3
CALCUTTA MEDICAL INSTITUTIONS.
increase of fevers, which are chiefly malarial, has been great in all the Presidency
towns since the introduction of a good and sufficient water-supply, but does not
say why this is so. The reasons I have advanced may be partial explanations.
Absence of equal improvement in drainage may, perhaps, be a still more impor
-tant explanation. All conclusions on this and other causes of alleged increase,
excluding of course of plague, are, however, discounted by the increase of the
population, as shown by the provisional returns of the census of 1901, which
show a rise of from 681,560 in 1891 to 843,487 in 1901, or 161,927 or no less
than 23.75 per cent. Dr. Cook suggests methods for reducing sickness and
mortality from malarial fevers, of which the practical ones are use of such drugs
as quinine, and filling up tanks and excavations where anopheles mosquitoes
breed, as well as levelling the ground and improving the surface drainage.
These measures have been the aim of sanitarians for many years past. Amongst
increase of deaths from "Other causes" tuberculosis is mentioned, and the remedy
is held to be diminishing overcrowding, condemning unsanitary areas, and
building sanitary dwellings,—all of which are, no doubt, most admirable
proposals, which are being taken up more or less efficiently by degrees. On the
whole, Dr. Cook considers that the causes of increased death-rate are of a more
or less permanent character ; but are, to a great extent, preventable by suitable
measures efficiently carried out, though he fears many of these are, from their
costliness, beyond the power of the Municipality. There are few perhaps who
would be disposed to differ from his general conclusions.
Major Dyson, the Sanitary Commissioner for Bengal, concurs generally
in Lieutenant-Colonel Bovill's views. As he thinks that Captain Rogers'
examinations of water-logged areas show that people who drink filtered water
suffered less from malarial fever than those who used other sources of supply,
it is necessary to be very cautious in attributing an increased fever-rate to the
introduction of filtered water. Major Dyson suggests a special investigation
into the influence of the railway embankments on the natural drainage of the
country, and so on the prevalence of malaria. He thinks that, while Lieutenant
-Colonel Bovill's suggestion for prevention are good, the expense for carrying
them out is almost prohibitive. In noting on Dr. Cook's report, the Sanitary
Commissioner is in general accord with his opinions and suggestions, and, as
regards both Howrah and Calcutta, considers filling up tanks and improving
drainage the two important points to which we should look when endeavouring
to improve the general health of the people.
Major Gibbons, I.M.S., Superintendent of the Campbell Hospital and Police
Surgeon of Calcutta, is of opinion that, although the general mortality has been
unusually high, the figures which attribute it to certain causes are inaccurate,
and particularly as regards plague. He observes that there was a peculiar type
of fever cases, which he had to treat, in the men of the police at the police
hospital. The temperature was very high, and was coupled with great prostra
-tion, necessitating prompt stimulation in order to save life. Most of the cases
recovered, but he has no hesitation in stating that the inhabitant of a filthy
b usti, who was attacked by disease of the same kind, would have died within a
short period, and his death would have been returned as plague by the plague
department, which returned numerous cases of that disease at a time when no
patients suffering from plague were admitted into his hospital, or, as he believes,
into any hospital in Calcutta. He observes that, contrary to the usual rule, the
police who served in the town suffered in 1900 more than the police whose
duty lay in the suburbs. The rise was remarkable, as the table below shows,
and was due to fever and dysentery. It is difficult to state the causes, but
he ventures to suggest that they will be found in the diet, overcrowding
and sewage-soaked state of the soil, and that there may be a cycle of fever
prevalence as there is of small-pox:—
Percentage of sickness
to strength.
YEAR.
Town
Police.
Suburban
Police.
1900
11.0
10.7
1899
7 6
11.8
1898
7.9
10.7
1897
6 9
9.3
1896
5.6
8.3
1895
6.9
13.5
13 2