18
REPORT ON THE
62. The cases of this disease registered in the year under report were as
follows:—
Admi t t ed.
Died.
Medical College Hospital
1
. . . . . .
Presidency General Hospital
17
2
Mayo Hospital
......
. . . . . .
Howrah Hospital
. . . . . .
. . . . . .
Police Hospital
2
1
63. Enteric fever gave 11 admissions and nine deaths in 1884. The
mortality was therefore at the exceptionally high rate of 818 per mille of the
total treated. The average number of cases of typhoid received annually into
the Presidency General Hospital, the only institution in Calcutta which ever
gives its complement of cases of this disease, was 10.6 with an average
mortality of 4.1 or at the rate of 386.8 per 1,000 of total treated.
64. In 1885 the total admissions was 20 with three deaths. In former
years the Police Hospital gave a constant enteric fever record; but during the
past five years the disease was absent from the force. In 1885 two cases were
admitted, one proving fatal.
65. The great difference in the death-rates at the Presidency General
Hospital in 1884 and 1885 is accounted for by Dr. Cleghorn, the Officiating
Surgeon Superintendent, "on the supposition that the cases admitted in the
latter year were of a milder type, or that the milder cases admitted in the
former year were entered as remittent fever," quite forgetting that he himself
may have admitted the latter as typhoid.
66. In my last annual report I discussed fully the confusion arising out
of this name or single-term typhoid. Opinions are as widely divergent as
ever on the debatable ground as to where the line should be drawn between
remittent fever of supposed malarial origin, and true enteric which so many
assume is begotten of filth.
67. Dr. Cleghorn treats the subject with fullness and care. He says:
"The difficulty attending a correct diagnosis of remittent fever is, I believe,
due to the imperfect knowledge which we at present possess of the fevers of this
country and to a general belief in the widespread influence and prevalence
of malaria."
68. The mystery surrounding the origin of many specific diseases has not
yet been fathomed. The classification of typhoid fever in this country, it
will be seen, therefore, from the figures entered in this table, is not altogether
a satisfactory one; and, as a statistical record for purposes of comparison, it
is not reliable.
69. I would strongly urge upon all medical officers the importance of a
post mortem examination in every case of death from remittent or suspected
typhoid fever.
70. Cerebro-spinal fever.—In my report for 1884 I drew attention to the
frequency with which cerebro-spinal fever is met among the very poor of
this city. I am pleased to see that my note of warning has been the means of
enlisting some earnest workers in this important field of enquiry.
71. It is not my purpose to discuss the etiology of the disease in this place.
A few cursory remarks in regard to the direction in which our researches
should be made alone seem called for.
72. As regards causation we know very little if anything, and speculation
must therefore be very wild and general. No doubt this form of fever,
like every other, must be due to insanitary influences of some kind, but
what the special influences are must be determined by repeated and very
careful enquiry, by studying the surroundings of cases, and discovering what
in the surroundings is invariably associated with this particular type of fever.
Some attribute its origin to malaria, another gives as causation prominence to
season, overcrowding, bad water-supply, unhealthy locality and hardship; while
others say that the disease only occurs in the cold weather, and is the result of
chill. All this is guess work, and in no way helps us out of the etiological
difficulty.
73. Respecting the pathological diagnosis, the anomalies in the typhus
process are so diverse that it is very difficult to judge them rightly in cases of
acute fever, whether the disease is due to a septic infection, to malaria, or to