52 APPENDICES. 



ticularly. I have had a few cases of severe bronchitis, pleurisy, 

 and pneumonia among natives, but none among Europeans. 

 (D.) Cholera was epidemic throughout the Kangra Valley in 



1856 and 1857. In the autumn of the former year the disease 

 was severe at Dhurmsalla and at several other hill stations. In 



1857 there were but a few cases. That elevation above the sea 

 confers no exemption from cholera is indisputable. 



(E.) Diarrhoea of the form peculiar to the hills is not uncom- 

 mon during the rains. I have treated several cases among 

 Europeans, and in some have had considerable difficulty in 

 checking the disease, although none have assumed the intrac- 

 table and severe form stated to be common in the Simla hills. 

 In my opinion the treatment of this complaint should be mainly 

 dietetic. Hot baths, with persevering friction of the skin, 

 especially over the liver, and mustard poultices or blisters to 

 the right hypochondrium, are to be recommended. A purely 

 farinaceous diet, in small quantities, should be insisted on at 

 once, and meat, vegetables, and fermented liquor absolutely 

 prohibited. Astringents, antacids, and opiates may be tried, 

 but will very often be found to produce either no effect at all, or 

 only a very temporary one. The treatment, in fact, should be 

 directed to re-establishing the hepatic secretion. 



The best prophylactic is to take regular exercise, notwith- 

 standing the rain, and to be moderate in food and drink. I have 

 not known a case of dysentery among the European population. 



(F.) The climate is well suited to dyspeptic patients. 



(G.) Although I have never had a case of rheumatism origi- 

 nate at the station, except among natives, I have known patients 

 subject to it, to have their sufferings severely aggravated by 

 coming to Dhurmsalla, and without doubt the climate is totally 

 unfit to rheumatic patients. 



(H.) For all cases of cachexia, whether syphilitic, scrofulous, 

 scorbutic, or malarious, the climate is very well adapted. 



(I.) Materials on which to found a comparison between the 

 climate and salubrity of Dhurmsalla and of other stations on the 

 outer Himalayan range are not available ; but as far as three years' 

 residence at this station and limited accounts of the other Bengal 

 Sanataria enable me to judge, I consider it at least equal to any 

 of them, and superior to several, and especially to the Simla group. 

 J. J. T. LAWRENCE, Civil Assistant-Surgeon. 



Dhurmsalla, April 1, 1860. 



