2^6 



NATURE 



[May 29, 19 19 



suppression of urine took place in spite of very copious 

 alkaline injections. It thus became clear that in all 

 severe cholera cases sodium bicarbonate should be 

 added to the hyoertonic saline solution as a routine 

 jneasure to combat the acidosis from the first, and 

 prevent it reaching? a danj^erous degree. The results 

 of this addition to the treatment were soon apparent, 

 and after three years' use of the alkaline solutions 

 the death-rate from renal complication among nearly 

 six hundred cases had fallen to 298 per cent, from a 

 figure of II- 1 per cent, during the previous three years, 

 or a reduction of 74 per cent, in the losses from this 

 deadly complication, and the last remaining cause of 

 death in cholera was thus largely conquered. 



^ The Diminution in the Mortality of Cholera. 



The results may be very briefly summarised in the 

 following table, showing the mortality under the 

 different forms of treatment, or rather the continued 

 elaboration of my system of treatment with increas- 

 ing knowledge derived from combined clinical and 

 pathological investigations extending over twelve 

 years, and culminating in a reduction of the mortality 

 between 1895 and 1905,' before I began wOrk, of 

 59 per cent, to one of 19-1 per cent, between 1915 

 and 19 17, or one-third of the former rate, while in 

 1917. among 208 cases, it was but 149 per cent., or 

 one-fourth of the earlier figure, although all cases 

 admitted moribund and dying before a saline injection 

 could be given, thus coming late in a hopeless state 

 from suppression of urine, and very young and verv 

 old persons w-ithout the stamina to allow the treat- 

 ment to have a fair chance, are included. T there- 

 fore think it mav fairly be claimed that cholera has 

 now been robbed of most of its terrors by simple 

 scientific investigation with the aid of physical methods 

 in thf^ use of the haemocrite and specific gravitv test, 

 chemical research in the use of permanganates to 

 destroy the toxins in the bowel, and alkalis to combat 

 the deadlv acidosis and physiological principles lead- 

 in£?^ to the use of atropine and the all-essential hyper- 

 tonic^ saline injections. More may vet be done, but 

 sufficient has already accrued to prove the inestimable 

 life-saving and economic value of medical research 

 work, and to encourage both administrative authorities 

 and ohilanthrooists to look on liberal expenditure on 

 mf^dical research as the best possible use of public and 

 private monev. 



Tnhle of Cholera Mortality under Different Methods 

 of Treatment. 



^•ear. Case< Drains MoruHty, Recoveries 



per cent. per cent. 



Normal Saline subcutaneous'v an(^ per rectum. 



1895 to 1905 ... 1243 788 59-0 41-0 



Normal Salines intravenously. 



^906 112 57 51.9 . 49.1 



Normal Saline snhcutantoisly and per rectum. 



^907 i.=;8 94 59-5 40-5 



Hypertonic Salines intravenously. 

 1908107-1909... 294 96 326 67-4 



Hypertonic Salines /A« Permanaanates. 



8-1909101914... 858 222 25-9 74-1 



Hypertonic Saline=, Permansanates, and Alkalis. 



1915 to 1917 .. 638 122 19-1 8o-9 



The Future of Medical Research in India. 

 The ^reat lesson to be derived from the researches 

 on cholera which I have related is the importance 

 of combined clinical and pathological investigations. 

 So strongly do I hold the necessity of medical re- 

 search workers hemp in the closest possible relation- 

 ship with lar^e hosnitals to enable them to work on 

 practical lines that I regard Pasteur's great discovery 

 of his preventive treatment of hydrophobia as having 

 NO. 2587, VOL. IO3I 



been a curse rather than a blessing to India, because 

 it has led to three important research laboratories 

 being placed on remote hilltops for the sake of the 

 relatively insignificant mortality from hydrophobia, to 

 the grave detriment of work on all the more important 

 tropical diseases. Now that the treatment of hydro- 

 phobia and other bacteriological methods can be 

 carried out in the plains with the help of a refrigera- 

 tor, as is being done at the present time in Rangoon, 

 no excuse for further repetitions of this grave mistake 

 remain. 



The serious disadvantage which so many of the 

 members of the bacteriological — or, as it should be 

 called, medical research— -department now labour 

 under by their divorce from large hospitals in the 

 plains will be partly removed when the schools of 

 tropical medicine in Calcutta and Bombay are opened, 

 when team-work so essential to the solution of the 

 larger medical problems will be possible. In addi- 

 tion, all the larger hospitals should have whole- 

 time pathologists, to . enable the abundant clinical 

 material they contain to be made available for re- 

 search purposes, and also to allow the clinical staff 

 and the patients to have the immense advantages in 

 the diagnosis and vaccine and other lines of treatment 

 which a bacteriological laboratory affords through 

 recent advances in our knowledge of medicine. For 

 example, fevers and dysentery are the two great 

 causes of disease and death In India, but it is only 

 with the help of microscopical examinations that they 

 can be rapidly diagnosed and efficiently treated, and 

 without this aid even the most experienced physicians 

 too often cannot do full justice to their patients. In 

 future, I understand pathologists of our medical col- 

 leges will be supplied from the bacteriological or 

 research department, and will make the subject their 

 life-studv, and not be eliiJlble for clinical posts. In 

 order to get the medical officers with the highest 

 abilities and scientific training required for success 

 In research to devote their lives to it, and to abandon 

 the much more lucrative clinical side of medicine, it 

 will be absolutely necessary to give them salaries in 

 proportion to the long and expensive scientific train- 

 ing of from six to eight years which they receive 

 after finishlngf their general school education. 



Now that the war has led to careful inquiries into 

 scientific education In Great Britain, and a greatlv in- 

 creased demand for men of science at home, the 

 difficulty In recruiting those required for Industrial 

 and educative progress In India will be much greater 

 than hitherto, while it will be still further enhanced 

 by the uncertainty of the prospects of young men 

 coming to India for their life's work in Government 

 service due to the proposed ten-vearly kaleidoscopic 

 changes In the constitution of this country. I have 

 felt it to be my duty to point out the rocks ahead in 

 this direction, and to Indicate the absolute necessity for 

 much more generous treatment in the Immediate 

 future of men of science of all branches of knowledge 

 required for service in India. 



The Need for Liberal Endowments of Medical 

 Research in India. 



Lastly, I wish to direct attention to the great life- 

 saving and economic importance of such investigations 

 as those which I have related on cholera, and manv 

 others which might be mentioned ; as when this is 

 fully realised bv the public, endowments of medical 

 research will surely be forthcoming in India on a 

 far larger scale than hitherto. Bengal and Bihar have 

 generously given me seven lakhs for the Calcutta 

 School of Tropical Medicine, half of which has been 

 expended on the Carmichael Hospital for Tropical 

 Diseases, and the remainder will be used for medical 

 research and the partial upkeep of the hospital under 



