9
CALCUTTA MEDICAL INSTITUTIONS.
charnel house, can appreciate the improvements which have been carried out
under the solicitude of its various Superintendents under whom it has been
placed, and yet down to 1890 cases of cholera used to occur in the wards.
Dr. Birch, one of the previous Superintendents, looking to the dangers of a
bazar milk and butter supply, recommended the institution of a large dairy and
the use of Danish butter. This was done, but still cases continued. A sanitas,
which is said to act satisfactorily, was erected for the disposal of all night-
soil. Still there were cases in the wards, and the last thing that has been
done is to substitute open drains for all covered drains within the com
-pound walls. In 1891 there was not a single case of cholera, and Dr. Crombie
attributes the exemption to these open drains, which can now be kept clean and
which are incapable of conveying sewer gases to the wards in conjunction with
the sanitary measures introduced by his predecessors. How far this additional
precaution will prevent future outbreaks remains to be seen, but I do not think
that the sanitary defects of the hospital have yet been entirely obviated.
The Calcutta water-supply is used for drinking and cooking purposes, but I
notice that tank water is still used for washing. In spite, too, of great efforts
to keep the privies clean, I confess I should like to see them remodelled on the
plan adopted by Dr. Birch at the Medical College. Until these two defects are
remedied, this hospital cannot be said to be in a perfectly sanitary condition.
16. In a similar manner cholera used to appear among the patients
under treatment in the Campbell Hospital. By the introduction of a pure
water-supply and other sanitary arrangements a great improvement was effected
until 1890, when I was able to report that not a single case had arisen in the
hospital during that year. In 1891, however, seven fresh cases occurred
among the patients, due, as Dr. Cobb thinks, to the use of bad milk, but, as
I have pointed out above, the defective state of the latrines may have also been
an important factor in determining the outbreak.
17. With regard to the Mayo Native Hospital, I am told that cases of
cholera used to occur in hospital some years ago, but there are none now, their
disappearance being coincident with the improvement of the drinking-water,
and more particularly with the improved system of latrines adopted some years
ago by Dr. Sanders.
18. In every outbreak of cholera, whether in a hospital or elsewhere,
there are always three factors, and the presence of all three is necessary for
the outbreak. The first is the introduction of the poison or germ, the second
is a suitable soil for the growth and development of the poison or germ, and the
third is some condition, meteorological or seasonal, which is essential for the
growth of the germ in the soil. Living in the endemic area, the prevention
of the first, i . e . ,
t h e i n t r o d u c t i o n o f t h e g e r m , i s d i f f i c u l t , b u t p r o b a b l y n o t
impossible, and hence the necessity for care for the purity of the water, milk,
and food supplies. The third we cannot control, but with the second we are
able to deal in the manner pointed out in the Sanitary reports of the Army
Sanitary Commission, especially for 1889, which has been published in 1891,
and it is the duty of each Superintendent to gradually work his hospital up to
the necessary degree of sanitary perfection as each defect becomes patent.
The practical immunity of the European residents of Calcutta of late years
from cholera is an instance of how much can be done, even by such imperfect
measures of sanitation as those which the Calcutta Municipality offers to
persons who are in a position to avail themselves of them.
19. As with cholera so with small-pox, which is the most infectious
of the exanthematous fevers, we know that in India its prevalence is practically
confined to two months of the year, and that it recurs with increased virulence
every fourth or fifth year in England as well as in India Our knowledge,
however, of the laws which determine this recrudescence is still rudimentary, but
we happily possess a prophylactic for this disease in vaccination, which, if it
were only fully accepted by the people and efficiently carried out, would make
a knowledge of these laws, however interesting, almost superfluous.
20. Dysentery.—The patients who suffered from this disease were a little
more numerous than in the previous year, but the rate of mortality was some
- w h a t l e s s , i t b e i n g 2 6 . 2 8 p e r c e n t . a g a i n s t 2 8 . 6 0 i n 1 8 9 0 . A s u s u a l t h e
greater proportion of the cases was treated at the Campbell Hospital. Of B