ENTERIC FEVER IN INDIA.

ENTERIC FEVER IN INDIA.

ENTERIC FEVER IN INDIA. was duly advised of the choice and the result was eminently satisfactory. No pledges whatever were asked or given. After the p...

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ENTERIC FEVER IN INDIA. was duly advised of the choice and the result was eminently satisfactory. No pledges whatever were asked or given. After the publication of the three names heading the list those candidates would be justified through their own committees or alone to take any advantage of the voting they considered desirable. There can be no expectation of a unanimous response to the scheme this year. I would only suggest that, as I am informed it will meet with the ready acceptance of a large number of the profession, we can hope that at future elections they will look to something similar as best suited to voice their wishes, and as a ready means by which to influence the indifferent members of our profession to vote for candidates generally recommended. Believe me, yours faithfully, LLEWELLYN WILLIAMS, Chairman, Wandsworth Division, British Medical Association. P.S.--If you decide to do what you can in the matter during the short time at our disposal, would you kindly send me a post-card, so that some idea may be formed of the progress being made. H. Broadbent (Manchester), Geo. List of candidates tKOtcn,.—&. Brown (Cornwall), Langley Browne (West Bromwich), J. F. Bullar (Southampton), Andrew Clark (London), A. Godson (Cheadle). Geo. Jackson (Plymouth), H. A. Latimer (Swansea), L. S. McManus (London), J. Rutherford Morrison (Newcastle-on-Tyne, C. J. Renshaw (Ashton-on-Mersey), J. M. Rhodes (Manchester), F. J. Smith (London), J. Smith (Chiswick), C. R Straton (Salisbury). *Copies of this circular can be obtained if ordered of me before Sept. 15th at the rate of 2s for every 50, or part of 50 ; if a large number were ordered the benefit of the printer’s reduction could be

obtained and money returned.

I

ENTERIC FEVER IN INDIA. APPOINTMENT

OF

the the

A

STANDING COMMITTEE.

THE Standing Committee appointed by the Government of India to consider the prevalence and prevention of enteric fever in India held its first meeting on July 31st and subsequent days in the United Service Institute, Simla. The following officers who constitute the committee were present: Surgeon-General W. L. Gubbins, C.B., M.V.O., V.H.S., A.M.S., principal medical officer, His Majesty’s forces in India (president); Lieutenant-Colonel J. T. W. Leslie, I.M.S., sanitary commissioner with the Government of India; Colonel R. H. Forman, R.A.M.C., principal medical officer, Bombay Brigade ; Colonel D. FfrenchMullen, I.M.S., principal medical officer, Sirhind and Jullundur Brigades ; Lieutenant-Colonel T. P. Woodhouse, R.A.M.C. ; Lieutenant-Colonel D. Semple, R.A M.C. (retired), director of the Central Research Institute of India; Captain Greig, I.M.S., on special duty, Central Research Institute of India ; Captain L. W. Harrison, R.A.M.C.; Captain E. Blake Knox, R.A.M.C. (secretary); Captain A. B. Smallman, R.A.M.C. ; and Lieutenant E. J. H. Luxmoore, R.A.M.C. Major A. R. Aldridge, R.A.M.C., sanitary officer, Army Headquarters, was also present as expert in army sanitation. His Excellency the Commander-in-Chief (Lord Kitchener) opened the meeting and in the course of his address made the following remarks : "I have thought it necessary to form this Standing Committee to advise us in our efforts to reduce the amount of enteric fever among the troops in this country and to coordinate the work of the whole medical profession, both civil and military, in this direction. It is hardly necessary for me to tell you that the three principal diseases the ravages of which cripple our troops are malaria, venereal, and enteric fever. I am glad to say that with regard to the two former we have made very successful progress in limiting the evil but when we come to enteric fever we are still, I am afraid, very much where we were. Last year we had no less than 1146 admissions and 213 deaths from this disease. This is an improvement on the record of 1904 but I regret to note that during the current year up to the end of June we had already 513 admissions and 126 deaths from this cause. It is evidently the duty of every one of us to fight enteric fever in every possible way. The ravages of cholera, the curse of the army in India in days gone by, are now happily a reminiscence of the past, and if we consider enteric fever as a no less dangerous disease than cholera, and are

equally energetic in stamping it out, I have great hopes that we shall succeed eventually in bringing this scourge in its turn under control. We know that the time when young soldiers are most subject to enteric fever is on their first arrival in this country and subsequently at certain seasons of the year when a prevalence of the disease may be annually anticipated. The general lines on which we should work are, I think, fairly clearly defined but the details of elaboration form, it appears to me,

crux on

which I

671

hope

greatest assistance

your advice and efforts will be of to us in dealing with this most

insidious disease. I may briefly suggest as the main outlines for our action : (1) sanitation of cantonments and barracks; (2) isolation of enteric patients ; (3) detection of the origin of an outbreak or of a single case ; (4) inoculation ; and (5) blood examination. On the subject of sanitation a great deal has been written and the success which has resulted from much practical work has proved what good results can be achieved in this direction. Ambala, for instance, has during the last 12 months been an instance of the good fruit which care and forethought, combined with attention to detail, can produce, and in many other places we have evidence to convince us that our efforts are not in vain. Of course, sanitary reform not means the expenditure of money, but money will be wanting for this object if we can be certain that we are working on the right lines. I will not enter into the much discussed question of the propagation and conveyance of the enteric germ through the medium of water, flies, These are evidently all means of infection, each dust, &c. in their degree, and measures for neutralising their pernicious influence must therefore be taken. In this connexion I will lay on the table for your consideration an able paper on the Sanitation of Cantonments, recently written by Colonel Thornhill. As regards the isolation of enteric patients and those who have been associated with them, I believe the importance of this precaution is now more fully recognised and enforced than used to be the case. All clothing and excreta must, of course, be most carefully disinfected. The detection of the origin of outbreaks ot enteric fever is a question of the gravest importance, but it is also one of great difficulty. More than once, however, conspicuously successful results have ensued when immediate and careful deductions have been persistently followed up. All cases of slight fever should be viewed with suspicion and the patient sent to hospital for diagnosis. Early diagnosis is an absolute essential, for it allows of early prophylactic measures being enforced. No efforts should be spared to ascertain the origin of an outbreak, or even of a single case, for on the correct results of such inquiry depend success or failure in preventing recurrence. Commanding officers and the whole military machinery of the unit should be associated with the medical officer in the search for the originating the precautions to be adopted to prevent cause and the spread of the disease should be at once communicated to all concerned. Full use should be made of blood examination in following up any clue that may be found. I now come to the important subject of inoculation. You are doubtless aware that we have for some time past been engaged on experiments in India in antityphoid inoculation and I am glad to say that great advances have been made on the old system which prevailed at the time of the South African war. By antityphoid inoculation we can assist the soldier’s tissues to resist the disease by providing him with fluids in the blood which react on, and cause disastrous results to, any bacterial invasion by typhoid germs. That by this means we can obtain fruitful results in India is proved by recent experience. Take the 17th Lancers, for instance. This regiment landed in India on Sept. 28th, 1905. The total number of enteric fever cases from that date to June 15th, 1906, has been 61, of whom 11 have died. Of these 61 cases two only had been inoculated and both recovered. 150 officers and men of the regiment The value of inoculation in other cases were inoculated. has been equally proved. But though we have in inoculation a possible solution of this grave question, I wish to point out to you, gentlemen, that this method of treatment is still comparatively in its infancy, and though we have, I think, sufficient data to jjustify us in introducing the system generally into this country, I look forward to great improvement in its operation being arrived at in the near future through the devoted and untiring energy of the professional experts in the subject, both in India and at home. I further anticipate that careful investigation and practical experience will lead us still further on the path towards doing away with some of the drawbacks which now attend the process. I have placed blood examination last, though I have referred to it before as an important factor in following up any clue to the discovery of the cause of an outbreak. We all, I think, realise that many men may, though apparently quite well, be carrying about the germs of enteric fever in their blood, and thus become the means of transferring the disease to others. This is often the case with convalescents

LOOKING BACK.-THE BRITISH MEDICAL ASSOCIATION.

672

from enteric fever, even after a considerable period of isolaTHE tion, and I consider that blood examination will therefore be of immense value in indicating to us where precautions are BRITISH necessary and where our preventive efforts should be MEETING AT TORONTO. directed. As a layman I can only suggest these views for your consideration as experts, and I will now leave you to (FROM OUR SPECIAL CORRESPONDENTS) the consideration of the details of this most important subject, with the assurance that your views and opinions THE seventy-fourth annual meeting of the British Medical will be received by me with the greatest interest and in the confilent anticipation that by following the practical lines Association commenced at Toronto on Tuesday, August 21st, which you may eventually suggest we may take an important under the presidency of Dr. R. A. Reeve, Dean of the Medical step forwards towards stamping out enteric fever among our Faculty of the University of Toronto. This is the second soldiers in India." The committee then passed to consider carefully enteric time on which the Association has met in Canada, and the fever wish reference to its prevalence amongst various second time the place of meeting has been outside the classes of individuals and communities in India. Statistics British Isles, the other occasion being the meeting at and evidence from the Army Medical Reports, the Annual Montreal in 1897. By Monday Toronto was beginning Reports of the Sanitary Commissioner and others from the to get full of medical men from the United States, year 1856 being placed before it. The various sources of who are present in large numbers, while not a few were then infection, excreta, fabrics, food, drink, &c., carefully considered and discussed in every detail and lines members of the medical profession from Montreal, Quebec, of present prophylaxis and a campaign for future prevention and more out-lying provinces and cities of the Dominion In the matter of cantonment sanitation had arrived. But the bulk of the travellers from England, were laid down. the committee had the advantage of the presence of the Ireland, and Scotland did not arrive until the actual day Inspecting Officer of Cantonments (Lieutenant-Colonel of the opening ceremony. On the morning of Tuesday it Thornhill, C I E.) whose views on this matter were of great assistance. The subject of antityphoid inoculation was fully was estimated that about 830 medical men had assembled, dealt with. It is hoped that the decisions arrived at and the but by the time the proceedings of the congress were in full line of action laid down will have marked beneficial results swing over 2200 members of the Association and accredited not only to the health of the army but also to the community visitors were present. India, South Africa, Egypt, Australia, at large The committee after five full days’sitting adjourned and the West Indies are all represented, while there are also until the middle of October when reports on the practical working of its various resolutions will be further examined visitors from Germany, and, as might be expected in Canada, from France. Many of the visitors from the mother country and, if necessary, added to. travelled by the Allan Line steamer 1-ortian and the Canadian Pacific Line steamer -Eiiipress (If Britain, and on both vessels a most comfortable passage was enjoyed.

MEDICAL ASSOCIATION.

Looking Back.

The choice of Toronto for the place of meeting was a The enthusiastic loyalty of the one. Canadians, their whole-hearted devotion to the mother country, and their more thanjustifiable pridein their own, with its vast extent and its great resources, perhaps nowhere find more open expression that in Toronto. Toronto strikes the visitor as the most English city in the Dominion in sentiment, but in outward appearance it is characteristically transatlantic. With a population of 263,749 it covers an area of 18z square miles, possessing an extensive front to the lake. Its streets are for the most part wide and, with the exception of the most busy ones, well wooded, giving a peculiar charm to them, while there are no less than 25 public parks with an extent of 1640 acres. There is an excellent service of electric street cars which on some of the principal thoroughfares run almost continuously, so that it is easy to get from one part to another. Its public buildings are large, handgome, and in many cases beautifully situated, as pictures have recently shown in THE LANCET when illustrating the edifices connected with the Medical School. Toionto forms the meeting place of the two great trunk railway lines of Canada-the Grand Trunk and the Canadian Pacific, while a third great transcontinental railway line is in process of construction. It is consequently a great centre for travellers of all sorts.

distinctly happy

FROM

THE LANCET, SATURDAY, Sept. 6th,

1828.

THE REPORT of the Select Committee on Anatomy is an upon the whole, a satisfactory document. Mr. W ARBURTOS is especially entitled to the thanks of the profession aud of the public for the zeal and ability which he exhibited as Chairman of the Committee ; and although a wider scope might, perhaps, have been beneficially given to some branches of the inquiry, we are not on that account the less disposed to acknowledge the value of what has been effected by the labours of the Committee....... There is a part of Sir ASTLEY COOPER’S evidence, which is likely to have a stronger influence than any arguments which can be urged in favour of an alteration of the law, towird-; inducing persons of a certain intellectual calibre, to support any measure which may have the effect of putting an endto the practice of exhumation The worthy baronet has not hesitated to declare that there is no person, however exalted his rank, whose body, if he were disposed to dissect it, he could not obtain. " Does the state of the law actuilly prevent the teachers of anatomv from obtaining the bjdy of any person which, in consequence of some peculiarity of structure, they may be particularly desir’us of procuring?-The law does not prevent, our obtaining the body of an

interesting, and,

individual if we think proper; for there is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain. " If you are wi ling to pay a price sufficiently high. you can always obtain the body of any individual ?-The law only enhances the price, and does not prevent the exhumation ; nobody is secured by the law, it only adds to the price of the subject." *

This declaration is well calculated to produce an effect on the fears of persons to whose understanding reason could fiad no access. We shall have frequent occasion to return to the Report, and to the Minutes of evidence taken before the Select Committee.

___

The great influx of visitors, both from Canada and the United States, as well as the extra number of people visiting the city in connexion with the Annual Canadian Exhibition which opens on Monday, August 27th, combined to render the principal hotels full to overflowing, but a large number of those taking part in the meeting of the Association have either been entertained by private hospitality or most comfortably housed in some of the residential colleges near the University. -

* We have given Sir Astley credit for what, we presume, he meant to say; but it is evident that the worthy baronet has with his wonted felicity of diction, made his threat appear rather to the living, than to the dead.

An informal dinner

was

given by the President-elect, Dr.

Reeve, in the University dining hall on Monday, August 20th,