LAHORE DIVISION.
125
Bowel com-
plaints.
Eye diseases.
Rheumatic
complaints.
Venereal
complaints.
every year, an immense surface of rotting vegetation is exposed to the direct rays of a power-
ful sun‫٭‬ . Of the effect of this there can be no
doubt. It is very appreciable to themen, even when
travelling by train, through the district contiguous
to the river, the residents of which, Europeans as
well as Natives, exhibit marked symptoms of marsh ague.
‫٭‬ This fact seems to have been overlooked by all
previous observers, and due weight has not been
given to it in the causation of the fever which has
been notorious in Mooltan for years past.
Decaying
vegetation.
The European as well as the Eurasian and Native employés of the Indus Valley State
Railway, which runs contiguous to the Chenab and Indus rivers, and crosses the Sutlej about 50
miles south of Mooltan, suffer severely from ague accompanied by splenic enlargements and
followed by a cachetic condition of the system. These sequelæ in many instances are of so
obstinate a character as to require the removal of the sufferers from the localities in which
attacked. Temporary removal, however, is not always attended by such benefit as is desired ; the
fever recurs again and again, and a permanent transfer becomes a necessity.
The system of irrigation canals of this district I look upon as another factor in the
production of the fever at Mooltan, though in a minor degree. The canals form a perfect net work
throughout the whole district and around the immediate neighbourhood of the station, and without
doubt contribute their share in the causation of disease. It is true they contain running
water, but in many of them the stream is sluggish, and in all there is more or less a growth of
vegetation. They are fed by the inundations of the rivers, and dry up as the inundations
subside. An immense surface of water pretty freely contaminated with vegetable as well as
animal decay, is thus exposed to a drying process which cannot fail to assist in the production
of materials prejudicial to health.
Irrigation.
My observations of the fever and its causes during the last outbreak do not bear out
the conclusions which Dr. Gunn my predecessor has arrived at. Although I cannot but
admit that great diurnal and nocturnal changes of temperature do take considerable part in the
causation of disease, yet I cannot admit that such changes are, or can be, the chief cause
of so extensive an outbreak of a fever of so characteristic a malarious type as we have in
Mooltan every year during the autumn. In August the last stage characterised the fever ;
it was of long duration, occasionally it had atendency to a continued character, and was
accompanied by severe headache and bilious vomiting. In September splenic enlargements
were the rule, and there was an occasional tendency to intestinal irritation, and to collapse
after excessive sudoresis. Some of the spleens were of such enormous size, that I doubt if
they were only of one year's growth. In October there was a marked tendency to critical
discharges and resulting collapse. Towards the end of the month, and during the two sub-
sequent ones, scurvy began to show itself. In November and December the cold fit was the
characteristic symptom—in some cases the only symptom—of the fever. Catarrhal com-
plications were supervened and pneumonia made its appearance. Anæmia was also a result
of repeated attacks of fever.
II. The Cutaneous and Cellulo Cutaneous.— These diseases give 65 admissions, of which
3 were from abcesses, 9 from ulcers and 38 from boils. There was nothing characteristic in
them beyond a tardiness in healing, owing, no doubt, to poorness of blood consequent upon
frequent attacks of fever, and the presence of a scorbutic taint, requiring constitutional treat-
ment and local support.
Features of
the disease in
different
months.
Skin diseases.
Accidents.
III. Accidents.—Accidents were second in the number of admissions, and give 125,
of which 68 were from contusions and 36 from wounds. None were of a serious nature, but
contusions accompanied by abrasion of the skin and the wounds generally were slow to heal for
reasons given in the preceding paragraph.
IV. The Digestive.— The diseases under this heading give 41 admissions, all of a simple
character, due generally to the immoderate use of opium, and to irregularities in diet.
V. Diseases of the eye.—There were 37 admissions from diseases of the eye, 29 from
conjunctivitis, and 5 from purulent ophthalmia, due undoubtedly to irritation caused by the
dust. As a rule they were of a mild character and required simple treatment.
VI. The Respiratory.—These diseases give 32 admissions, of which 24 were from bronchial
catarrh and bronchitis, and 7 from pneumonia. This latter disease particularly attacked debi-
litated and old men, and was of a low typhoid type, requiring free stimulation and nourishing
food. Counter-irritation and calomel and opium were valuable, but there was marked intolerance
of tartar emetic. The attack was generally insidious, and the patient did not seek aid till the
disease was well advanced and the lungs extremely affected, hence the large mortality. The
absence of pain was marked.
VII. Rheumatic.— From this cause there were 13 admissions, generally of the character
always seen in native hospitals. Some of the cases appeared to be more due to the presence
of scurvy than otherwise.
VIII. Enthetic— This class of disease gives only 10 admissions, 6 from syphilis and 4
from gonorrhœa, of a very ordinary character. There is a remarkable immunity from vene-
real diseases in Mooltan, considering the proximity of a large city.
Chest diseases.
XVII. Principal causes of mortality.— There have been 5 deaths in hospital during the
year, 1 from fever, 3 from pneumonia, and 1 from inflammation of the muscles.
Deaths.