6
REPORT ON THE .
Cholera from the
shipping.
Proposed
connexion of the
Fort with the
municipal sewers.
Principal
diseases of the
in-door patients.
Decrease in the
number of small-
pox cases.
Slight increase of
enteric fever, but
a decrease in its
mortality.
Fevers.
with a correspondingly improved death-rate. These ideas may by some be considered as
thoroughly Utopian, but I think they will not be regarded. as such by those who are
acquainted with the history of the cause, outbreak, and disappearance of some of those
pestilential diseases that were observed in London during the 14th, 15th, 16th, and 17th
centuries—diseases that caused greater, mortality and considerable more panic in England
than any epidemic of cholera has ever created in India.'
16. The shipping, as usual, has contributed a goodly number of the cholera cases that
were treated in hospital ; but I question whether the following, which are the most generally
accepted theories as to the etiology of the disease among the sailors who .frequent this
port,—viz. first, the discharge of the Fort sewage into the river ; second, unhealthy
emanations from the unembanked foreshore during the periods of low water ; and third,
the use of the river water, which is considered to be contaminated with the poison of chole ra_
are sufficiently established. To my mind, no satisfactorily conclusive evidence has yet
been offered on which to rest the belief that cholera has been dependent on any or all
of these causes ; and I now (in common, I dare say, with many others who are acquainted
with the life of the sailor when on shore) am more and more inclined to think that the
sailors, as a rule, contract the disease in those purlieus of the town where vice; filthy surround-
ings, and cholera seem to have found a congenial' and a common home. No doubt the
sickness and mortality of the European sailors when at this port would be much diminished
if stringent measures were' taken for preventing them going on shore and wandering
through the bazars during the daytime in the hot weather. By the rules of the Sailors'
Home any party of twenty men or any single individual may, by giving intimation, have
wholesome food served up there at very moderate charges, so that there is really little
excuse for their frequenting grog-shops and other objectionable houses.
17. It is stated in the resolution on my report of the Calcutta medical institutions for
1875 that a scheme was under the consideration of Government for disposing of the sewage
of the. Fort by connecting the drains with the municipal sewers. I am not aware how it has
been proposed to carry this measure into effect, but I think there can' be little doubt as to the
benefits likely to result from such a sanitary improvement ; provided that the work is
thoroughly well done, and that due provision will be made for the thorough flushing and
ventilation of the sewers, as well as every precaution taken against the escape. of sewer gases
within the confined area of the Fort. Such a result might indeed give rise to far greater
evils than any which, I believe, are experienced under the present system.
18. Statement No. VI shows the principal diseases of the in-patients (Christian and
native) treated in each hospital, as well as the mortality caused by them. Taken in order of
frequency, it is observed that fevers, injuries, diarrhoea, dysentery, bronchitis, anaemia,
phthisis, cholera, liver diseases, pneumonia, &c., contributed the highest numbers to the total
treated of Christian patients, and that fevers, anemia, injuries, dysentery, diarrhoea,
cholera, phthisis, bronchitis, pneumonia, &c., acted similarly in respect of native patients.
Cholera, fevers, phthisis, dysentery, anaemia, diarrhoea, tetanus, &c., caused the greatest
mortality, but tetanus, cholera, phthisis, pneumonia, anaemia, liver diseases, &c. (as shown
by the death-rate per cent. of treated), were the most fatal diseases of the Christian patients.
Similarly, amongst the native patients, anaemia, dysentery, fevers, cholera, diarrhoea,
phthisis, injuries, &o., caused the greatest mortality, but tetanus, cholera, phthisis, dysentery,
diarrhoea, anaemia, pneumonia, &c., proved to be the most fatal diseases in the order now
enumerated. Oa a comparison of the diseases shown in Statement No. VI with those regis-
tered in 1875, it has been ascertained that there was a marked decrease in the number of
small-pox cases— 60 against 215 in 1875, and with likewise a lessened death-rate, viz. 333 . 3
per mille against 372.09.
There was a slight increase of enteric fever in 1876, but the mortality from it was at the
rate of 431.8 per mille, against 525 per mille in 1875. Of the 44 cases of this disease, 22
were Europeans, with five deaths, or at the rate of 227 per mine treated, and 22 were natives,
of whom 14 died, or at the rate of 636 per mille treated. There is thus a very marked differ-
ence in the mortality of the two races from this disease, and it is one regarding which I am
unable to offer any satisfactory explanation., since 14 of the 'native patients attacked were
policemen, who, as I have already stated, are well fed, well clothed, and well cared for.- 'I
have in paragraphs 9 and 12 of the summary of the report of the Police Hospital drawn atten-
tion to the water supply and sewers, as being the not improbable causes of this disease
amongst the police force. It is also worthy of note that no case of enteric fever was treated
amongst the native patients of the General, Campbell, or Howrah Hospitals, with but six in
the Mayo and one in the North Suburban Hospitals respectively.
There was a decrease in the number of intermittent, remittent, and continued fevers,
as compared with 1876, by 421 cases ; but the differences in the death-rate of the two years
from these diseases is very striking, showing an increased percentage in two, a much lessened
one in the third, viz. in 1875 the death-rate from remittent fever was 311 . 08 per mile,
in 1876, 353.5. In 1875 the death-rate from intermittent fever was 18.94 per mille, in
1876 7 . 7. In 1875 the death rate from continued fever was 18 58, in 1876 it was 47 . 4
per mine.