previous years the ratios of deaths from this 26"5*, 16 66, 12 58, and 5*40. The average of the six years ending with 1869 was 3106 per cent., consequently no improvement lias occurred. I think that the 4 fatal cases of sloughing and gangrene might be also fairly attributed to hospitalism. This would increase the number of preventible tion.
cause
In the four
were
deaths to 14 out of 32 ; but I will state the number of deaths from indisputable hospitalism as 10. For
months past, my attention has been very strongly increasing prevalence of Erysipelas in Calcutta
some
drawn to the and its
hospitals.
This very insidious and destructive malady hangs more or less about every hospital in Europe; and, in London, it takes from time to time, an epidemic character, invading the bestregulated hospitals and killing many in their private dwellings. Formerly, erysipelas was a very rare disease in Calcutta. It was very seldom seen in the surgical wards of this hospital; and, in the medical wards, it was so rare that, during my daily visits for ten years, I only recollect to have seen one case of (facial) erysipelas in the medical wards. In a London hospital of like size hundreds of cases of erysipelas would have occurred among the in-patients during the above period. The subjoined table displays clearly the recorded statistics of erysipelas in this hospital during the past ten years :? on,
ERYSIPELAS IN CALCUTTA.
By Surgeon-Major
N. Chevers, M.D., Medical College.
Principal,
Calcutta
and important observations are extracted Report of the Medical College Hospital for the year 187J, placed at our disposal by the Surgeon-General, Indian Medical Department. J SURGICAL OPERATIONS.
[The following interesting
from the Annual and have been
There remained, at the end of 1873, 26 persons who had
undergone great operations, and 136 operations of importance This give9 a were performed during the year under report. total ol 162 operations. Of these, 96 recovered, 3 were discharged relieved, 5 unrelieved, 32 died and 26 remained under treatment. The result is a death-rate of 197 53 against the following numbers in the previous six years :?259 2, 170 61, 155-77, 207 08, 200 and 133-08. But of the above number of 162 cases, only 136 were treated to a termination (and it is only among such that a comparison of the mortality of different, years can be instituted with accuracy). Among these the proportion of deaths was 235 29 per thousand. 11 years. termination.
Cases treated to a
Surgical Operations for
Years.
No. of
cases.
Mortality
Died.
per
thousand.
Total number of
Out-patient treated.
in-patient treated.
Total number of deaths from erysipelas in
hospital.
Total number of deaths after
operation. Years.
10 13 31 50 156
1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 (up to
3 3 2 3 5 2 2 4 11 7 0
3 2 6 6 4 7 4 7 18 7 5
April 1st.) 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872
1873 1874
Amongst the tributed
as
28 38 42 40 36 25 35 37 31 36 49 32
155 170 158 141 161 163 157 165 177 187 163 136
180 7 223-5 2658 283 7 223 7 153 4 222 9 224-2 1734 192-5 3C0 6 235-29
32 fatal cases, the causes of deaths were dis-
follows:?
Exhaustion
...
32
...
...
...
Tetanus
...
Shock
...
Dyseutery Total It ia noticcable that the deaths from includes
...
11 10 2 2 5 1 1
...
Septicaemia Sloughing Gangrene
erysipelas
and
pyaemia)
were
septicaemia (which number, being
10 in
31 25 per cent, of the total number of fatal eases after opera.
shows that, up to 1873, very few cases of admitted year by year. Nevertheless, small as the numbers were, tliev, with some fluctuation, steadily but very slowly increased. The admissions of cases of erysipelas in each of the first eight years of the decennial period were 6, 5, 8, 9, 9, 9, 6, 11. In 1873 there was a sudden rise to 29 This
table
erysipelas
were
admissions, of whom 11 were Europeans and 18 Natives. I went on furlough early in April 1872, and remained absent until December 1873. Before leaving, I was almost daily in communication with my Surgical Colleagues upon the subject of hospitalism. They seldom ceased to complain of the manner in which the subjects of their most hopeful operation# were attacked with pyaemia, osteo-myelitis, grangrene &c., but I feel confident that the word "Erysipelas" scarcely ever passed their lips. As the table shows, erysipelas occasionally presented itself, but never for any long period as an established form of hospitalism. Mr. Partridge, the officer of longest experience of this hospital and its diseases, informs me tliat erysipelas never gave him any trouble here or mucli attracted his attention until recently. The statistics explain this, seeing that, in the first eight years, the total deaths in hospital from erysipelas were only 1, 1? 4, 2, 3, 2, 1, 1; and also considering The rate would have been
sinplftfl. erysipelas,
higher had
we
included one
fptal
case
of
ERYSIPELAS IN CALCUTTA.?BY N. CHEVERS.
December 1, 1875.]
315
eleven mouths of
first
ended in sloughing of the whole cellular tissue of the arm, and on the 31st with symptoms of sceptic poisoning. On the 20th, the very day on which the erysipelas made its appearance in the Mahomedan, a Hindu wns admitted to
began
The
the
that, of patients who had undergone surgical operations during the eight years, there were only three deaths from erysipelas? 1 in 1865 and 2 in 1867. I was not here during the first 1873, the year in which erysipelas make a formidable appearance in the wards. surgeons who were in the charge at the beginning of that ore dead, and their regarding the disease is lost to
Partridge forms
me
operated, but there
testimony duty
returned to
that,
in
some
on
two
the 1st three
or
year Mr.
April
1873.
cases
where he had
He in-
that form of cellulitis which is erysipelatous set in, clear evidence of a spread of erysipelas from
was no
to case, or reason to believe that erysipelas had taken up a fixed position in the hospital. Dr. McConnell, who was at the hospital during the whole of 1873, and who performed and case
recorded all the
jpost-mortem examinations, informs
that
me
occurred in 1873 which led him to think that erysipelas had become nosocomial, that it was inclined to spread from
nothing
to case in hospital, or that the dread of it caused the surgeons to feel unwilling to operate in any of their cases. We have seen that, in 1873, 29 patients suffering from
case
erysipelas were admitted to hospital?6 patients died of erysipelas, 2 of them after important surgical operations. In that year the number of out-patients subject to erysipelas considerably increased,? 7 Europeans and 55 Natives. That the erysipelas did not, in the first place, arise in this hospital, i.e., that it was not generated here on account of the operation within the building of any of our insanitary conditions, is proved by the above statistics of the number of persons who were udmitted to hospital for the treatment of erysipelas. The prevalence of erysipelas in the city, entirely apart from the hospital, is also proved by our out-patient records. In the eight years, 1865-72, the numbers of outpatients treated for erysipelas were 40, 13, 34, 50, 156, 22, 26, 21. In 1873 they were 62, and in 1874, 61. With a view to ascertain how far the erysipelas wave has extended through the city and the surrounding district, I have made enquiry of the officers in medical charge of the other principal hospitals. Dr. Robert Bird, of Howrah, informs me that he has had no cases of erysipelas among the Europeans and Eurasian patients of his hospital, and only 4 among the native patients. Of these 4 cases 2 were admitted from a village in the Hooghly district, and 2 originated in the hospital, one idiopathieally Bnd the other traumatically." These cases occurred very lately. Dr. Bird adds a fact which is of great value, as showing how broadly spread throughout the district the erysipelatous influence is, "I see the disease is also being met with in the district. I have to countersign a good many certificates in favor of Railway Baboos, and I note that, recently, 4 or 5 cases of erysipelas have occurred among these men. The disease, therefore, although met with, can scarcely be said to have assumed epidemic proportions in this place." Dr. Cayley, in charge of the Mayo Hospital, has given me the subjoined facts, which, viewed by the light of the experience of our other hospitals, become of great interest and value, when we consider that his is a perfectly new hospital, which was only opened in September last, and in which the ordinary recognised causes of hospitalism can hardly have had time to "
accumulate.
opening of the hospital in September, admitted, on the 21st, with erysipelas of the face and head of 9 days' duration. She was in a sinking state on admission, and died in 24 hours. Nearly three months later, on the 10th of December, a Mahomedan man was admitted, of course to a different part of the hospital, with a crushed little finger. On the 19th, it was found uecessary to amputate the finger. On the 20th, erysipelas appeared aud spread up his forearm and arm. This Soon after the first
a
woman
was
he died
compound fracture of the first, metacarpal hand, and considerable laceration of the soft parts. On the 24th erysipelatous inflammation of the skin appeared and spread up to the elbow, and a good deal of suppuration and swelling occurred in the neighbourhood of the injury. On 6th January the inflammation subsided and. same
ward with
bone of the left
the
man
Dr.
recovered. has not had any other cases of erysipelas; but, amputation, the wounds have, for a time, owing to unhealthy inflammation and more or less
Cayley
in several cases of done
badly, sloughing of
the
flaps or coverings. obliged me with a document* which appears so valuable and pertinent to the question at issue that I annex it in the appendix (A) in original. The Presidency General Hospital is placed in a tolerably open situation, very much apart from most of the insanitary influences of the city, an d generally enjoys a remarkable immunity from hospitalism. Previous to October last the hospital appears to have been On the 31st of October (I wrote for free from erysipelas. tents on account of the prevalence of erysipelas here, in the Medical College Hospital, on the 5th of November) a European man was admitted with erysipelas which had Dr. Ewart has
attacked
an
ulcer
on
the foot.
The
disease
was
cellulo-
good deal of suppuration and well. case eventually got There were 8 more admissions with erysipelas on the 28th January, 5th February, 12th February, 14th February, 14th March, 20th March, 21st March, 21st March. The rapidity with which these cases were brought in, in February and March, shows how powerfully the erysipelatous influence had become developed without. Within the hospital, two patients were attacked with erysipelas. The first, a European, suffering from a compound fracture of the tibia, was seized on the 17th of January after lie had been lying a month in hospital. The second, a Mnssalmaun, who had undergone amputation of a finger, was attacked with erysipelas on the 19th February, three days after the operation. None of the cases in the General Hospital were fatal. Dr. Woodford has obliged me with the following data regarding the appearance of erysipelas in the Campbell Hospital, Sealdah. He notices it as a very remarkable fact that, from the time at which this large city hospital was opened, on the 1st of July 1867, no case of erysipelas was admitted or occurred within its walls until the early part of last year; it will be noticed that the Surgeons consider that the disease first assumed a really formidable character in our (Medical College) Hospital in February 1874. A patient, admitted to the Campbell Hospital on the 26th of that month, wus attacked with erysipelas in hospital, and died on the 7th March. In 4 other cases erysipelas attacked patients while under treatment in hospital. Of these, two recovered and were discharged on the 30t.h July and 25th of October. The remaining two died on the 31st October and the 16th February last. Fifteen other patients were admitted with erysipelas. Of these, three died. The patients suffering from erysipelas cutaneous, and there sloughing, but the
were
19 in all.
was
a
The last admission
was on
the 28th
of March
of the present year. Dr. Woodford's return of these cases is annexed. (B). Early in 1874 erysipelas took on a new and far more aggres-
sive character in the Medical College Hospital. The cases from outside were numerous. Three Europeans and 58 Natives were ?
treated in the out-door
Prepared,
at his
dispensaries
request, by Dr. French.
;
seven
Europeans
THE INDIAN MEDICAL GAZETTE.
316
and seven Natives were admitted with the disease
(29
cases
admitted the year before) and eight deaths erysipelas occurred in the wards. In five of these erysipelas attacked
of
were
and destroyed patients who had undergone important surgical operations. Mr. Partridge tells me that it appears to him that this evil
set in from the 6th of February, when a Chinaman was admitted to his ward with erysipelas of the head and face. Cellulitis was established, and he died on the 19th. Since then, appears to have taken up its abode in the building, from case to case, (that is to say each of the Surgeons has noticed an instance in which it has done so) ; it attacks in-patients suffering from diseases, such as epithelioma
erysipelas it spreads
tongue and mama.ary abscess, in which, commonly, no particular tendency to erysipelas 5 it attacks and kills patients who have undergone surgical operations so frequently that the Surgeons are anxious lest it should occur whenever they are obliged to operate, and are unwilling to perform any operations which can be avoided or postponed. The subjoined table displays, at a glance, the statistical history of erysipelas in the hospital during 1874 as far as it. is shown in the returns, but it is defective as not showing some cases in which patients were attacked with erysipelas in hospital and recovered. Cases of Erysipelas, 1874. of the
there is
Died
Out-Patients
TbeatED-
Admitted
with
Died
op
Ektsipelas
Ektsipelas.
from
Erysipelas afteb
Sur-
gical
ope-
KATIONS.
[December 1,
1875.
What remains of the history of erysipelas in this hospital, up to the present date, is briefly as follows: In the present year 8 natives have come for out-door relief with erysipelas (generally the cutaneous variety and little more severe than ery5 natives have been admitted with erysipelas, of Besides this, a native woman, with a small sinus of very long standing in the thigh which was opened,
thema)
;
whom 3 have died.
subsequently of phlegmonous erysipelas. In a native, operated upon for scrotal tumor, erysipelas attacked Of late, almost every case the wound and proved fatal. operated upon has been attacked with erysipelas, suppuration has only occurred in a few of these cases. The disease has been generally of the cutaneous form. Considering that a near connexion often exists between erysipelas and puerperal fever, I have made special enquiry of Dr. Charles, who informs me that, although he has had some
died who
was
cases
of the latter disease within the last year
inclined to attribute them either
or
two, he is
to
hospitalism or to erysipelatous influence; lie has generally imputed these cases to the length of labour. He considers that puerperal fever was more prevalent ten years ago than it has been of late. This report was sent in on the 16th April. At the end of not
the first week of June, Dr. Charles informed me that Puerperal fever had taken such hold upon his wards that accommodation, in a separate building, was needful for his lyingin
women. He promised that he would vacate this building immediately he could do so with perfect confidence that his patients were safe. He occupied the building from the 12th of .Tune until the 11th of August. This, I feel confident, was no mere coincidence. It was a clear development of that immutable law in disease which teaches us that, when erysipelas is prevalent, puerperal fever
is threatened. Ke-
January
To
1 Re-
maining maining
1 Admitted 2 1
February March
April May
June
July
August
September
October November
December
Totals
...
I may here remark that it has appeared to in our present returns very
figures
me
that the
imperfectly
represent the true amount of hospitalism in the building, inasmuch as nothing is said about those cases of intercurrent hospitalism in which recovery takes place (such as a case of osteo-myelitis, in which the progress of bone disease stopped only after the third amputation) or of those in which compound fractures, accidental flesh wouuds, abcesses, &c., are attacked with some form of hospital taint. I have, therefore, with the full concurrence of all my hospital colleagues, provided for each physician and surgeon " a separate Register of Nosocomial Diseases," a very simple form in which will be entered every case in which a patient 13 attacked in hospital with septicaemia, sloughing after operl ospital gangrene, osteo-myelitis, other nosocomial disease. Name, ward and
ations, fractures, &c.,
erysipenumber, dates of admission and discharge or death, result, original disease or injury, operation, hospital disease, date of its first
las
or
appearance. Each entry will up, these registers
and prevalence of
scarcely occupy a minute. If properly kept will, henceforward, fully represeut the nature our hospital diseases.
one
who has for many years watched the progress of
hospitalism in this hospital it is very noticeable how completely the waves of contagium, which gradually follow one upon another, alter in character from time to time. At one time, we have a prevalence of septicaemia as displayed by the charcteristic suppurative changes, principally in the liver and lungs; then true hospital gangrene has its day, and entirely disappears; then osteo-myelitis, then erysipelas; one succeeding the other with singularly little intermixture, during the prevalence of each of the other forms of hospitalism. Thus osteo-myelitis, formerly dreaded in every case when a bone was divided, has disappeared; hospital gangrene has only shown itself on one occasion in the hospital. Formerly, the Chandney Hospital was scarcely ever free from hospital gangrene. Erysipelas has now, for the first time, assumed in the Medical College Hospital the character of hospitalism. A London Surgeon, visiting this hospital at present, would Yours and all the other hospitals in and near probably say : "
attacked as we frequently are ; you are rather troubled at present by our almost constant foe erysipelas. It is frequently much worse with us. Your hospital now suffers as that palace?New St. Thomas's Hospital?began to suffer Calcutta
are
now
erysipelas very soon aftor it was opened. Writing about two years ago, of King's College Hospital, a fine modern building, Mr. John Wood precisely describes " our own There came into the hospital, present condition. the time, I concluded that a at from made and, enquiries similar condition prevailed in most or all of the London Hospitals?a very unfavourable change, erysipelas and its concomitant, pyajmia, began to show themselves, the former not springing up in the hospital itself, but imported with patients. The wounds began to suppurate more, primary healing was less common, and the erysipelatous blush appeared with blameworthy impartiality in cases treated in all kinds of ways." It was clearly beyond the power of our science to avoid the from
Decicmbkh 1,
ERYSIPELAS IN" CALCUTTA..?13 Y N. CHE VERS.
IS75.]
wave which has spread throughout the whole of Calcutta; but, the morbid influence having come upon us, its destructivewe have done every thing in sanitation to limit ness. Among the measures taken have been cleanliness of buildof the bedding of the ing, clothing and bedding, destruction
erysipelas
of the builderysipelas cases, white washing and fumigation ing, attention to internal and exterior drains, the free use of disinfectants, especially the carbolate of lime and charcoal, the scrupulous destruction improvement of the water closets, of new ones tarred within of porous gamlabs ; the provision of wounds ; the strict and without, the antiseptic treatment On the 5th November, I indentcases. of isolation erysipelas ed, through the Deputy Surgeon-General, Presidency, Circle, for six tents.
Into these the council-room ward patients
were
removed on the 13th idem. They remained out until the 10th December; and, in the meantime, the interior of the councilroom
was
thoroughly scraped, lime-washed
and
sick 4th January, the whole of the native The
tents.
hospital
was
painted.
were
On the
removed into
repaired and thoroughly limewere brought back to the building
then
washed -within. The sick on the 11th of February.
Towards the close of last rains, early in September, accident revealed what I consider to be a vital defect in the sanitary condition of this hospital. There suddenly occurred a caving in of a part of the ground floor of the building, to the superficial extent of some 10 by 6 feet and to a depth of about two feet. This was represented to the Executive Engineer, who had the hollow excavated. Early in November, I wrote to the Engineer Officer, requesting that he would expedite the work as serious disease (erysipelas) existed in the hospital, and as I considered that this was the filth-sodden earth, probably due to putrid exalations from I and foul water in the excavation which, suggested, should be filled in as soon as possible with clean and solid material. This repair having been effected, I drew the attention of the on excavating the earth of Engineer Officer to the facts that, the hollow, extremely foul black water was almost immediately most filthy and a Reached, and that the soil taken out was bones and broken compound of what appeared to be ditch-mud, I solicited his opinion upon the best mode of repottery. had reason to think that exhalations from medying this evil, as I in the hospital. I enquired whether this hollow caused sickness the building is of this character, and of floor whole the the floor should be gradually dug out whether the soil below *
whether the floor
or concrete, and replaced by clean material with a layer of concrete or asphalt. should be thickly covered if I wished it, he would dig The Engineer Officer replied that, the nature of the ascertain and other in floor places or
Up the
floor is very low (beiug He suggested that, as the the building) he was of opinion outside the than ground lower the evil would be to raise the that the best way of remedying six inches of hydraulic conlevel of the floor with a layer of it advisable to expose the patients to the crete. Not thinking the floor, I begged that the risk of further opening up furnish an estimate of the cost of Executive Engineer would trust that it will be the pleasure the above work. I earnestly this important work to be carried of Government to permit at least its eastern out, as it is known that the building (or on wooden piles, on the site
sub-soil.
wing) stands, partly supported of
one or
more
most offensive
present,
old tanks which were evidently filled in with rubbish, the only covering of which is, at
a common
tiled
flooring.
The increased prevalence in Calcutta, of late years, of erysi-
pelas
and of its usual
companion
in
European cities,
the true
enteric fever of Jenner, is a subject which deserves very close and serious attention. Enteric fever was formerly very rare it in Calcutta, it is still by no means a common disease ; but From a fixed habitat in the city. taken have to up appears
317
1870, we have admitted cases every year to the total number of 30, 9 Europeans and 21 Natives. Of these patients, 12 have died, 4 Europeans and 8 Natives. I am not prepared to carry out the argument that the present mode of draining Calcutta, by flushing the filth away in underground sewers, is the cause of this increase ; but I and others never ceased to oppose the introduction of this antiquated and filthy mode of conservancy as long as the question remained open to admitted fact that erysipelas argument; and it is a
generally
and enteric fever rage most where closed sewers most abound.
(A) CASES OF ERYSIPELAS, PRESIDENCY GENERAL HOSPITAL, TO 30th MARCH 1875. 1st Case?Traumatic Cellulo-cutaneous Erysipelas. Admitted with the disease.?John Courtney, European, aged 30, a sergeant in the Ordnance Department, of intemperate habits,
admitted into Dr. Ewart's ward on 31st October 1874, on the foot, and cellulo-cutaneous erysipelas of the
was
with ulcer
There was
part.
of the tissues. was
discharged
good deal of suppuration and sloughing gradually got better; on the 23rd January
a
He
cured.
Erysipelas, attacked in hospital.?W. New, European, aged 21 years, a seaman, 7 months in India, was admitted into Dr. Ewart's ward on 17th. December 1874, for compound fracture of the tibia. About a month afterwards, on the 17th of January, the wound and surrounding tissues suddenly became erysipelatous. He was at once removed from the surgical ward and placed on the 1st floor, where the blush gradually disappeared. He has not 2nd Case.?Traumatic Cutaneous
since then been re-attacked. 3rd Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease ?W. Clarke. European, aged 25 years, seaman, was admitted into hospital on the 28th January 1875 for a
growth on the scalp which Dr. Ewart removed. A week afterwards he was discharged perfectly cured, 3 days afterwards he was re-admitted with cutaneous erysipelas of the scalp and surface which was cured in about 10 days time. Note.?It is doubtful whether this case ought to be entered under the head of traumatic or idiopathic, considering that the of his discharge and was perfectly healed at the time
wound
when attacked
I have returned it
by erysipelas.
as
idiopathic
cutaneous. 4th Case.?Traumatic Cellulo-cutaneous Erysipelas. Admited with the disease.?Joseph Shead, European, aged 22 years, police sergeant, was admitted into Dr. Ewart's ward on the
5th February 1875 for fracture of the 2nd and 3rd phalanges of the little finger and slight erysipelas of the hand. This quickly subsided, and on the 5th day after admission the finger was
amputated.
(now as
Two
days
after
of the cutaneous-cellular
far as the elbow
puration,
an
hand, and he
perfectly
joint. opening was was
As
the
variety)
there
was
operation erysipelas set a
in and extended deal of sup-
good
made on the dorsal aspect of the sent down to the first floor. He is now
well.
Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease.?Henry Glise, European, aged 29 years, police constable, was admitted into Dr. Ewart's ward on the 12th February 1875, for idiopathic cutaneous erysipelas of the face. He rapidly recovered, and was discharged cured on 18th idem. 6th Case.?Traumatic Cutaneous Erysipelas. Admitted with the disease.?Mr. E. Miller, Eurasian, aged 48 years, was admitted into Dr. Ewart's ward on the 11th February 1875, for a wound and erysipelas of the scalp. The erysipelas rapidly disappeared, and the wound healed. She was discharged cured on the 19th idem. 7th Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease.?Mary Fleury, Eurasian, aged 15 years, was admit5th
THE INDTAN MEDICAL GAZETTE.
ted into Dr. Ewart's ward cutaneous three
erysipelas and she
days,
on
14tli March
of the left
was
It
leg.
discharged cured
1875, with idiopathio rapidly disappeared in on
18th March.
8th Case.?Traumatic Cutaneous the disease.?J. H. was
Erysipelas. Parkins, European, aged 35
admitted into Dr. Ewart's ward
Admitted with
years, Seaman, 20th March 1875, with
on
the dorsal aspect of the right hand and erysipelas the part. The erysipelas rapidly disappeared and ulcer
ulcer
an
of
on
He
liealed.
discharged cured on the 23rd idem. erysipelas attacked the ulcer this case is returned
was
'Note.?As
[Df.cember
Concluding Remarks. From the foregoing it will be seen that the first case (European) was admitted from outside with traumatic cellulocutaneous
erysipelas.
2nd.?There
two
were
wounds attacked in
Case.?Traumatic Cutaneous
10th
Seaman, was admitted 1875, with ozoena and
4>t7i?There admitted There
ety,
was
4
were
into
wore
5th.?There
with
of the cellulo-cutaneous uttaeked in
no
was
(3 Europeans and 1 Eurasian) idiopathic cutaneous erysipelas.
cases
hospital
no case
and none
or
cellular vari-
hospital.
death.
(B.)
into Dr. French's ward on 21st March The cutaneous erysipelas of the face.
nose
affection is
getting
11th Case.?Traumatic
Nos.
well.
Cellulo-Cutaneous Erysipelas,
1? 2* 3 4 5 6 7 8 9 10* 11 12* 13 14 15 16 17* 18 19
at-
tacked in Hospital.?Khumroo Khan, Mussulman, aged 50 years, was admitted into hospital into the native ward on 28th February 1875, for ulcer on the dorsal aspect of the left index finger and necrosis of the bone. On the 16th Dr. Ewart amputated at the metacarpo phalangeal joint. On the 19th, or three days afterwards, the wound and hand were attacked by the cellulo-cutaneous erysipelas, which extended up the elbow-joint. As suppuration was extensive, counter openings were made on the back of the hand and along the forearm. The patieut is now progressing favourably. Abstract of the 11 Cases.
Admitted with
disease.
Attacked in
Hospital.
Ki.CE.
European Eurasian Native Totals Tbaumatic.
Admitted with disease.
Attacked in
Hospital.
Race.
...
...
...
0
2
2
4
10
0
1
0
1
0
1
0
0
0
0
0
0
0
0
0
1
0
1
J
3rd
Cases treated in the
of Erysipelas the Campbell Hospital
Shombhoo Oojerum
...
...
Result.
26th Feb. 1874 Male Female 6th Mar. Do. 21st ? Male 23rd ,, Female 4th April Do. 25th May Male 18th J une Female 16th Aug. Male 14th Sept. Do. 21st ? Do. 23rd ? Female 10th Oct. Do. 15th ,, Male 27th ? Female 19tb Dec. Mule 10th Jan. 18 Female 13th Feb. Do. 17th Mar. Male 28th )(
...
... ...
Kaminey
Cadoo Johur
...
Sing Dossy Peer Mohamud ...
Rakhal Balak Dinoo Shama
...
... ... ...
...
Ramgutty
...
Ram Preo Ghorbani Hhorbo Unkunem
...
...
Bhowaniprosad which
April
Sex.
admission.
Khama Sreemonto
Surgical January 1874.
since
Date of
Name.
Names to
Idiopathic.
Totals
and tho
variety. 3rd.?There were 5 cases (4 Europeans and 1 Eurasian) admitted into hospital with traumatic erysipelas, oellulo-cutaiieous variety.
Number
nose has been affected for about three months, and some two or three weeks ago one or two pimples formed externally on or about 18th or 19tli March. Cutaneous erysipelas appeared, and he The erysipelas has now disappeared, came to hospital on 21st.
Eurasian
Native) of
other of the cellulo-cutaneous
Admitted
Erysipelas.
?with the disease.?George Kaye, European, aged 30 years,
Native
and 1
the cutaneous
was
24th idem.
on
Europeen
(1 European
one
Idiopathic.
-Idiopathic Cutaneous Erysipelas. Admitted with the disease.?John Gillies, European, aged 38 years, Seaman, was admitted into Dr. Ewart's ward on 21st March 1875, with idiopathic erysipelas of the right hand; there were two small biillce on the inside of the middle finger. He was discharged 9th Case.
and the
cases
hospital,
under the head Traumatic.
cured
1, 1875.
*
is
1875.
prefixed
...
are cases
Wards
Date of
th 30th 25th 26th 5th 29ih 3rd 26th 6th 2at,h 26th Died Do. 31st 30th Cured 1st Do. 26th Do. Relieved. 17th Died 16th Do. 18th Otherwise 31st Died Cured Otherwise Do. Died Otherwise Cured Do. Do. Do ...
...
...
... ...
...
...
... ...
...
...
which occurred in the
of
Result.
Mar. 1871
July
,,
Mar.
,,
,,
?
?
?
May July Aug.
?
Jan. Oct.
?
,,
1875
1874
Sept.
?
Oct.
?
?
N or. Dec. Jan. Feb.
? ,,
1875
Mar.
? ?
?
Hospital.
Tariney CnuRN Pal, Resident Assistant Surgeon.
cause
In the four
were
deaths to 14 out of 32 ; but I will state the number of deaths from indisputable hospitalism as 10. For
months past, my attention has been very strongly increasing prevalence of Erysipelas in Calcutta
some
drawn to the and its
hospitals.
This very insidious and destructive malady hangs more or less about every hospital in Europe; and, in London, it takes from time to time, an epidemic character, invading the bestregulated hospitals and killing many in their private dwellings. Formerly, erysipelas was a very rare disease in Calcutta. It was very seldom seen in the surgical wards of this hospital; and, in the medical wards, it was so rare that, during my daily visits for ten years, I only recollect to have seen one case of (facial) erysipelas in the medical wards. In a London hospital of like size hundreds of cases of erysipelas would have occurred among the in-patients during the above period. The subjoined table displays clearly the recorded statistics of erysipelas in this hospital during the past ten years :? on,
ERYSIPELAS IN CALCUTTA.
By Surgeon-Major
N. Chevers, M.D., Medical College.
Principal,
Calcutta
and important observations are extracted Report of the Medical College Hospital for the year 187J, placed at our disposal by the Surgeon-General, Indian Medical Department. J SURGICAL OPERATIONS.
[The following interesting
from the Annual and have been
There remained, at the end of 1873, 26 persons who had
undergone great operations, and 136 operations of importance This give9 a were performed during the year under report. total ol 162 operations. Of these, 96 recovered, 3 were discharged relieved, 5 unrelieved, 32 died and 26 remained under treatment. The result is a death-rate of 197 53 against the following numbers in the previous six years :?259 2, 170 61, 155-77, 207 08, 200 and 133-08. But of the above number of 162 cases, only 136 were treated to a termination (and it is only among such that a comparison of the mortality of different, years can be instituted with accuracy). Among these the proportion of deaths was 235 29 per thousand. 11 years. termination.
Cases treated to a
Surgical Operations for
Years.
No. of
cases.
Mortality
Died.
per
thousand.
Total number of
Out-patient treated.
in-patient treated.
Total number of deaths from erysipelas in
hospital.
Total number of deaths after
operation. Years.
10 13 31 50 156
1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 (up to
3 3 2 3 5 2 2 4 11 7 0
3 2 6 6 4 7 4 7 18 7 5
April 1st.) 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872
1873 1874
Amongst the tributed
as
28 38 42 40 36 25 35 37 31 36 49 32
155 170 158 141 161 163 157 165 177 187 163 136
180 7 223-5 2658 283 7 223 7 153 4 222 9 224-2 1734 192-5 3C0 6 235-29
32 fatal cases, the causes of deaths were dis-
follows:?
Exhaustion
...
32
...
...
...
Tetanus
...
Shock
...
Dyseutery Total It ia noticcable that the deaths from includes
...
11 10 2 2 5 1 1
...
Septicaemia Sloughing Gangrene
erysipelas
and
pyaemia)
were
septicaemia (which number, being
10 in
31 25 per cent, of the total number of fatal eases after opera.
shows that, up to 1873, very few cases of admitted year by year. Nevertheless, small as the numbers were, tliev, with some fluctuation, steadily but very slowly increased. The admissions of cases of erysipelas in each of the first eight years of the decennial period were 6, 5, 8, 9, 9, 9, 6, 11. In 1873 there was a sudden rise to 29 This
table
erysipelas
were
admissions, of whom 11 were Europeans and 18 Natives. I went on furlough early in April 1872, and remained absent until December 1873. Before leaving, I was almost daily in communication with my Surgical Colleagues upon the subject of hospitalism. They seldom ceased to complain of the manner in which the subjects of their most hopeful operation# were attacked with pyaemia, osteo-myelitis, grangrene &c., but I feel confident that the word "Erysipelas" scarcely ever passed their lips. As the table shows, erysipelas occasionally presented itself, but never for any long period as an established form of hospitalism. Mr. Partridge, the officer of longest experience of this hospital and its diseases, informs me tliat erysipelas never gave him any trouble here or mucli attracted his attention until recently. The statistics explain this, seeing that, in the first eight years, the total deaths in hospital from erysipelas were only 1, 1? 4, 2, 3, 2, 1, 1; and also considering The rate would have been
sinplftfl. erysipelas,
higher had
we
included one
fptal
case
of
ERYSIPELAS IN CALCUTTA.?BY N. CHEVERS.
December 1, 1875.]
315
eleven mouths of
first
ended in sloughing of the whole cellular tissue of the arm, and on the 31st with symptoms of sceptic poisoning. On the 20th, the very day on which the erysipelas made its appearance in the Mahomedan, a Hindu wns admitted to
began
The
the
that, of patients who had undergone surgical operations during the eight years, there were only three deaths from erysipelas? 1 in 1865 and 2 in 1867. I was not here during the first 1873, the year in which erysipelas make a formidable appearance in the wards. surgeons who were in the charge at the beginning of that ore dead, and their regarding the disease is lost to
Partridge forms
me
operated, but there
testimony duty
returned to
that,
in
some
on
two
the 1st three
or
year Mr.
April
1873.
cases
where he had
He in-
that form of cellulitis which is erysipelatous set in, clear evidence of a spread of erysipelas from
was no
to case, or reason to believe that erysipelas had taken up a fixed position in the hospital. Dr. McConnell, who was at the hospital during the whole of 1873, and who performed and case
recorded all the
jpost-mortem examinations, informs
that
me
occurred in 1873 which led him to think that erysipelas had become nosocomial, that it was inclined to spread from
nothing
to case in hospital, or that the dread of it caused the surgeons to feel unwilling to operate in any of their cases. We have seen that, in 1873, 29 patients suffering from
case
erysipelas were admitted to hospital?6 patients died of erysipelas, 2 of them after important surgical operations. In that year the number of out-patients subject to erysipelas considerably increased,? 7 Europeans and 55 Natives. That the erysipelas did not, in the first place, arise in this hospital, i.e., that it was not generated here on account of the operation within the building of any of our insanitary conditions, is proved by the above statistics of the number of persons who were udmitted to hospital for the treatment of erysipelas. The prevalence of erysipelas in the city, entirely apart from the hospital, is also proved by our out-patient records. In the eight years, 1865-72, the numbers of outpatients treated for erysipelas were 40, 13, 34, 50, 156, 22, 26, 21. In 1873 they were 62, and in 1874, 61. With a view to ascertain how far the erysipelas wave has extended through the city and the surrounding district, I have made enquiry of the officers in medical charge of the other principal hospitals. Dr. Robert Bird, of Howrah, informs me that he has had no cases of erysipelas among the Europeans and Eurasian patients of his hospital, and only 4 among the native patients. Of these 4 cases 2 were admitted from a village in the Hooghly district, and 2 originated in the hospital, one idiopathieally Bnd the other traumatically." These cases occurred very lately. Dr. Bird adds a fact which is of great value, as showing how broadly spread throughout the district the erysipelatous influence is, "I see the disease is also being met with in the district. I have to countersign a good many certificates in favor of Railway Baboos, and I note that, recently, 4 or 5 cases of erysipelas have occurred among these men. The disease, therefore, although met with, can scarcely be said to have assumed epidemic proportions in this place." Dr. Cayley, in charge of the Mayo Hospital, has given me the subjoined facts, which, viewed by the light of the experience of our other hospitals, become of great interest and value, when we consider that his is a perfectly new hospital, which was only opened in September last, and in which the ordinary recognised causes of hospitalism can hardly have had time to "
accumulate.
opening of the hospital in September, admitted, on the 21st, with erysipelas of the face and head of 9 days' duration. She was in a sinking state on admission, and died in 24 hours. Nearly three months later, on the 10th of December, a Mahomedan man was admitted, of course to a different part of the hospital, with a crushed little finger. On the 19th, it was found uecessary to amputate the finger. On the 20th, erysipelas appeared aud spread up his forearm and arm. This Soon after the first
a
woman
was
he died
compound fracture of the first, metacarpal hand, and considerable laceration of the soft parts. On the 24th erysipelatous inflammation of the skin appeared and spread up to the elbow, and a good deal of suppuration and swelling occurred in the neighbourhood of the injury. On 6th January the inflammation subsided and. same
ward with
bone of the left
the
man
Dr.
recovered. has not had any other cases of erysipelas; but, amputation, the wounds have, for a time, owing to unhealthy inflammation and more or less
Cayley
in several cases of done
badly, sloughing of
the
flaps or coverings. obliged me with a document* which appears so valuable and pertinent to the question at issue that I annex it in the appendix (A) in original. The Presidency General Hospital is placed in a tolerably open situation, very much apart from most of the insanitary influences of the city, an d generally enjoys a remarkable immunity from hospitalism. Previous to October last the hospital appears to have been On the 31st of October (I wrote for free from erysipelas. tents on account of the prevalence of erysipelas here, in the Medical College Hospital, on the 5th of November) a European man was admitted with erysipelas which had Dr. Ewart has
attacked
an
ulcer
on
the foot.
The
disease
was
cellulo-
good deal of suppuration and well. case eventually got There were 8 more admissions with erysipelas on the 28th January, 5th February, 12th February, 14th February, 14th March, 20th March, 21st March, 21st March. The rapidity with which these cases were brought in, in February and March, shows how powerfully the erysipelatous influence had become developed without. Within the hospital, two patients were attacked with erysipelas. The first, a European, suffering from a compound fracture of the tibia, was seized on the 17th of January after lie had been lying a month in hospital. The second, a Mnssalmaun, who had undergone amputation of a finger, was attacked with erysipelas on the 19th February, three days after the operation. None of the cases in the General Hospital were fatal. Dr. Woodford has obliged me with the following data regarding the appearance of erysipelas in the Campbell Hospital, Sealdah. He notices it as a very remarkable fact that, from the time at which this large city hospital was opened, on the 1st of July 1867, no case of erysipelas was admitted or occurred within its walls until the early part of last year; it will be noticed that the Surgeons consider that the disease first assumed a really formidable character in our (Medical College) Hospital in February 1874. A patient, admitted to the Campbell Hospital on the 26th of that month, wus attacked with erysipelas in hospital, and died on the 7th March. In 4 other cases erysipelas attacked patients while under treatment in hospital. Of these, two recovered and were discharged on the 30t.h July and 25th of October. The remaining two died on the 31st October and the 16th February last. Fifteen other patients were admitted with erysipelas. Of these, three died. The patients suffering from erysipelas cutaneous, and there sloughing, but the
were
19 in all.
was
a
The last admission
was on
the 28th
of March
of the present year. Dr. Woodford's return of these cases is annexed. (B). Early in 1874 erysipelas took on a new and far more aggres-
sive character in the Medical College Hospital. The cases from outside were numerous. Three Europeans and 58 Natives were ?
treated in the out-door
Prepared,
at his
dispensaries
request, by Dr. French.
;
seven
Europeans
THE INDIAN MEDICAL GAZETTE.
316
and seven Natives were admitted with the disease
(29
cases
admitted the year before) and eight deaths erysipelas occurred in the wards. In five of these erysipelas attacked
of
were
and destroyed patients who had undergone important surgical operations. Mr. Partridge tells me that it appears to him that this evil
set in from the 6th of February, when a Chinaman was admitted to his ward with erysipelas of the head and face. Cellulitis was established, and he died on the 19th. Since then, appears to have taken up its abode in the building, from case to case, (that is to say each of the Surgeons has noticed an instance in which it has done so) ; it attacks in-patients suffering from diseases, such as epithelioma
erysipelas it spreads
tongue and mama.ary abscess, in which, commonly, no particular tendency to erysipelas 5 it attacks and kills patients who have undergone surgical operations so frequently that the Surgeons are anxious lest it should occur whenever they are obliged to operate, and are unwilling to perform any operations which can be avoided or postponed. The subjoined table displays, at a glance, the statistical history of erysipelas in the hospital during 1874 as far as it. is shown in the returns, but it is defective as not showing some cases in which patients were attacked with erysipelas in hospital and recovered. Cases of Erysipelas, 1874. of the
there is
Died
Out-Patients
TbeatED-
Admitted
with
Died
op
Ektsipelas
Ektsipelas.
from
Erysipelas afteb
Sur-
gical
ope-
KATIONS.
[December 1,
1875.
What remains of the history of erysipelas in this hospital, up to the present date, is briefly as follows: In the present year 8 natives have come for out-door relief with erysipelas (generally the cutaneous variety and little more severe than ery5 natives have been admitted with erysipelas, of Besides this, a native woman, with a small sinus of very long standing in the thigh which was opened,
thema)
;
whom 3 have died.
subsequently of phlegmonous erysipelas. In a native, operated upon for scrotal tumor, erysipelas attacked Of late, almost every case the wound and proved fatal. operated upon has been attacked with erysipelas, suppuration has only occurred in a few of these cases. The disease has been generally of the cutaneous form. Considering that a near connexion often exists between erysipelas and puerperal fever, I have made special enquiry of Dr. Charles, who informs me that, although he has had some
died who
was
cases
of the latter disease within the last year
inclined to attribute them either
or
two, he is
to
hospitalism or to erysipelatous influence; lie has generally imputed these cases to the length of labour. He considers that puerperal fever was more prevalent ten years ago than it has been of late. This report was sent in on the 16th April. At the end of not
the first week of June, Dr. Charles informed me that Puerperal fever had taken such hold upon his wards that accommodation, in a separate building, was needful for his lyingin
women. He promised that he would vacate this building immediately he could do so with perfect confidence that his patients were safe. He occupied the building from the 12th of .Tune until the 11th of August. This, I feel confident, was no mere coincidence. It was a clear development of that immutable law in disease which teaches us that, when erysipelas is prevalent, puerperal fever
is threatened. Ke-
January
To
1 Re-
maining maining
1 Admitted 2 1
February March
April May
June
July
August
September
October November
December
Totals
...
I may here remark that it has appeared to in our present returns very
figures
me
that the
imperfectly
represent the true amount of hospitalism in the building, inasmuch as nothing is said about those cases of intercurrent hospitalism in which recovery takes place (such as a case of osteo-myelitis, in which the progress of bone disease stopped only after the third amputation) or of those in which compound fractures, accidental flesh wouuds, abcesses, &c., are attacked with some form of hospital taint. I have, therefore, with the full concurrence of all my hospital colleagues, provided for each physician and surgeon " a separate Register of Nosocomial Diseases," a very simple form in which will be entered every case in which a patient 13 attacked in hospital with septicaemia, sloughing after operl ospital gangrene, osteo-myelitis, other nosocomial disease. Name, ward and
ations, fractures, &c.,
erysipenumber, dates of admission and discharge or death, result, original disease or injury, operation, hospital disease, date of its first
las
or
appearance. Each entry will up, these registers
and prevalence of
scarcely occupy a minute. If properly kept will, henceforward, fully represeut the nature our hospital diseases.
one
who has for many years watched the progress of
hospitalism in this hospital it is very noticeable how completely the waves of contagium, which gradually follow one upon another, alter in character from time to time. At one time, we have a prevalence of septicaemia as displayed by the charcteristic suppurative changes, principally in the liver and lungs; then true hospital gangrene has its day, and entirely disappears; then osteo-myelitis, then erysipelas; one succeeding the other with singularly little intermixture, during the prevalence of each of the other forms of hospitalism. Thus osteo-myelitis, formerly dreaded in every case when a bone was divided, has disappeared; hospital gangrene has only shown itself on one occasion in the hospital. Formerly, the Chandney Hospital was scarcely ever free from hospital gangrene. Erysipelas has now, for the first time, assumed in the Medical College Hospital the character of hospitalism. A London Surgeon, visiting this hospital at present, would Yours and all the other hospitals in and near probably say : "
attacked as we frequently are ; you are rather troubled at present by our almost constant foe erysipelas. It is frequently much worse with us. Your hospital now suffers as that palace?New St. Thomas's Hospital?began to suffer Calcutta
are
now
erysipelas very soon aftor it was opened. Writing about two years ago, of King's College Hospital, a fine modern building, Mr. John Wood precisely describes " our own There came into the hospital, present condition. the time, I concluded that a at from made and, enquiries similar condition prevailed in most or all of the London Hospitals?a very unfavourable change, erysipelas and its concomitant, pyajmia, began to show themselves, the former not springing up in the hospital itself, but imported with patients. The wounds began to suppurate more, primary healing was less common, and the erysipelatous blush appeared with blameworthy impartiality in cases treated in all kinds of ways." It was clearly beyond the power of our science to avoid the from
Decicmbkh 1,
ERYSIPELAS IN" CALCUTTA..?13 Y N. CHE VERS.
IS75.]
wave which has spread throughout the whole of Calcutta; but, the morbid influence having come upon us, its destructivewe have done every thing in sanitation to limit ness. Among the measures taken have been cleanliness of buildof the bedding of the ing, clothing and bedding, destruction
erysipelas
of the builderysipelas cases, white washing and fumigation ing, attention to internal and exterior drains, the free use of disinfectants, especially the carbolate of lime and charcoal, the scrupulous destruction improvement of the water closets, of new ones tarred within of porous gamlabs ; the provision of wounds ; the strict and without, the antiseptic treatment On the 5th November, I indentcases. of isolation erysipelas ed, through the Deputy Surgeon-General, Presidency, Circle, for six tents.
Into these the council-room ward patients
were
removed on the 13th idem. They remained out until the 10th December; and, in the meantime, the interior of the councilroom
was
thoroughly scraped, lime-washed
and
sick 4th January, the whole of the native The
tents.
hospital
was
painted.
were
On the
removed into
repaired and thoroughly limewere brought back to the building
then
washed -within. The sick on the 11th of February.
Towards the close of last rains, early in September, accident revealed what I consider to be a vital defect in the sanitary condition of this hospital. There suddenly occurred a caving in of a part of the ground floor of the building, to the superficial extent of some 10 by 6 feet and to a depth of about two feet. This was represented to the Executive Engineer, who had the hollow excavated. Early in November, I wrote to the Engineer Officer, requesting that he would expedite the work as serious disease (erysipelas) existed in the hospital, and as I considered that this was the filth-sodden earth, probably due to putrid exalations from I and foul water in the excavation which, suggested, should be filled in as soon as possible with clean and solid material. This repair having been effected, I drew the attention of the on excavating the earth of Engineer Officer to the facts that, the hollow, extremely foul black water was almost immediately most filthy and a Reached, and that the soil taken out was bones and broken compound of what appeared to be ditch-mud, I solicited his opinion upon the best mode of repottery. had reason to think that exhalations from medying this evil, as I in the hospital. I enquired whether this hollow caused sickness the building is of this character, and of floor whole the the floor should be gradually dug out whether the soil below *
whether the floor
or concrete, and replaced by clean material with a layer of concrete or asphalt. should be thickly covered if I wished it, he would dig The Engineer Officer replied that, the nature of the ascertain and other in floor places or
Up the
floor is very low (beiug He suggested that, as the the building) he was of opinion outside the than ground lower the evil would be to raise the that the best way of remedying six inches of hydraulic conlevel of the floor with a layer of it advisable to expose the patients to the crete. Not thinking the floor, I begged that the risk of further opening up furnish an estimate of the cost of Executive Engineer would trust that it will be the pleasure the above work. I earnestly this important work to be carried of Government to permit at least its eastern out, as it is known that the building (or on wooden piles, on the site
sub-soil.
wing) stands, partly supported of
one or
more
most offensive
present,
old tanks which were evidently filled in with rubbish, the only covering of which is, at
a common
tiled
flooring.
The increased prevalence in Calcutta, of late years, of erysi-
pelas
and of its usual
companion
in
European cities,
the true
enteric fever of Jenner, is a subject which deserves very close and serious attention. Enteric fever was formerly very rare it in Calcutta, it is still by no means a common disease ; but From a fixed habitat in the city. taken have to up appears
317
1870, we have admitted cases every year to the total number of 30, 9 Europeans and 21 Natives. Of these patients, 12 have died, 4 Europeans and 8 Natives. I am not prepared to carry out the argument that the present mode of draining Calcutta, by flushing the filth away in underground sewers, is the cause of this increase ; but I and others never ceased to oppose the introduction of this antiquated and filthy mode of conservancy as long as the question remained open to admitted fact that erysipelas argument; and it is a
generally
and enteric fever rage most where closed sewers most abound.
(A) CASES OF ERYSIPELAS, PRESIDENCY GENERAL HOSPITAL, TO 30th MARCH 1875. 1st Case?Traumatic Cellulo-cutaneous Erysipelas. Admitted with the disease.?John Courtney, European, aged 30, a sergeant in the Ordnance Department, of intemperate habits,
admitted into Dr. Ewart's ward on 31st October 1874, on the foot, and cellulo-cutaneous erysipelas of the
was
with ulcer
There was
part.
of the tissues. was
discharged
good deal of suppuration and sloughing gradually got better; on the 23rd January
a
He
cured.
Erysipelas, attacked in hospital.?W. New, European, aged 21 years, a seaman, 7 months in India, was admitted into Dr. Ewart's ward on 17th. December 1874, for compound fracture of the tibia. About a month afterwards, on the 17th of January, the wound and surrounding tissues suddenly became erysipelatous. He was at once removed from the surgical ward and placed on the 1st floor, where the blush gradually disappeared. He has not 2nd Case.?Traumatic Cutaneous
since then been re-attacked. 3rd Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease ?W. Clarke. European, aged 25 years, seaman, was admitted into hospital on the 28th January 1875 for a
growth on the scalp which Dr. Ewart removed. A week afterwards he was discharged perfectly cured, 3 days afterwards he was re-admitted with cutaneous erysipelas of the scalp and surface which was cured in about 10 days time. Note.?It is doubtful whether this case ought to be entered under the head of traumatic or idiopathic, considering that the of his discharge and was perfectly healed at the time
wound
when attacked
I have returned it
by erysipelas.
as
idiopathic
cutaneous. 4th Case.?Traumatic Cellulo-cutaneous Erysipelas. Admited with the disease.?Joseph Shead, European, aged 22 years, police sergeant, was admitted into Dr. Ewart's ward on the
5th February 1875 for fracture of the 2nd and 3rd phalanges of the little finger and slight erysipelas of the hand. This quickly subsided, and on the 5th day after admission the finger was
amputated.
(now as
Two
days
after
of the cutaneous-cellular
far as the elbow
puration,
an
hand, and he
perfectly
joint. opening was was
As
the
variety)
there
was
operation erysipelas set a
in and extended deal of sup-
good
made on the dorsal aspect of the sent down to the first floor. He is now
well.
Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease.?Henry Glise, European, aged 29 years, police constable, was admitted into Dr. Ewart's ward on the 12th February 1875, for idiopathic cutaneous erysipelas of the face. He rapidly recovered, and was discharged cured on 18th idem. 6th Case.?Traumatic Cutaneous Erysipelas. Admitted with the disease.?Mr. E. Miller, Eurasian, aged 48 years, was admitted into Dr. Ewart's ward on the 11th February 1875, for a wound and erysipelas of the scalp. The erysipelas rapidly disappeared, and the wound healed. She was discharged cured on the 19th idem. 7th Case.?Idiopathic Cutaneous Erysipelas. Admitted with the disease.?Mary Fleury, Eurasian, aged 15 years, was admit5th
THE INDTAN MEDICAL GAZETTE.
ted into Dr. Ewart's ward cutaneous three
erysipelas and she
days,
on
14tli March
of the left
was
It
leg.
discharged cured
1875, with idiopathio rapidly disappeared in on
18th March.
8th Case.?Traumatic Cutaneous the disease.?J. H. was
Erysipelas. Parkins, European, aged 35
admitted into Dr. Ewart's ward
Admitted with
years, Seaman, 20th March 1875, with
on
the dorsal aspect of the right hand and erysipelas the part. The erysipelas rapidly disappeared and ulcer
ulcer
an
of
on
He
liealed.
discharged cured on the 23rd idem. erysipelas attacked the ulcer this case is returned
was
'Note.?As
[Df.cember
Concluding Remarks. From the foregoing it will be seen that the first case (European) was admitted from outside with traumatic cellulocutaneous
erysipelas.
2nd.?There
two
were
wounds attacked in
Case.?Traumatic Cutaneous
10th
Seaman, was admitted 1875, with ozoena and
4>t7i?There admitted There
ety,
was
4
were
into
wore
5th.?There
with
of the cellulo-cutaneous uttaeked in
no
was
(3 Europeans and 1 Eurasian) idiopathic cutaneous erysipelas.
cases
hospital
no case
and none
or
cellular vari-
hospital.
death.
(B.)
into Dr. French's ward on 21st March The cutaneous erysipelas of the face.
nose
affection is
getting
11th Case.?Traumatic
Nos.
well.
Cellulo-Cutaneous Erysipelas,
1? 2* 3 4 5 6 7 8 9 10* 11 12* 13 14 15 16 17* 18 19
at-
tacked in Hospital.?Khumroo Khan, Mussulman, aged 50 years, was admitted into hospital into the native ward on 28th February 1875, for ulcer on the dorsal aspect of the left index finger and necrosis of the bone. On the 16th Dr. Ewart amputated at the metacarpo phalangeal joint. On the 19th, or three days afterwards, the wound and hand were attacked by the cellulo-cutaneous erysipelas, which extended up the elbow-joint. As suppuration was extensive, counter openings were made on the back of the hand and along the forearm. The patieut is now progressing favourably. Abstract of the 11 Cases.
Admitted with
disease.
Attacked in
Hospital.
Ki.CE.
European Eurasian Native Totals Tbaumatic.
Admitted with disease.
Attacked in
Hospital.
Race.
...
...
...
0
2
2
4
10
0
1
0
1
0
1
0
0
0
0
0
0
0
0
0
1
0
1
J
3rd
Cases treated in the
of Erysipelas the Campbell Hospital
Shombhoo Oojerum
...
...
Result.
26th Feb. 1874 Male Female 6th Mar. Do. 21st ? Male 23rd ,, Female 4th April Do. 25th May Male 18th J une Female 16th Aug. Male 14th Sept. Do. 21st ? Do. 23rd ? Female 10th Oct. Do. 15th ,, Male 27th ? Female 19tb Dec. Mule 10th Jan. 18 Female 13th Feb. Do. 17th Mar. Male 28th )(
...
... ...
Kaminey
Cadoo Johur
...
Sing Dossy Peer Mohamud ...
Rakhal Balak Dinoo Shama
...
... ... ...
...
Ramgutty
...
Ram Preo Ghorbani Hhorbo Unkunem
...
...
Bhowaniprosad which
April
Sex.
admission.
Khama Sreemonto
Surgical January 1874.
since
Date of
Name.
Names to
Idiopathic.
Totals
and tho
variety. 3rd.?There were 5 cases (4 Europeans and 1 Eurasian) admitted into hospital with traumatic erysipelas, oellulo-cutaiieous variety.
Number
nose has been affected for about three months, and some two or three weeks ago one or two pimples formed externally on or about 18th or 19tli March. Cutaneous erysipelas appeared, and he The erysipelas has now disappeared, came to hospital on 21st.
Eurasian
Native) of
other of the cellulo-cutaneous
Admitted
Erysipelas.
?with the disease.?George Kaye, European, aged 30 years,
Native
and 1
the cutaneous
was
24th idem.
on
Europeen
(1 European
one
Idiopathic.
-Idiopathic Cutaneous Erysipelas. Admitted with the disease.?John Gillies, European, aged 38 years, Seaman, was admitted into Dr. Ewart's ward on 21st March 1875, with idiopathic erysipelas of the right hand; there were two small biillce on the inside of the middle finger. He was discharged 9th Case.
and the
cases
hospital,
under the head Traumatic.
cured
1, 1875.
*
is
1875.
prefixed
...
are cases
Wards
Date of
th 30th 25th 26th 5th 29ih 3rd 26th 6th 2at,h 26th Died Do. 31st 30th Cured 1st Do. 26th Do. Relieved. 17th Died 16th Do. 18th Otherwise 31st Died Cured Otherwise Do. Died Otherwise Cured Do. Do. Do ...
...
...
... ...
...
...
... ...
...
...
which occurred in the
of
Result.
Mar. 1871
July
,,
Mar.
,,
,,
?
?
?
May July Aug.
?
Jan. Oct.
?
,,
1875
1874
Sept.
?
Oct.
?
?
N or. Dec. Jan. Feb.
? ,,
1875
Mar.
? ?
?
Hospital.
Tariney CnuRN Pal, Resident Assistant Surgeon.
