) F. N. Macnamara. Op. cit., page 129.
(28) F. N. Macnamara. Op. cit., page 130.
(29) F. N. Macnamara. Op. cit., page 209.