HEALTH OF THE ARMY.

286 instructed by the Local Governinto the cause and extent of the inquire epidemic of enteric fever at Bangor, has made a preliminary statement to the sanitary authority of that place. He arrives at the conclusion that the main cause of the outbreak, which up to last week had led to 141 attacks and 8 deaths, was pollution of the water-supply above the point of intake, but that the disease was spread by the gravely defective condition of the sewers and house-drains in respect of ventilation. In all these respects his opinion is confirmatory of that given by Dr. Rees, the local medical officer of health. Dr. Barry strongly urged remedial measures upon the authority. DR.

BARRY, who

was

ment Board to

with 40 deaths in the Frontier Field ratio of 9’07 and 3’07 respectively. The stations at which it was most prevalent and fatal were elusive of 90

cases

Force, being in the

Nowshera, Lucknow, Ranikhet, Dugshai, Barellly, Sitapur, and Moradahad. The 30th Regiment, which had just arrived from England, had 65 cases and 13 deaths at Bareilly and

Rauikhet and other stations in the Rohilcund division. In the Peshawar division the disease occurred chiefly in the 8th Hussars, 12th and 14th Regiments. No information is given as to the corps in which it prevailed in the other divisions. Nearly half of the cases occurred in the second quarter of the year. Cholera was the cause of 6 ’8 admissions, and 4’86 per 1000 of the strength. It prevailed in an epidemic form at Allahabad and Lucknow. At the former station the admissions were in the ratio of 57’, and the deaths of 42’ per 1000, and at the latter of 26’7 and 17’St. respectively. It also prevailed, though much less severely, at Cctwnpore, THE outbreak of small-pox in Newcastle is causing conMoradabad, and Peshawar. Among troops on the march, siderable anxiety to the inhabitants of the town. Fortu- the average strength of which for the year was 2180, there nately the sanitary authorities are in possession of a hospital were 41 cases and 34 deaths. With reference to the to which cases may be removed, and the means of removal, advantage derived from the immediate removal of troops in the shape of a comfortable ambulance, is provided by the from a station on the outbreak of cholera, the priucipal medical officer observes, "The benefits derived from leaving Corporation. The epidemic seems to be almost entirely the infected locality have again been plainly shown, but confined to the Byker district. In spite of energetic action this should be done as soon as possible, and to as great a distance as possible. on the part of the authorities, and the increased labours of ’ Preparatory’ camps in the neigh. of the infected barracks rarely produce any good bourhood the vaccination officers, the disease appears at present toIt would be more prudent to prepare a camp at a effect. give no indications of subsidence. selected distant site as soon as the disease IS reported in the city or district, and to remove the troops to it by railway at the earliest indication of disease in cantonment The cir. cumstances of the epidemic at Allahabad were plain as to HEALTH OF THE ARMY. the danger which is incurred by keeping the troops loitering about an infected locality instead of removing No. II. them to a sufficient distance." As we have already stated, diseases of the digestive system IN an average annual strength of 50,136 European soldiers are the class which has given rise to the highest rate of mor. in in of the field force exclusive Afghanistan, tality. In the Peshawar division the deaths by serving India, dysentery the proportion per 1000 of strength admitted into hospital and diarrhoea, amounted to 9’47 per 1000 of mean strength, was 1748, died 24’65, sent to England as invalids 29’88, and and among troops on the march to 8’97. The rati)was also constantly non-effective from sickness 69’32. These are all very high in the Meerut and Rawal Pinii divisious. It is lower than in 1879, but, with the exception of the invalids, worthy of note that there was not a single death by either of these two diseases recorded at the hill stations. There were considerably above the average of the last ten years. The 230 admissions and 86 deaths by sunstroke, but no in’ormareduction upon the results of the preceding year has been tion is as to the localities where or the circumstances given manifest in all three Presidencies except as regards the under which they occurred; the admissions were in the ratio deaths in Bombay, where there has been a very marked in- of 7.50, and the deaths of 2’80 per 1000 of strength. From an examination of the tables we infer that Peshawar and crease. In the Bengal Presidency the admissions were in the ratio of Lahore furnished an undue proportion of the deaths. The remarks Surgeon-General Crawford-now Director 1763, the deaths of 29’26, the invalids of 25’51, and the con- General—on thebysanitary conditions of the troop-! in Bengal, stantly sick of 70-29 per 1000. These ratios, and especially and their influence on the character of prev iling diseases, are the deaths and mean sick, are very unsatisfactory compared deserving of careful study. We cannot afford space to enter with the average of the last ten years, although lower than upon all the points discussed, but shall contine ourselves to the in 1879. If the strength and casualties of the field force following extracts on the subject of the diet of the soldier. In a memorandum hy the Army Sanitary Commission it is were added the death-rate would be as high as 32 ’68 per stated "that by the experience of medical officers much of the 1000, of which only 1.68 was caused by wounds in action. loss from in Indian climates is due to the continued The most prevalent diseases were fevers, which gave rise to action of habits of eating, drinking, and clothing, which nearly half the admissions, and next to them rank diseases are directly opposed to the requirements of those climates. of the digestive system. The latter were the most fatal, In every one of these points improvements C1n be in. though very little higher than fevers, and next to these was troduced. What is wanted, in fact, is not transference cholera. The Peshawar division as usual furnished the to India of the European method of rationing and highest proportion of cases, from the prevalence of paroxysmal management, but the adoption of a rational reim’n for fevers, which were the cause of a great amount of sickness the British soldier adapted for Indian climates; p.sibly also in the Meerut, Gwalior, and Rawal Pindi divisions. more than one such regimen would be required in different The highest death-rate was in the Peshawar, and next districts of the country." On this Dr. Crawford remarks: to it, omitting troops on the march, in the Oudh division; "Sucha proposal is extremely plausible, and no one cao doubt in the former the excess was chiefly from dysentery and but that if diets of large bodies of soldiers could he made a great proportion of disease diarrhœa, fever and cholera, and in the latter from fever more suitable to the and cholera. In the appendix to the report a table is given under Group IX. [diseases of the digestive system] would But the practical difficultie3 in the way are "taken from the report of the principal medical officer," disappear. showing the deaths at each of the stations, but The sum of enormous, and even supposing that six or seven such suit, them when grouped in divisions differs so much from those ahle diets for India, from Colombo to Peshawar and accounted for in the classified table of diseases that it seems Thayetmyo, could be arranged and enforced, the possibility quite untrustworthy. For instance, in the Uudh division only of reduced dietetic diseases would still remain doubtful, 59 out of 82 are allotted to stations, in Mperat 59 out of 76, because it is less what the soldier eats and drinks by order in Sirhind 38 out of 62, in Rawal Pindi 45 out of 82, and in which produces disease than what he eats and drinks withPeshawar 96 out of 126. We cannot but think that if the out order ..... And the Sanitary Commission do not table could not be corrected to at least a much nearer state what is to be done if the soldier does not accept that approximation it would have been better omitted, or some view of a reduced diet...... The remarks of the Army Sanitary Commission do not appear to have been haed on explanation of the discrepancies should have been given. A table appended to the report shows that 278 cases of a sufficieut appreciation of the fact that the main difficulty enteric fever and 94 deaths occurred in the command, ex- to be overcome in reducing dietetic disease in India is to -

immediately

invaliding

climate,

287 induce the soldier to be self-denying, temperate, and careful drinking water" as the cause of it. Half the cases and deaths individually. So far as the regulations are concerned every occurred in the last quarter of the year. There were no forethought is given as to what he should eat and drink and cases of cholera in the command during the year. The morwhat he should avoid. But considerations of health are tality from dysentery was very high in the Sind circle, which rarely balanced against temporary enjoyment, and sickness includes the station of Kurrachee, and it was also high in the too often fallows, not from want of due care by the autho- presidency division. rities, but, in spite ,of all rules, by the carelessness of the There dues not appear to be anything calling specially for soldier himself." These are evidently the matured opinions remark in the health of the troops on board ship, except the of a man accustomed to deal practically with soldiers, as occurrence of two cases of enteric fever in H.M.S. Euphrates opposed to the theoretical ideas evolved in a room in the on the voyage from Malta to Bombay, probably contracted in Malta, which suggests the possibility of a connexion with great establishment at Pall-maAl. In Madras the strength of the troops was 10,280. and the the cases which occurred ill the Bombay command in the last admissions into hospital were in the proportion of 1370’, the quarter of the year. deaths of 10’51, the invaliding of 23’15, and the mean sick of 6296 per 1000. These ratios are all lower than in 1879, and those of the deaths and invaliding are considerably A NEW MEDICAL SOCIETY FOR THE under the average of the last ten years. The artillery WESTERN SUBURBS OF LONDON. the of admissions and both furnished highest proportion deaths, the cavalry the lowest of admissions, and the infantry of deaths in the command. Paroxysmal fevers were the ON Friday afternoon, July 23th, a numerously and influmost prevalent diseases, and next to them diseases of the attended meeting of medical men practising in the entially digestive system, and the latter gave rise to the highest western districts and suburbs of London took place in the death-rate. Of the larger stations, Bellary and Ihangoon both furnished heavy sick rates, and Kamptee a high death- board-room of the ’Ve5t London Hospital, and after voting rate. This excessive sickness was due to the prevalence of Dr. Goddard Rogers into the chair, carried a series of resoparoxysmal fevers, and the mortality at Kamptee chiefly to lutions, the most important of which constituted a new, enteric fever and sunstroke. Twentv-five admissions and now named the "West London Medicoeleven deaths by enteric fever are recorded. Of these 1 society. This, to meet at the above-mentioned occurred at Bellary, 1 fatal case at Tayrangoon, 13 cases Chirurgical Society," is on the first Friday of every month, at 8 P.M., and 6 deaths at Secunderabad in a force of 2530 men, and 10 hospital The throughout the winter, for the consideration of subjects cases with 4 deaths among 770 men at Kamptee. evidence with regard to the disease at Kamptee points very connected with the arts and sciences of medicine, surgery, clearly to contaminated water-supply as the cause, and the and midwifery. The annual subscription is five shillings, outbreak ceased on the well being clo-ed. No information and there is no entrance fee. Though intended mainly for is given as to circumstances under which the casjs the use and advantage of local practitioner-!, all "medical occurred at Secunderabad or the probable causes. Only men not practising homœopathy" are eligible for memberone case of cholera, which, however, terminated fatally, ship. The Society has been started with considerable enoccurred in the command, at Tayrangoon in British Bjr- thusiasm, although in consequence of the near approach mah. As usual, in this Presidency, hepatitis and abscess of the holiday season and the deire to give the council and of the liver proved the most fatal in the class of diseases secretaries time to prepare for next winter, the meeting was of the digestive system, having been the cause of 14 out of held at somewhat short notice. The Society is likely to com21 deaths. mence with about a hundred original members. The Council The average strength of the troops in Bombay was 9200. are keeping thelist of original members open, and the secreThe ad,n,*,,4;-tons into hospital were 2118. the deaths 25.10, taries are anxious to receive applications for membership. the invaliding 51’96, and the mean sick 70 89 per 1000. The The following afficers were elected for the first year :-Preproportion ot deaths was one-half higher than in 1879, but sident : Dr. Edward Hart Vinen. Vice-Presidents : Dr. the 0 .!ler ratios were lower than in that year ; all, however, Thurlichum, Mr. B. J. Vernon, Mr. Hemming, and Mr. were greatly above the average of the last ten years. The Frederick Lawrence. Treasurer: Mr. William Bird. most prevailing diseases were paroxysmalfevers, the cases of Council: Drs. Aiderson, Picket, Goddard Rogers, Sinclair, which were nearly equal to the average strength, and diseases Thompson, W. Travers, Messrs. Alderton, Barnes, Sunn, of the digestive system, which were upwards of one-fourth Ottley, Potter, Walker, and Willing. Secretaries : Mr. C. of it. Fevers and diseases of the digestive system were the B. Keetley and Mr. F. F. Schacht. The new Society has an excellent room to meet in, very causes of upwards of half the deaths. The admissions were at and conveniently Baroda, Kurrachee, Neemuch, placed for access by rail and omnibus, and excessively high Ahmednugger, and the deaths at Kurrachee, Bombay, and it has already a goodly number of members ; it has an able Ahmednugger. The uuhealthiness of Kurrachee is attributed and experienced president, and the idea of it appears to have by the principal medical officer to the arrival of the 98th been everywhere received with great cordiality. A district Regiment in September " in a weakly state, many of the men which includes, besides hospitals, three magnificent Poorpresentingsymotoms of a scorbutic taint, supposed to have law infirmaries and several dispensaries must furnish plenty originated in Malta, where they had served four years, and of material. three years previously in the West Indies ; they suffered much at Kurrachee from paroxysmal and other fevers." The (lep6t of the 68th Regiment was also stationed there during the absence of the regiment in Afghanistan, and this may have contributed to the high sick-rate. At Poona " a considerable proportion of the garrison was formed by depots consisting of the more weakly men of regiments on field ser. REPORTS OF THE METROPOLITAN ASYLUMS BOARD HOSPITALS. vice in Afghanistan, from which also many men were sent back in bad health;" and the lst battalion Rifl:; Brigade Fulham Hospital.—Mr. R. D. R. Sweeting, the medical arrived at an unfavourable season during the month of of this hospital, reports that daring 1881 the superintendent October. The high rate of sickness and mortality at Bombay and Culaha is also "accounted for by the arrival of the 61st total admissions of small-pox patients were 1952, the mortality regiment from Malta at the most unfavourable period of the beiog at the rate of 7’3 per cent. amongst the vaccinated, year." There can be no doubt that the high rates of sickness 31’0 amongst thoe whose vaccination was "doubtful," and and mortality in Bombay were greatly influenced by the amongst the unvaccinated. During the months ofy Afghan war, which involved the necessity for troops being 44’3 and November cases were admitted only from the October out to India at unfavourable periods, and also for the brought weak and sickly men being left, behind when the regiments borough of Chelsea, in accordance with the terms of an inleft for service in the field. There were 63 cases with 33 junction which was obtained against the use of the hospital deaths of enteric fever in the command, bei’1g in the ratio of for the metropolis generally. Amongst the more interesting, 5’76 and 3’59 per 1000. The stations at which it was most adverted to in the report we would note the following. prevalent were Mhow, Kurrachee, N!1,,4seerabtd, Poona, and points as 120 vaccinated children under ten years of age As and the medical officer that " states from many Kirkee; principal all the information collected suspicion is attached to the were admitted. Only three of them were efficiently vaccinated, ’

’

Public Health and Poor Law.