( 6 )
14. It is unfortunate that the enquiry cannot be extended by means of
the records of the Health Office of Calcutta. Pulmonary diseases are the class
concerning which, above all others, these records afford no guidance. Acute
chest-diseases, attended with heat of skin, are for the most part returned as
fevers, and their prevalence or otherwise cannot be inferred with even an
approximation to truth. Those unattended with heat are named asthma.
Some little evidence may be gathered from the admissions into hospital.
The number of natives admitted in 1878 to four hospitals for pulmonary disease,
other than phthisis, was not unusually large, but the fatality was greater than
in either of the preceding years. The same is true of phthisis on the figures.
The hospital returns of bowel disorders exhibit reduced admissions but extra-
ordinary fatality, as already said.
15. In the Patna asylum deaths rose from 13 in 1878 to 35 in 1879.
If the latter year were one of improved public health in Bengal generally, it
was not so at Patna, where it is described as the most unhealthy year since
1874. The increase here was in the ordinary climatic diseases chiefly.
Cholera prevailed in the neighbourhood and there were six deaths in the
asylum. There had been none in 1878. Diarrhœa caused four deaths in 1879
against two in 1878 ; Dysentery five against one ; fever seven against four;
pulmonary diseases four against two. Here also a case of cirrhosis of the liver
is entered in 1879. Not having access to the asylum diary, I am unable to trace
the histories of the several cases at Patna. The register of fatal cases shows 13
deaths within a year of admission, of which six were from fever and dysentery,
all of persons sick on admission; and, of the entire number of persons who
died, five only are noted as healthy on admission. The sickness of the
asylum corresponded closely with the prevailing sickness in its neighbourhood,
and with that of the Patna Jail in respect of cholera and bowel diseases. The
Superintendent mentions " dampness, chills, and cold" as producing the chief
admissions into hospital. Five deaths are ascribed to general debility, which
probably are cases of the same kind as those called anæmia at Dullunda.
16. In the Dacca Asylum the increase of mortality fell on sufferers from
bowel affections and pulmonary diseases. There were, under the first head,
nine deaths in 1879 and three only in 1878; under the second, seven in 1879 and
one in 1878. The sick lists of the last five years at Dacca shew great improve-
ment in asylum health ; but this, as I have said elsewhere, depends on differ-
ence of practice in recording admissions to hospital. The Superintendent, in
his report for 1879, says little of the mortality. The register of deaths gives
the following information. Of the bowel diseases two cases were among the
admissions of the year, but received in fair health. Of the other residents, three
were in bad health on admission, but one of them had been 12 years in the
place. The cases of pneumonia all originated in the asylum during the year, as
did one of pleurisy. Phthisis occurred among old residents only, and they are
noted as having been healthy on admission.
At Dacca, then, there was increase of fatal sickness in the asylum in 1879,
especially in diseases of the bowels and lungs. Dr. Crombie altered his
diet scale during the year and was not completely satisfied with the
change, as he found some loss of weight among the people in the cold weather.
On examining this loss, I found it to be not only less than is usual with
natives in the cold months, but actually less than the daily fluctuations of a
healthy man at all seasons; and as minor fluctuations had taken place in the
interval, of a perfectly normal kind, there is no more reason for connecting
increased mortality at Dacca with the change than there is at Patna, where
no change took place.
At Dacca, again, the jail figures are significant in respect of pulmonary
disease.
Dacca Jail. ...
Admissions into hospital ...
Deaths ... ...
Phthisis.
1877.
4
0
1878.
3
0
1879.
5
3
Respiratory
affections.
1877.
36
4
1878.
35
2
1879.
43
10
Bowel disorders.
1877.
120
6
1878.
246
9
1879.
252
11
Of bowel diseases the jail suffered no material increase. The Mitford Hospital
shewed no increase of other pulmonary affections, but some little increase of
phthisis over 1878. Of bowel disorders there was diminution.