In its first two decades, the school suffered an unexpectedly high death rate, with forty children dying between 1848 and 1858, of whom thirteen were the victims of an outbreak of cholera in 1857. In the next ten years, there were seventy-two further deaths, and in 1870 a Punjab Medical Department report proposed measures to improve the school's sanitation, as well as "a separate hospital for the treatment of contagious diseases". The headmaster, the Rev. John Cole, was inspired to write a book called "Notes on Hygiene with Hints on Self-discipline for Young Soldiers in India" (1882).