NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
70
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS,
Princip al
causes
death during
the, years
1865–1872.
6. The chief causes of death during the eight years ending 1872, are
demonstrated in the subjoined statement :—
No. Diseases.
Treated. Died.
D e a t h s t o t r e a t e d
R a t i o p e r 1 , 0 0 0 d e a t h s t o t o t a l d e a t h s .
1 Cholera
...
735
417
5 6 7 . 3 4
333.33
2 Dysentery ...
1,789
131
73.22
1 0 4 . 7 1
3 I Hepatitis ...
411
57 138.68
45.56
4 Typhoid fever
102
33 323.52
26.37
5 Remittent fe-
ver
...
527
36 140. 07
2 8 . 7 7
6 i Phthisis ...
336
136
4 0 4 .
. 7 6
108.71
7 Pneumonia...
69
26 376.81
20.78
8 Insolatio ...
132
11
8 3 . 3 3
8.79
9 Other diseases 17,023
404
23.73
322.94
Principal causes al
death in 1872.
7. The following table illustrates the sickness and mortality from the
above-mentioned diseases, and other diseases during the year under review, in
conformity with the plan adopted in my report for 1871 :—
No.
Diseases.
Treated
Died.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated from
all diseases.
Total deaths.
1
Cholera
...
94
42
446.80
12.1
269.2
2 Dysentery
...
188
8
42.55
2.3
51.2
3 Hepatitis...
4 3
8
186.01
2.3
51.2
4 Typhoid fever...
1 7
11
647.05
3.1
70.5
5 Remittent fever
...
19
5
203.15
1.4
32.0
6 Phthisis...
5 4
19
351.85
5.5
121.8
7 Pneumonia ...
7
4
5 7 1 . 4 2
1.1
25.6
8 Insolatio
...
7
0
0
0
0
9 Other diseases
...
3,014
59
19.07
17.1
378.2
I now propose to deal with the statistics of these diseases separately,
during the past eight years.
GENERAL HOSPITAL.
71
1 ST.—CHOLERA.
8. Table exhibiting the admissions and deaths from cholera during the
eight years ending 1872 :—
Years.
Treated.
Died.
RATIO 0F DEATHS PEE MILLE TO
Treated.
Total treated from
all diseases.
Total deaths.
1865
102
47
460.7
19.3
276.4
1866
177
118
6 6 6 . 6 48.8
495.7
1867
78
48
615.3
20.1
315.7
1868
120
65
5 4 1 . 6 26.5
367.2
1S69
61
44
721.3
16.6
314.2
1870
76
37
486.8
11.5
2 7 4 . 0
1871
27
16
592 5
6.2
172.0
1872
94
42
4468
12.1
269.2
Admiss ions and
deaths from cho-
lera during the
years 1865-1372.
This statement is instructive. It is, I think, sufficient to make us pause
before we lend ourselves altogether to the theory, which holds that cholera is
propagated almost solely through the medium of the water-supply of the
community. If this were so, the decrement in the diffusion of the malady in
1871, when full effect was given throughout the European portion of the mercan-
tile marine of this port (from which nearly all the cases of cholera are admitted
into the General Hospital) to the orders for the provision of the filtered water
of the corporation to the shipping population, ought certainly to have been
maintained in 1872. In both of these years, the care which, to my personal
knowledge, has been bestowed on the supply of pure, wholesome, filtered water,
has been unparalleled in any previous year over which these figures extend.
And, notwithstanding this extreme precaution, in spite of an unfailing and
abundant supply of the same water as is used in both the European and native
divisions of the town, we are confronted with the fact, that the satisfactory
diminution of the prevalence of cholera among the floating population of the
port in 1871, has not been sustained in 1872 ; and that its frequency has
actually been greater than it was in 1867, 1869, and 1870, when the water-
supply was comparatively impure and unwholesome, and not provided from the
municipal water-works. The fact is, that in three of the years when the
supply of water was derived from filtering companies, the prevalence of cholera
exceeded, and in three it fell below that of the year under report. Thus, in.
1865, 1866, and1868, the admissions amounted to 102, 177, and 120, respectively,
whilst in 1837, 1869, and 1870, the admissions reached 78, 61, and. 76 : whereas,
in 1872, 94 cholera cases were treated in hospital.
The decrease Of cho-
lera among sai-
lors has not been
sustained.
9. In my last report I drew attention to the dimunition of cholera in
1871, and suggested that if this were maintained, or still further developed in
future years, Snow's theory of the chief mode by which cholera is supposed
to be spread, through a contaminated water-supply, will have received irrefragable
support, and the path will have been indicated for the suppression and eventual
comparative extinction of the malady in the other cholera fields in the delta of
the Ganges. I regret now to have so soon to record evidence which, to my
mind, is calculated to make us hesitate in pinning our faith to this theory.
1 am free to admit that one of the modes of communication of the disease
A doubt thrown on
Snow's theory of
cholera propaga-
tion.
GENERAL HOSPITAL.
73
15. The following statement shows the position in the port and town
from which the cholera cases treated during 1872 have been derived :—
Cases.
Esplanade
..
...
...
... . . .
28
Prinsep's Ghât ...
...
...
...
...
5
Hastings
...
...
.. ... ...
18
Colvin's Ghât
...
...
...
......
Town of Calcutta ...
...
...
...
...
7
Garden Reach
...
...
...
...
...
6
Calcutta Moorings
...
...
...
... 12
Baboo Ghât
...
...
...
...
...
1
Engine House
...
...
.... ...
...
3
Sailors' Home
..... ...
. ..
...
...
3
Salt Golahs
...
...
...
...
...
1
Hooghly Ghât
...
... ...
...
...
1
Bankshall
...
...
..
...
...
7
Chundpal Ghât ......
1
Total
94
Localities whence
cholera cases
were brought.
16. The mortality to total deaths from all causes has fluctuated from 495.7
in 1866 to 172 and 269 .2 in 1870 and 1872 respectively.
2ND.-DYSENTERY.
17. Tabular statement exhibiting the admissions and deaths from dysen-
tery during the eight years ending 1872 :-
YEARS.
Treated.
Died.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated from
all diseases.
Total deaths.
1865
...
272
32
117.6
13.1
188.2
1866
...
281
32
1 1 3 . 8
13.2
134.4
1867
...
234
10
42.7
4.2
65.7
1868
243
12
49.3
4.8
67.7
1869...
260
17
65.0
6.4
121.4
1870
...
173
14
80.9
5.4
173.7
1871
138
6
43.4
2.3
6 4 . 5
1872
...
188
8
42.55
2.3
51.2
Admissions
and.
deaths from
dysentery during
the years 1865-
1872.
The prevalence of dysentery has varied from 281 admissions in 1866 to
138 in 1871. During the current year the disease has been frequent, the
admissions having amounted to 188. As regards the death-rate to treated
this has fluctuated from 117 . 6 in 1865 to 42 . 55 in 1872. It accounts for
2. 3 per mille to total treated from all diseases, and 51 . 2 per mille of total
deaths from all diseases.
In my last report it was stated that " dysentery, which, in its earlier stages,
is almost as manageable by ipecacuanha as an ordinary intermittent, is by
74
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS.
Advantage of early
t r e a t m e n t .
quinine, becomes a most appalling disease when extensive sloughing has taken
place, or when, as not unfrequently happens, it becomes complicated with
abscess of the liver. Nearly all the cases which prove mortal have passed
through one or other of these conditions, or both, long before the patients have
sought for admission into hospital." The results of the year under review
form no exception to the rule. But, considering the general unhealthiness of
the year, the mortality has nevertheless been very low for this malady. In
hospital practice a death-rate to treated of 42 . 55 in the thousand is exception-
ally favorable. It would be lower even than this if cases were admitted
earlier, or before destructive ulceration of the mucous membrane had advanced
to such an extent as to render therapeutical management rather palliative than
curative in its effects. As with cholera, so with this disease, it is reasonably
expected that one of the many benefits anticipated from the establishment of a
well-ordered and
°w
ell-manaaed river-side dispensary will be a palpable reduction
of the death-rate. For it may be fairly expected that, as these cases will be
brought earlier under the influence of our sovereign remedy—ipecacuanha,
not only will sloughing, but another important sequel or consequence of
the disease, viz. abscess of the liver, be rendered less frequent in. their occur-
rence.
•
3RD.—HEPATITIS.
A dZa i s
t Il i s o Is, 0 m Vi ed:
18. Tabular statement exhibiting the admissions and deaths from hepatitis
patitis
during during the eight years ending 1872 :—,
the years 1865-
72,
YEARS.
Treated.
Died.
RATIO OF DEITIES PER AIME TO
Treated.
Total treated from
all diseases.
Total deaths.
1865
...
47
, 9
191.4
3.4
52.9
1866
•••
41
7
170.7
2'8
29'4
1867
..
51
9
176'4
3.7
59.2
1868
•••
58
6
103'4
2.4
33.8
1869
1104
52
6
115.3
22
42.8
•
1870
•••
62
7
1129
2.7
51.8
1871
II.
57
5
87'7
1.9
53.7
1872
.140
43
8
186.0
2.3
51.2
The admissions from this disease have fluctuated from 62 and 58 in 1870
and 1868, to 41 and 43 in 1866 and 1872. The death-rate has varied from
191-4 and 186 in 1865 and 1872 to 103-4 and 877-7 in 1868 and 1871. The
mortality to total treated was 3 . 4 and 3 . 7 in 1865 and 1867 ; whilst in 1871 and
1872, it amounted to 1 .9 and 2-3 in the thousand. Of the deaths to total
deaths it was answerable for 59 . 2 in 1867 and 29 . 4, 33 .8 and 51 . 2 in 1866,
1868, and 1872.
GENERAL HOSPITAL.
75
4TH.—TYPHOID FEVER.
19. Table exhibiting the mortality and sickness from typhoid fever dur- Admissions and
roilt
iIna''the eight years ending 1872 :-
deaths
Typhoid f
f
e er
YEARS.
Treated.
Died.
1865-n.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated from
all diseases.
Total deaths.
1865 .
•••
17
3
176.1
1.2
17.6
1866
..•
18
3
166'6
1.1
12.6
1S67
Oa.
12
4
333.3
1.6
26'3
1868
.••
5
3
600.0
1.2
16.9
1869
•••
4
3
750'0
1'1
21.4
1870
.••
14
1
71.4
0.3
7.4
1871
•116
15
5
333.3
1.9
53.7
1872
•••
17
11
647.0
3.1
70.5
Thus in no year has the hospital been free from cases of typhoid fever.
The cases are not numerous it is true, but they are sufficiently so, to show that
this zymotic disease is endemic in Calcutta. Its prevalence during 1872 has
only been exceeded in one year of the series, viz. in 1867, in the former year •
.
amounting to 18 in the latter to 17 admissions. The connexion of this fever
with sewer air has almost been established of late years. In the case of the Probable causation,
Prince of Wales, medical opinion seemed to countenance and confirm this
mode of generation and causation. And if this theory be really founded on fact,
there is not much difficulty in understanding how a certain proportion of the
sailors, who so largely seek medical relief at the General Hospital, do become
. . ,
attacked with the malady, seeing that they must often be brought under the
influence of the abominable emanations arising from the neglected and untrap-
ped sewers debouching into the river, where many of the ships are anchored
during their detention in port.
20. The mortality is very fluctuating; the minimum having been
experienced in 1870, when it amounted to 71 44, and the maximum in 1869,
when it reached the high figure of 750 in the thousand. During the past •
, . .
4
year, the ratio of deaths to treated was 647, whilst it was answerable for 70.5
q
in a thousand deaths from all causes.
4
5TH.-REMITTENT FEVER.
i
b
21. Tabular statement exhibitin o. the sickness and mortality from remit-
Red-
Admissions
an
tent fever during the eight years ending 1872 :-
deaths from Re-
mittent fever
daring the years
YEARS.
Treated.
Died.
1865-1b72.
RATIO OF DEATHS PER MILLE TO
Treated.
f
Total treated from
all diseases.
Total deaths.
1865
...
27
2
740
0.8
111
1866
•••
43
4
93.0
1.6
16.8
1867
-•
51
23
176.4
3.7
59.2
1868
•
• •
14
1
71'4
0.4
5.6
1869. • .
21
4
190.4
1.5
28.5
1870
•
. .
37
5
135.1
1.9
37.0
1871
•.•
45
6
133'3
2.3
64.5
1872
.
. .
19
5
263.1
r4
32.0
7 6
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS.
A special inquiry
regarding Re-
mittent fever
desirable.
These remittents account for a death-rate of 263 . 1 in the thousand cases
treated, for 1 .4 to total cases, and for 32 . 0 of the deaths to total deaths from
all causes. I propose having a careful registry kept of all the cases of this
kind in future, with a view to test how many of the so-called remittents are
typhus, typhoid, or relapsing fevers, and submit the first series of results in
my next annual report. • This will entail much labor and close investigation.
For cholera, two officers are now investigating that subject with nothing else
to do. Considering, therefore, the vast importance of the subject of these
fevers, I trust the Inspector-General will be pleased to place an officer at my
disposal temporarily, to assist me in carrying out this important project. I
believe the results of such an investigation will much more than repay the
slight outlay that will thus be involved.
Admissions and
22. Table exhibiting the sickness and mortality from phthisis during the
deaths
from
Phthisis during eight years ending 1872 :-
the years 1865-
YEARS.
Treated.
Died.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated from
a all diseases.
'total deaths.
1865 •
•••
46
16
348.8
6.5
94'1
1866
...
46
14
304.3
5.7
58.8
1867
,..
48
23
479.1
9.6
151.3
1868
...
61
19
311'4
7'7
107'3
1869
•••
71
8
253'5
7'0
128.5
1870
•••
50
18
360.0
6.9
133'3
1871
Sol
60
19
3166
7.4
204'3
1872
...
51
19
351'8
5.5
121.8
There has not been much fluctuation in the number of cases of phthisis
treated. There has also been much uniformity in the ratio of mortality to
treated, as also in the death-rate to total cases treated. The ratio of deaths
to total deaths has varied from 58 . 8 in 1866 to 201 . 3, and 121 . 8 in 1871 and
1872.
7TH.-PNEIIMONIA.
Admissions and
23. Table exhibiting the sickness and mortality from pneumonia during
deaths
from
Pneumonia dur- the eight years ending 1872 :-
ing the _ years
---• -
YEARS.
Treated.
Died.
___
liATIO OF DEATHS PER MILLE TO
Treated.
Total treated from
all diseases.
Total deaths.
1865
kb.
11
7
636'3
2.8
41.1
1866...
s
4
500.0
1'4
16.8
1867
0••
‘6
3
5000
1'2
10-7
1868
•..
8
2
250.0
0'8
11-2
1869
•••
11
1
90.9
0'3
7.1
1S70
•••
8
3
375.0
1'1
22-2
1S71
IDS,
10
2
200.0
0.7
.
21.5
1872
GOO
..-.---
7
• 4
571.4
1.1
25.6
r
GENERAL HOSPITAL.
77
This is not a common form of disease, but it is a steady contributor to
the mortality of the hospital. During the year the ratio of deaths to
treated was 571.4 in the thousand; of the total deaths, 25 in the thousand were
accounted for by this disease.
8TH.—INSOLATIO.
24. Table exhibiting the sickness and mortality from insolatio during the
eight years ending 1872:—
Admissions and
deaths from sun
-stroke during the
years 1865-72.
Years.
Treated.
Died.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated
from all diseases T Totaldeaths
1865
53
3
56.6
1.2
17.6
1866
25
4
160.0
1.6
16.8
1867
14
0
. . . . . . . . .
. . . . . . . . .
. . . . . . . . .
1868
7
2
285.7
0.8
11.2
1869
14
0
. . . . . . . . .
. . . . . . . . .
. . . . . . . . .
1870
5
1
200.0
0.3
7.4
1871
7
1
142.8
0.3
10.7
1872
7
0
. . . . . . . . .
. . . . . . . . .
. . . . . . . . .
Thus we have lost no case of insolatio during the past year. For such
a grave disease, the mortality throughout the eight years, has been remarkably
low.
OTHER DISEASES.
25. Table exhibiting the Sickness and mortality from " other diseases
during the eight years ending 1872:—
Admissions and
deaths from other
diseases during
the years 1865 -
72.
Years.
Treated.
Died.
RATIO OF DEATHS PER MILLE TO
Treated.
Total treated
from all diseases. Total deaths.
1865
1,856
51
274
20.9
300.0
1 8 6 6
1,777
52
29.6
21.1
218.0
1 8 6 7
1,883
46
24.4
19.3
302.6
1 8 6 8
1,933
67
34.6
27.3
378.5
1869
2,147
47
21.8
17. 7
335.7
1 870
2,126
49
23.0
19.2
362.9
1871
2,187
33
15.0
12.9
354.8
1872
3,014
59
19.0
17.1
378.2
U
78
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS.
Sickness and mor
-tality among
men, women, and
children.
26. In the following Statement, the sickness and mortality is demonstrated
among men, women and children, separately, during the eight years ending
1872:—
Years.
MEN.
WOMEN.
CHILDREN.
Treated. Died
Deaths
per mine. Treated . Died.
Deaths
per mille. Treated. Died.
Deaths
per mille.
1865
2,134
148
69.16
177
13
73.44
120
9
75.00
1866
2,051
214 100.33
226
14
62 . 50
139
10
71.94
1867
1,931
123
63.69
284
12
42 25
162
17 104.93
1868
2,019
142
70.33
267
21
78.65
163
14
85.88
1869
2,224
119
53 . 50
270
13
48.4
147
8
54.42
1870
2,167
109
50.30
263
15
57 . 00
121
11
90.90
1871
2,859
76
36.91
348
8
23 . 52
147
9
61.22
1872
2,856
134
46.88
410
14
34. 14
177
8
45.20
27. The increase in the mortality among the men has been mainly caused
by the greater prevalence of cholera during 1872 as compared with 1871.
Among the women the death-rate was higher in 1872 than 1871, but very
much lower than in any other year of the series; whilst amongst children, the
ratio of deaths to treated has been. lower during the past year than in any other
year, included in the statement.
"Moribunds."
28. The mortality at the General Hospital has always been abnormally
heightened by the inclusion of moribunds in the tables. It is not right that
cases which have been adjudged absolutely hopeless, and beyond all the re
-
sources of curative art on admission, and which die from within one to twelve
hours, should be embodied in the general list of deaths without comment
Seeing that no attention had been previously directed to this question, I accord
-
ingly gave instructions to the apothecary to place on record the exact time
every patient who died during the year had passed in hospital. The results
have been summarised in the subjoined. statement, showing the number of
patients who died within certain. periods of time, varying from 6 hours to
6 months and 26 days.
Duration of re
-sidence of fatal
eases.
Deaths within
Men.
Women.
Children.
Total.
6 hours
14
1
2
17
12 "
12
1
2
15
24 ''
2
0
0
2
36 ''
1
0
1
2
48 ''
1 2
0
1
13
3 days
8
0
0
8
GENERAL HOSPITAL.79
Duration of resi-
dence of fatal
cases.
Deaths within
Men.
Women.
Children.
Total.
4 days
7
2
0
9
5 ,,
9
0
0
9
6 ,,
7
0
0
7
7 ,,
4
1
0
5
8 ,,
2
1
1
4
9 ,,
3
0
0
3
10 ,,
3
0
0
3
11 ,, 5
0
0
5
12 ,,
3
0
0
3
13 ,,
2
0
0
2
14 ,,
1
0
0
1
15 ,,
2
1
0
3
17 „
1
0
0
1
18 ,,
1
0
0
1
19 ,,
3
0
0
3
20 ,,
0
1
0
1
21 ,,
3
0
0
3
22 ,,
2
0
0
2
23 ,,
1
0
0
1
26 ,,
0
1
0
1
28 ,,
1
1
0
2
29 ,,
2
0
0
2
31 ,,
5
0
0
5
One month and 1 day
0
0
1
1
1
,,
2 days
0
1
0
1
1 ,,
3 ,,
0
1
0
1
1 ,,
6„
1
0
0
1
1 ,,
7 ,,
1
0
0
1
1 ,,
10 „
0
1
0
1
1 , ,
11 ,,
1
0
0
1
1 ,,
21 ,,
1
0
0
1
2 ,,
4 ,,
1
0
0
1
,,
11 ,,
1
0
0
1
,,
18 ,,
1
0
0
1
,,
25 ,,
1
0
0
1
3 ,,
19 ,,
2
0
0
2
Duration of resi-
dence of fatal
eases.
80
REPORT ON THE CALCUTTA MEDICAL INSTITUTIONS.
Deaths within
Men.
Women.
Children.
Total.
2 months and 26 „
1
0
0
1
4 ' ' 2 ' '
1
0
0
1
' ' ' ' 2 0 ' '
1
1
0
2
6 '' 8 ''
2
0
0
2
'' '' 17 ''
2
0
0
9
'' '' 27 ''
1
0
0
1
Total
134
14
8
156
29. If all patients who died within six hours after admission were reckoned
as moribunds, the ordinary death-rate would have been 40.57 per mille
during 1872, instead of 43.30. If, however, the rule were to be extended to those
who died within twelve hours, then the mortality to treated during 1872 would
be 36. 35 per mille. I think the same practice which has been sanctioned at the
College with reference to moribunds should be introduced into the General
Hospital, and I hope the Inspector-General will be pleased to authorize me
to make the change in next year's report.
Surgical opera
-
tions.
SURGERY.
30. Seven cases remained over from last year, and ten new cases for
operation have been admitted, making a total of seventeen treated during the
year. The cases have all done well, and uphold the remarks which I made
last year relative to the freedom of the hospital from septicæmic diseases
The question of setting apart the small demi-upper roomed building formerly
occupied by the sick women and children of European troops garrisoning
Fort William, for native surgical sick, has already been formally submitted
for the approbation and sanction of Government. As the transfer to the
Surgeon of the General Hospital of the accommodation vacated on the 14th
August 1872 by the military authorities has removed the difficulty of finding
suitable espace for the reception and management of native surgical cases,
I
trust this proposal will soon meet with the favorable decision of Government.
Midwifery
MIDWIFERY.
31. There have been sixteen deliveries during the past, and one remained
over from last year. The whole of these cases Cave done well. To this list
must be added four cases of abortion, which have been also treated with suc
-
cess. There has not been. a trace of septicæmic or other conditions of blood
poisoning to which the puerperal state renders the lying-in-woman more than
usually liable, in any of these cases.
DIETING.
32. This has been carried on as satisfactorily as it can be, until the covered
trays are provided. The pattern selected turned out to be too unwieldy. A
lighter one has now been chosen. When ready, one good, substantial tray will
be available for each of the three divisions of the hospital. These, together
with an additional cooking store which has been sanctioned, and an improved
83
GENERAL HOSPITAL.
make the place more inviting and cheerful, pictures have been put up in various
places, and evergreens plentifully supplied for the verandahs. He has also
rendered me substantial aid in obtaining pictures and evergreens for my own
wards and verandahs, and in planting fruit trees, flowers, and shrubs in the
hospital compound.
SUBORDINATE MEDICAL ESTABLISHMENT.
Senior Apothecary L. Estrange, the steward of the hospital, has fully
sustained his reputation in conducting his arduous duties to my entire satis-
faction.
IMPROVEMENTS.
42. The hospital has now been provided with lockers for the sick, so that the
food, medicine, and small articles of clothing, &c., belonging to each patient,
can be stored away without difficulty. This is a marked improvement upon
the old plan, of having open shelves, adding much to the convenience and com-
fort of the patients, and to the general orderly appearance of the wards. Wire
netting and chicks have been supplied to the verandahs of the central block
and the western wing. These appliances are useful in keeping out the crows,
&c., and in cooling the wards during the heat of the day in the hot months of the
year. Head rests have also been provided for the bed-ridden cases, enabling us
to contribute materially to the comfort of these helpless patients. For these
improvements I am mainly indebted to Lady Napier, who, during her short stay
in Calcutta, repeatedly visited the hospital, and took a warm interest in the wel-
fare of the institution and its inmates.
44. Gas has been laid throughout the wards of the eastern wing.
I am
now engaged in arranging for a substantial Portland cement flooring in all the
wards, similar in pattern and quality to that which has been used in some of
the floors of the mint. Colonel Hyde, Master of the mint, has kindly allowed
Mr. Sills to lend me all the assistance in his power, with a view to the accom-
plishment of this object.
VISITORS.
45. The hospital has been visited by Lord and Lady Napier of Merchistoun
and Lord Napier of Magdala ; The Honorable George Campbell, Lieutenant-
Governor of Bengal ; Dr. Campbell Brown, C. B., Inspector-General of Hospitals,
and Mr. George Saunders, the Deputy Inspector-General of Hospitals.
JOSEPH EWART,
M . D . ,
Surgeon, General Hospital.
Subordinates.
Improvements.
Visitors.