72
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS.
Water is probably
not the only
means of cholera
diffusion.
may probably be through the medium of an impure supply of water: but I am
also constrained to believe that this is is not the only mode by any means, and
that, especially in its epidemic form, it can diffuse itself among mankind
through almost any conceivable article of food, and that it probably, in the
majority of instances, gains access to the system through the atmosphere
breathed in respiration. But the whole subject of the mode or modes by which
cholera is engendered and propagated is involved in such obscurity, that it is
even now hazardous to venture any fixed opinion upon it.
Mortality of cho-
lera,
depends greatly
on the stage at
which treatment
is commenced.
10. The mortality to treated has fluctuated considerably, from 721.3 in
1869 to 446.8 in the thousand in 1872, which is only 13.9 less than it was
in 1865. After many years of close attention to this important question, my
conclusion is, that no particular plan of treatment has much real effect over
the disease when it has fairly passed into the stage of collapse; but that
much good can be accomplished during the earlier career of the malady, I
am as positively convinced as I am of any principle of medical science. We
have received a slightly greater number of cases during the preliminary stage
than we did in previous years, and it is to this, rather than to any innovation
in the treatment employed, that I attribute the decrement in the mortality
to cases admitted.
Anticipated benefit
from a river side
dispensary.
11. When the river side dispensary, the erection of which has been sanc-
tioned by His Honor the Lieutenant-Governor, on a spot near Prinsep's Ghât,
fixed upon by Mr. James Crawford, Collector of Customs, and myself, is com-
pleted, I anticipate a still further reduction in the mortality to treated, inas-
much as the patients will be received there, and placed under immediate thera-
peutical management at a much earlier period than they can possibly be
under the present haphazard arrangements. This dispensary will be placed
under the charge of the authorities of the General Hospital, who will arrange
to have the patients detained during the heat of the day, and removed by
dhoolee or ambulance to the hospital in the cool of the morning or evening.
It is also in every way probable that the benefits thus anticipated in regard
to cholera will be extended to other serious cases of disease.
The sanitary con-
dition of the
river bank de-
mands attention.
12. But I still think that no efforts should be relaxed in endeavouring
to amend the sanitary condition of the river bank. It is in a very insanitary
condition at those points where the old sewers, with their open and untrapped
mouths, are reeking with most offensive exhalations. I would suggest that
means be adopted to have these carefully trapped, so that the emanations pro-
ceeding from them may be mitigated, or prevented to the greatest extent
possible. It has long been noted that ships moored in the vicinity of these
sewer openings have been very liable to become infected with cholera.
13. This point has been looked into by Dr. Lewis, special Officer for the
investigation of cholera, who has rendered me valuable assistance in the
management of the cholera cases in hospital.
14. Drs. Lewis and Cunningham are resident at the hospital, and see
and prescribe for every case immediately on admission, conducting it through-
out under my supervision; and thus, having a direct interest in the result of
the cases, they have been most energetic in investigating the localities from
which our supply of cholera cases is derived. Without committing themselves
to any final opinion regarding the generation and diffusion of the disease,
I am authorized to say that they have been much struck with the remarkably
insanitary state of those portions of the river bank from which the greatest
number of cases have been sent to hospital.