CALCUTTA MEDICAL INSTITUTIONS.

13

proposal for the increase and re-organization of the hospital establishment in
October, which has been sanctioned since the close of the year. This will add
materially to the efficiency of the staff. Sundry improvements, enumerated in
paragraphs 43 and 44 of the report, have been effected during the year and
others are in progress. On the whole the hospital has undergone, during the
year, a decided change for the better.

Re-organization of
hospital estab-
lishment.

      21. A greater number of sick has been treated than in any of the eight years
whose statistics are shown in Dr. Ewart's report. The increase has been mainly
due to the prevalence of dengue. The death-rate has been higher than that of
1871, but lower than of any other year of the eight, whether cholera is included
or excluded. The greater number of cases of cholera treated accounts to a great
extent for the higher death-rate. Cholera contributes fewer deaths to the total
mortality however than in of the eight years, 1871 excepted.

Statistics.

      22. The number of cases of cholera treated in the hospital has been nearly
four times as many as in 1871, and has exceeded three years of the remaining
six. The rate of mortality has been favorable. In this respect there is a marked
contrast with the Medical College Hospital. Dr. Ewart again insists on the
advantage of early treatment, and anticipates great benefit from the river side
dispensary which is about to be erected.

Cholera.

      23. I would draw pointed attention to the remarks made on the insanitary
state of the river bank. There is evidently great room for improvement, and
the information which has already been collected would seem to indicate that
much of the sickness to which seamen frequenting this port are liable is due
to the polluted state of the river bank, and the unguarded manner in which
sewage is conducted into the river. It is satisfactory to find that so very
interesting and promising a field of investigation, as the sailors and shipping
frequenting the Hooghly, is being worked by Drs. Lewis and Cunningham.

Insanitary state of
the river bank.

     24. Dr. Ewart is specially devoting his attention to the subject of remit-
tent fever—an affection regarding which there is a considerable variance of
opinion. I cannot support his request for a special medical officer to assist
him in this inquiry. Now that examinations for the Indian Medical Service are
to be held every half-year, there will always be some young Assistant Surgeons
attached to the hospital, whose services may be utilized for the purpose
of making and recording the exact clinical observations which Dr. Ewart
contemplates.

Remittent Fever.

     25. The table given in paragraph 26 is a very interesting one, and bears
an instructive comparison with statement No. 12.

     26. There can be no objection to Dr. Ewart's showing how many patients
have died within 24 hours of admission under a heading of moribunds, and
excluding these from the mortality of the hospital as a special statement, but I
consider it essential, for the purpose of indicating the health of the community,
and permitting of a comparison between different institutions, that in all the
returns and statements, not constructed specially with the object of showing the
number of moribunds, the total number of deaths which have occurred among
those admitted in whatever condition should be included. The manner in which
the moribunds have been shown in the report of the Medical College Hospital
is, I think, unobjectionable.

Moribunds.

       27. The hospital library has suffered from the operation of an order,
directing that all indents for books should in future be submitted to the Secre-
tary of State. I think that, under the circumstances mentioned in paragraph 37,

Library.

D