9
CALCUTTA MEDICAL INSTITUTIONS.
9. PARTICULAR DISEASES—Small-pox. —All cases are now sent to Sealdah for
admission into the small-pox wards of the Campbell
Cases. Deaths. Ratio
per cent.
Confluent ... 8
6
75
Semi-confluent 19
4
21.05
Discrete
... 16
1
6.25
Modified
... 4
0
0
Hæmorrhagic 2
2
100.
49
13
26.53
Hospital. These are completely isolated, have
been very greatly improved of recent years, and
now afford most comfortable accommodation for
both European and native patients. Forty-nine
cases were admitted during the year, classified as
in the margin.
Thirty-six of the 49 had not been vaccinated.
Of these 10, or 27.77 per cent. died. Thirteen were
said to have been vaccinated, 3 of whom, or 23.07
per cent. died. In nine of these cases the vaccinal scars were not distinct, and
this was the case in all three fatal cases. Good vaccination leaves clear
characteristic indelible marks, and their absence proves that an efficient vaccina-
tion has not been done. None of the four cases in which the marks were
distinct were fatal, two were cases of modified and two of discrete small-pox.
The mere operation of vaccination conveys no protection against small-pox,
unless it produces the disease vaccinia, and unless this is allowed to run its
course to maturity. Vaccination with bad lymph, or destruction of the vesicles
by the application of mud, turmeric and other drugs—a practice common in
this country—is followed by no security, and all but three or four of the above
cases were probably examples of this, for in one of the discrete cases, it is
expressly noted that the scars, though distinct, were not deep. In two of the
three cases where the scars seem to have been more or less normal, the disease
was modified and involved little or no danger to life. The returns therefore,
afford strong evidence, if such were needed, of the efficacy of vaccination.
10. Cholera—as we have seen, was much less prevalent among the
general population than in previous years. The admissions to hospital were 431
against 709 and 761 in the two previous years. The type, though sufficiently
severe to cause 241 deaths, or 55.9 per cent. of the cases, was less virulent than
in 1892, when the death-rate was 59.9. Europeans and Eurasians had a death-
rate of 57.14, and all other classes of 55.85. Howrah Hospital treated 118
including 30 Puri pilgrims, the Medical College Hospital 110, the Campbell
Hospital 98, and the Mayo 90. There were 11 cases with 7 deaths at the
Presidency General Hospital. No case originated in the hospital, and the
Superintendent attributes this exemption, which has now lasted three years, to
the sanitary improvements which have been gradually introduced, and now leave
little to be desired. That cholera should occasionally arise in hospital within the
endemic area, and in a town where it is always present, is hardly to be wondered
at, especially where the water supply is of doubtful purity. Thus, at Howrah,
the insanitary condition of which is notorious, where there is no safe water-
supply, and where deaths from cholera occurred in every month of the year,
two Europeans and six natives developed cholera in hospital, at intervals
varying from one to seven days after admission. The hospital itself is clean
and well kept, and the cause of the attacks could not be traced. With the
exception of two cases at Sealdah for which no cause is assigned, no case
originated in any Calcutta hospital, all of which have the advantage of a pure
water-supply. There can be little doubt that in the great majority of cases
the germs of cholera are conveyed into the system through water, and the facts
above mentioned conform to previous experience in Calcutta and elsewhere.
11. Professor Haffkine of the Pasteur Institute of Paris, whose work was
mentioned in last year's report, has since been actively engaged in performing
his protective inoculation against cholera. He has done about 22,600 in upper
India and 900 in the last few weeks in Calcutta. So far as is known, no one
has died or been in danger of dying, so that the process—unlike inoculation
for small-pox—is free from risk. Whether it is really efficient can only be
proved by time, after operations on a large scale. Professor Haffkine has as
yet heard of but one person having had cholera after inoculation. This was
a boy of ten who developed the disease between the second and third day
after the first inoculation, that is to say, before it had produced its effect ;
while the process is not complete till a second inoculation, some days after
B