The Health of the Army.

1086 the post

as

to other and

he may lack opportunities for the teaching, while he may not have the individual aptitude for an

lucrative that there is little

stepping-stone

a

training,

more

upon the staff. He alleges inducement for seasoned workers in the field to

positions

compete for arduous and responsible branch of his profession. All that the appointment of ansesthetist because they receive no can be done for him, as yet at any rate, is to see that he is

adequate being of

status

and

their work

is

brushed

aside

thoroughly grounded in the principles of giving anaesthetics in uncomplicated cases, and the specialist anaesthetists told, do not enjoy the privileges accorded to physicians will no doubt approve of such a man giving an2esthe. and surgeons, to assistant physicians and assistant tics, if only because it is he whom the public will in surgeons, and to officers such as surgeon-dentists who many cases employ. There are vastly more operations, large control special departments. "A Hospital Anaesthetist" and small, where anaesthetics are used than it is possible complains that surgeons ignore the usual amenities which that any specialist class could cope with, while rural should exist among colleagues, and in the case of the neighbourhoods, towns of under 5000 inhabitants, and anaesthetists dictate to them what they should do and with- parochial authorities cannot possibly support the services For the present all that hold from them alike courtesy and appreciation of their of a member of such a class. done is to the of their The natural result can be make teaching in anaesthetics at all special knowledge department. of this, we are asked to believe, is that the public as a our schools thorough, to insist upon all students learning body do not hold the anaesthetist in much repute and are the principles of the administration of anaesthetics as a not encouraged by consulting surgeons to call him in as compulsory subject, to raise the position of the anpsthetid an expert when dangerous or critical operations have to be upon our hospital staffs to that of the other members of the faced. The surgeon is sought with care while the anaesthetist honorary staff, and to trust that such reforms will result in is chosen at haphazard is practically the complaint of the the diffusion of generally adequate skill. scant value.

Thus,

we

are

as

anaesthetists

"

writer to the Times.

expressed by and the

The view is much the

system

of

same as

He considers that the

Dr. HEWITT.

teaching

at

hospitals can hardly

some

and circumstances

are

that

personnel capable of

The Health of the Army.

have failed to

improvement, bring home to the minds of all of us that in some instances there is a lack of organisation in this department. This has led to public comment and undoubtedly a vast amount of misapprehension exists upon the subject of anaesthetics, the bulk of the public being unaware of the importance of the

THE Army Medical Report for the year 1907 recently issued has excited more than usual general comment. This is probably due to the fact that during the present period of reorganisation and transfiguration of our land service military affairs have aroused greater interest than they do

work of the anaesthetist.

army has come in for its share of this increased attention, with the result that the public is able to realise with

normally in

It is usual to hear of the

the

public

mind.

The medical

organisation of

our

wonders of modern surgery and the triumphs of the scalpel; how often is it recognised that a skilled and experi-

importance of the influence of the physician in enced anaesthetist has fought for his patient’s life through a matters of State. The report deserves the wide comment weary hour or more and has enabled his eminent colleague that it has obtained, for it bears record to good and careful the surgeon to accomplish another victory ?2 For the sake of work on the part of this department and enables us to the patient the potential dangers of the anaesthetic are mini- perceive that a deep debt of gratitude is due to the men mised, and in some cases this may lead to the ansesthetic of science and men of affairs-amongst whom SIDNEY being given by men sound, no doubt, in the knowledge HERBERT and EDMUND A. PARKES are the most famousof their profession but lacking in a scientific grasp of who after the Crimean war founded, in the face of the facts underlying the rules governing narcotism. strenuous opposition, the Army Medical School. One It may happen that such men undertake the duty re- section alone of the present report affords a triumphant luctantly and only yield to the entreaties of a nervous vindication of the foundation of that school-namely, that patient who dreads the advent of a stranger, while it is not which deals with the almost complete stamping-out of recognised by the public that a rule-of-thumb knowledge "Malta fever." This fever but a few years ago was a of anaesthetics is not skilled ansesthetisation. mysterious disease of unknown origin, levying a heavy toll While all are agreed that medical students ought to be on our regiments, and it may be counted one of the greatest taught more fully the recognised methods of administering victories of modern science, systematically equipped and anaesthetics, the amount which they should be taught and the organised, in general, and of the medical department of the due relations of the specialist anaesthetist to the general army in particular, that this toll will no longer have to be practitioner make up between them a most delicate ques- paid. The official statistics proving the reality of this tion. To administer anaesthetics with complete knowledge triumph of therapeutics have been so recently before our in difficult cases and with the absolute minimum of risk readers that we need not recapitulate them here. We publish in another column an abstract of the report on demands scientific knowledge and judgment begotten of in to can do it be held individual who diseases as they affected the troops in 1907, but it ought experience-those the same regard at their schools and hospitals as any will be convenient now to draw attention to two outstanding But for causes of sickness in the army. The amount of venereal disother specialist attached to the institution. this very reason every medical student cannot become anL ease appears always to vary in every part of the world from anxsthetist of this class ; he cannot in the present; various reasons, some easily traceable, and others unknown. PLATO the

,

.

state of the curriculum

spare

the necessary time for thei

It is

a

matter of

great regret that

the entries for 1907

1087 the water-supply has been force !tmd extended, and accommodation

208 per 1000 of the strength of the employed in the London district. Such an amount of infection reveals a state of affairs not only deplorable in itself

amounted to

dealt with, lavaincreased, plunge- and shower;ory 1aaths erected, and the gravity of the question of sewage but fraught with danger to the public health, unfortunately < disposal has been recognised. Should the hygiene and not only of this but of future generations, a danger for thesanitation of our army ever attain the standard now mitigation or stamping out of which, in the present state of indicated the result will more than reward and justify public opinion, it seems hopeless to look to legislation. the care and expense. The present state of affairs is a The death-rate and invaliding rate from diseases of the matter of gratification, at least when compared with that heart and circulatory system are high and afford abundant revealed half a century ago after the Crimean war. We material for study and investigation. It is said, and fairly must briefly notice, however, a section of the report which strong evidence is brought forward to support the dictum, appears to us both gloomy and unsatisfactory :this deals with that a soldier of 30 is " at least five years older than a civilian the all-important subject of recruiting, touching essentially of the same age," and this sudden passing of the soldier and, as we have on several recent occasions emphasised in into middle age is due to circulatory troubles, but the these columns, indicating the grave problem of the health and physique of the young adult male population. Last numerous exceptions to such a generalisation and the fact in that the officer class are not affected the same way year, roughly speaking, nearly 300 per 1000 recruits were would seem to indicate that the admittedly unsatis- either rejected on inspection or found unfit within three factory state of things arises from causes which are months of enlistment. Notwithstanding that a fixed capable of being brought under control. We are inclined standard of weight has been abolished, that the medical to believe that a series of causes acting together are examiners have passed all who came up to the often responsible : syphilis, alcohol, tobacco, malarial physical requirements of infantry of the line, although over

with climatic changes and altered conditions they were afterwards rejected by the recruiting officer of blood pressure. "As regards the relative importance because they were too small for the corps of their choice, of the different causes of invaliding, diseases of the thata more lenient standard of dentition"has been circulatory system still hold the first place," as they have adopted,° that varicocele is viewed with greater leniency done, with one exception, for the past 27 years. While now than in past times," and that men are now accepted disordered action of the heart in immature recruits may be ’’ with only one-sixth of the normal acuteness of vision in sometimes entirely functional in its nature " as from a one eye, provided that the other is normal," "the majority dilated stomach," in which case they ought not to be of recruits were growing lads ...... 95 per cent. of the total invalided but detected and cured, we must reiterate the out of work at the time of enlistment ...... in many instances

infection,

conclusion which we have recently on several occasions ex- suffering from want of food ...... most of the men will not pressed in these columns, that, as a rule, it is due to different be capable of doing the work of a mature soldier for at least forms and degrees of cardiac dilatation, which, apart from two years....... Immaturity has always been the outstandany valvular defects, leads to regurgitation at the auriculo- ing defect of our recruits, and in this respect little or no ventricular orifice. It would be interesting if we could improvement was shown during the year." Both under the obtain from the medical records of civil life some data head of recruiting and invaliding the unsatisfactory result as to the prevalence of diseases of the heart and of employment of inexperienced medical men is alluded to. circulatory system amongst those constantly engaged in It is impossible to exaggerate the importance of these points, arduous labour, as in lifting and removing articles of heavy being, as they are indeed, the finger on the pulse of the Recent investigations have given an furniture. We are inclined to surmise that in the case of national health. the soldier it is the intermittent nature of the heavy work, uncertain answer to the question whether the national health at any rate in the case of persons with fairly sound arteries, was improving or deteriorating. We should like to see a small practical committee appointed which would make up that does the mischief. During the past year important changes were intro- its mind and give us a definite opinion on this point. duced in the scale of rations for foreign stations, Practical experienced medical men and employers of labour which were brought into more uniformity as regards could tell us more real truth on this subject than philanstatesmen, and men of science, with their own grocery and vegetable rations, the scale adopted being to grind and their own theories to establish at the per diem : tea, j- ounce, or coffee, 1* ounces; sugar, of facts. 2 fresh expense 1-36th

salts

ounces;

ounce ; pepper, ounce; or dried vegetables, 2 ounces, and this must be considered together with the purchase value of the

vegetables,pound,

messing allowance granted served

are

now

and

dining

to

the

to each soldier. mess

collectively

taxeshropists,

Annotations.

The meals in

" No quid nimis."

rooms

halls

RECENT CHANGES IN THE NAVY. specially set apart for the purpose, which allows of a greater variety in foods and obviates the I WE are glad to notice that the new medical directorof the navy has lost no time in strengthening the and of the men’s dormitories dirty unhealthy practice using course. Haslar During the last session the examination of for meals. Steady, if slow, improvement is reported recruits, the administration of anaesthetics, and other in the comfort of barrack buildings from year to year. subjects coming within the sphere of a naval surgeon’s Reconstruction and remodelling of the drainage systems We observe have been systematically taught. recent the have been widely proposed and in some instances in- with pleasure that on the whole changes the navy have been attended of the in have been victualling married soldiers’ improved quarters augurated,

general

duties