THE NAVAL AND MILITARY MEDICAL SERVICES.

THE ANNUS MEDICUS 1906. and so it is frequently not easy to calculate the dose of anaesthetic for injection in any given case. He meets

1803

of enormous difficulty. There has not, however, been lack of expression -of opinion in regard to the medical r requirements entailed by modern systems of warfare and as t the absolute need for our preparedness for war if we are to to escape a recurrence of some of thise blunderings and reprehensible breakdowns which might have been prevented 1had they been foreseen and provided against. We wish we ccould believe that the truth of this has even yet been fully

operation,

c one

a any

difficulty by leaving the injection cannula in place and reinjects if the necessity arises for so doing. We can only note the papers of E. VARV ARO,24 LAZARUS,25 MELTZER,21 and FREUND,27 all bearing upon this subject. this

Stovaine has been used in ear and throat surgery with by Dr. DAN McKENZIE, but many observers have found that this analgesic and novocaine and alypin are realised. The Director-General and the War Office. liable to produce severe irritation and even gangrene if allowed to act for long upon mucous or subcutaneous strucLet us take, for example, the official position of the tures. KOELLNER’s experience with alypin in ophthalmic Director-General of the Army Medical Service. That f from its special nature, duties, and responsibilities, practice is favourable and MARCHETTI agrees with him.service, H. BRAUN, who has done so much for local and intra-spinalis not as other departments. It is not enough that its methods of anaesthesia, has introduced, and speaks strongly head may on oocasion be summoned and consulted as an in favour of, novocaine, which he combines with suprarenin. expert by a war council. He should, in our opinion, be He compares it with alypin and stovaine. With regard toa member of that council and thus should have the opporthe power which suprarenal extracts are stated to possess, in itunity of representing the views of the medical service virtue of which they render cocaine and allied bodies less with all the influence attached to such a p’sition at a time toxic, Dr. BERRY of New York has investigated the question when these opinions would be of real use. In June last Mr. and has arrived at a less favourable opinion of the safeguard BRODRICK, under the heading of " Medkal Science and Miliso afforded. Indeed, he points out that the suprarenal tary Strength," and Sir FREDERICK TREVES in connexion unless extracts, very cautiously used, are liable to produce therewith, published some very pertinent communications in further toxsemia. the Times as to the limitations under which medical science It is impossible to do more than to epitomise the wide labours in actual war. These authorities fully recognised literature upon spinal injection. The records differ very much that the views and recommendations of the Director-General and results advanced as being favourable include several regarding the sanitation and health of the army in preparadeaths—FREUND, for example, had a death in 209 cases,- tion for war should be of a direct and personal kind with the suggest limitations, and give a somewhat alarming list of Army Council and not have to be filtered through the heads after-effects. These deaths are, we are assured, the result of of any military department in order to reach it. faulty technique, but the facts remain and accentuate the The Qnestion of a Medical Reserve. need of caution before the adoption of methods which appear There is the question of a medical reserve, and espealso neither to be free from danger nor to eliminate severe for war. Have all the needful arrangements in this after-suffering to the patient. CHAPUT, PREINDISBERGER, cially been put upon any adequate and satisfactory PENKERT, and BARDET have each shown, in speaking of respect yet We cannot regard the Royal Warrant of Oct. 23rd special analgesics, the need for extreme care and further footing? the revised regulations respecting appointinvestigation before it can be said that the methods and last,l containing drugs employed are capable of being regarded as safe or ment to the Army Medical Reserve of officers, as otherwise than a partial and tentative effort to do so ; and we are meanwholly trustworthy. while hopefully content to await Mr. HALDANE’S declaration of his army scheme for further information.. In connexion THE NAVAL AND MILITARY MEDICAL SERVICES. with this subject of army medical expansion in war in relaThe End of 1905 folloned by the great Political Change tion to volunteer training we may refer to Sir ALFRED of 1906. The end of 1905 found the nation in the throes of a KEOGH’S address to the Manchester companies of the Royal wholesale reorganisation of its army system and somewhat Army Medical Corps in November last, in which the Directorbewildered by several radical and comprehensive schemes of General stated some of the problems of the Medical Service with which he had to cope.2 army reform, army sanitation, the organisation and provision of a medical reserve, and, with a view to increased efficiency, The Royal Navy Medical Nervice. the systematic and progressive development of the medical In a leading article on the Health or the Royal Navy services on their then existing lines. Nor will it be for- which appeared in THE LANCET of Jan. 20 h, p. 169, we said gotten that towards the end of 1905 came the resignation of that sufficient time had not elapsed to show what had been Mr. BALFOUR and the succession of Sir H. CAMPBELLfull effect of the improvements in this service in affording BANNERMAN to the post of Prime Minister, with the appointadvantages and a better scope for the pursuit of ment of a new Ministry and of Mr. HALDANE as the new; scientific work. We were, however, enaled to point to the Secretary of State for War. These changes were soon very satisfactory health conditions of the navy as recorded in to be followed by the decisive results of the General the last published statistical report and to the excellence of Election in favour of the present Government. There still the professional papers in its appendix as strong evidence of remains at the end of the present year, as everyone knows, the valuable work that was being done by naval medical almost everything to be done in these respects, and notwithand especially perhaps in regard to Mediterranean ’ officers, standing the enunciation on the part of the Government of: fever. With all that concerns this disease the me ical officers, numerous vitally important principles, together with several of the Mediterranean fleet and those of the army stationed in indications of the direction which these will probably’ local garrisons are unhappily only too well acquainted. It take, the nation must nevertheless be content to wait’ was evident, we declared, that naval medical efficers areuntil the year 1907 for the promised declaration of what ready to avail themselves of the increased means and is to be our future army and navy policy. The task ofE opportunities of special and systematic research which have formulating any national army scheme suitable to the nature of late been introduced into their service and that many and complex requirements of this country is confessedly of them possess the necessary scientific qualifications for successfully turning these opportunities to the best account. 24 Il Policlinico, June, July, and August, 1906. 25 Zeitschrift für und Diätet Therapie, April, 1906. Physiologie 26 Medical Record of New 1 THE LANCET, Dec. 8th, 1906, York, August 25th, 1906. p. 1620, and March 31st, 1906, p. 923. 2 THE LANCET, Dec. 15th, 1906, p. 1673. 27 Deutsche Medicinische Wochenschrift, October, 1906.

success

I

--

,

’

Iincreased the I

1804

THE ANNUS MEDICUS 1906.

The Position of the Royal Navy Medioal Service. We must not here omit to call attention to the report of an interesting introductory address by Sir LAMBERT ORMSBY, past President of the Royal College of Surgeons in Ireland, delivered at the opening of the winter session at the Meath Hospital and County of Dublin Infirmary, of which Sir LAMBERT ORMSBY is the senior surgeon. In this address the position of the Royal Navy Medical Service is reviewed in very stringent terms. While we must all admit that there are defects in that’ service about which we are practically th re are LAMBEBT quite agreementwith withSir Sir LAMBEBT ORMSBY, ORMSBY, there are quite ininagreement others which are, we think, susceptible of

Indian Medioal Serviee. The Indian Medical Service is, we think, to be congratulated on its improved condition and on the position which it occupies at the present time in the estimation of the profession and the public. Service in India holds out many inducements, both purely professional and otherwise, to the medical officer in the way of affording a greater scope and variety of life and occupation for his selection. The reader may usefully refer to the Students’ Number of THE LANCET of Sept. lst of this year for such further information as will serve to make him au courant with the position of this service so far as any changes and advantages have affected it during the explanation. and the serial letters from our special correThe Cooporation of the Civil and Military Branohes of the year present in India have served to keep our readers well Medical Profession in Peace and in War. spondent with the current medical history of the occurIn continuation of previous efforts and in striving to acquainted rences in that country. this the Director-General of the Medicat

reasonable material

develop

object

Army

Progress in Scientific

Service in February last delivered an address at the West London Hospital to inaugurate a course of lectures on Army Medical Administration and Duties. The subject is one which furnishes ample room for comment. The relation between arms and medicine is more intimate than may at first sight appear, the association of the civil and the military branches of the medical profession is likely to grow closer in the future, and it is certain that medicine and hygiene largely influence the successful issue of campaigns.3

Research.

A great impetus has been given to medical progress by the introduction into India of scientific laboratories and of increased means and opportunities for special and scientific research. To cite a recent instance by way of illustration. At the time that KITASATO is carrying on his investigations on plague at Tokio a commission comprising officers of the Indian Medical Service has been working on the same sub. ject in India, where they have been making a series of admirably devised experiments which have been carried out with great care and technical skill. Our knowledge of the etiology of this disease has been thereby advanced and rendered more precise. We now know far more about the relation in which the rat flea stands to the rat and the rat to man in the spread of plague infection. At the present time, however, there appear to be only two methods regarded as trustworthy in Indian experience for combating plague-namely, to run away from it or to have recourse to Haffkine’s prophylactic treatment. Enteric Fever in the Army and in India.

Appointment of a Reconstituted Advisory Board for the Army Medical Services. We publish in the Annotations of our present issue an official communication from the War Office announcing the appointment of a new Advisory Board which is to be " more distinctly advisory in its functions" than its ’ The details will be found on p. 1827.

predecessor.

Changes affecting the Medical S’ervices Generally. Speaking generally of the Naval, Military, and Indian Medical Services, we may say that no very important changes other than those referred to in the preceding paragraph have taken place in the regulations or conditions of service during the year 1906. Such as have arisen have been duly

As usual, enteric fever bulks largely in the list of army diseases and in the space devoted to them in the columns of THE LANCET during the past year. Out of the many chronicled and commented upon at the time of their occur- leading articles, reviews, and other notices which have It is doubtful whether any very marked improve- appeared it may suffice to refer to our leading article rence. ment has been realised in the quality of the candidates of Oct. 6th,4 and to our review of an exhaustive treatise for the services, which was hoped for as the result of the on " Enteric Fever in India and in Other Tropical beneficial alterations which have been introduced into the and Subtropical Regions," by Major ERNEST ROBERTS, conditions of service. As to the medical qualifications I.M.S.5 There has been during the past year, and there still of the competitors, there does not appear to be any great is, an unusual amount of active and earnest investigation change since the Netley days though there may be a few taking place into the causes of the lamentable prevalence more men who can write M.B. Lond. or F.R.C.S. Eng. after of this scourge among our troops in India. A special comtheir names. An improvement in the professional knowledge mittee of experts has been appointed by Lord KITCHENER, and practical work of the lieutenants-on-probation passing the Commander-in-Chief, to consider the best measures for through the Medical Staff College in London has, we believe,stamping it out ; and in other directions also increased not been very evident. The Indian Medical Service still efforts are being made to mitigate its ravages through the maintains the best position and attracts the larger number iinstrumentality of mixed committees composed of medical : and of more highly qualified competitors. engineer officers. No very special addition of fundamental importance has been made to the literature of the subMilitary Hygiene.ject of enteric fever since the publication of the report of the A beginning has been made by the establishment of a schoolcommission on the war of 1898, and since Spanish-American of military hygiene at Aldershot for a more general system ofhe efforts of KOCH and his followers to suppress the disease instruction of regimental officers and soldiers. A greati.n a number of in have been made known. places Germany deal, especially on field service, depends upon their properly Similar measures have been applied in India and its canton. understanding and carrying out sanitary precautions intnents during 1906, in addition, of course, to those which had sufficient time to make them effective. In these and other een long previously adopted. It has only of late perhaps respects much has been practically carried out during k)een sufficiently recognised that the liability to relapses 1906, but something remains to be done. In matters ofnd often the long-continued appearance of the bacillus scientific hygiene, bacteriology, clinical medicine, and sur-t yphosus in the urine of patients may form serious and gery it is gratifying to notice that the Journal of the Royal insidious sources for the maintenance and spread of infection Army Medical Corps continues to maintain its excellent in camps. Still, practically speaking, and especially in time standard. 4 THE LANCET, Oct. 6th, 1906, p. 942. 3 THE 5 THE LANCET, Feb. 17th, 1906, p. 460. LANCET, NOV. 17th, 1906, p. 1356. -

THE ANNUS MEDICUS 1906.

of war, what has to be safeguarded is the water-supply if we would prevent the occurrence of those epidemics of an explosive nature with which the past history of war has unhappily familiarised us. The

Japanese Army

and Navy : Disease and Casualties Enteric Fever.

:

1805

When we reflect upon the hopeless ignorance and indifferwhich not infrequently obtain with local authorities in the matter of the public health and the absurdly small pay at which the services of sanitary officers in rural districts are valued, we begin to appreciate what an enormous leeway has to be made up before even county councils-the most hopeful of our local administrative bodies-can be got to take a proper view of their public health possibilities and be placed in a position enabling them better to fulfil them. All this indifference naturally finds its expression or echo in the national assembly-i.e., in the relative apathy of both Houses of Parliament-and it may certainly be said (with entire freedom from the least political bias) that the present House of Commons has so far betrayed a singular absence of either enthusiasm or interest in public health questions. We had hoped that that new section of the House which represents manual labour as distinguished from labour of other types would have succeeded in giving greater prominence to an aspect of administration which affects its class in a very intimate fashion not only as regards housing, factory, and workshop conditions, but also ’with respect to the purity of food and the medical examination of school children. But other interests which apparently are regarded as affecting the labouring classes more deeply have intervened and public health legislation is practically at a standstill. Apparently, too, the President of the Local Government Board has been unsuccessful in instilling into his colleagues in the Cabinet that enthusiasm in public health questions with which he is himself animated. ence

The remarkably successful results achieved by the Japanese in their war with Russia during 1904-05 will cause their official medical history of that war when published to be of the greatest interest and importance to all medical officers. We hope that in the statistical section of that history the strength will always be stated for the purpose of the ready calculation and comparison of ratios. We may meanwhile call attention to our reports of three lectures on the preservation of health amongst the personnel of the Japanese army and nnvy delivered at St. Thomas’s Hospital this year by I, Baron TAKAKI, late Director-General of the Medical Department of the Imperial Navy; the first of these was published in THE LANCET of May 19th (p. 1369). In connexion therewith we may also refer to some excellent articles on the medical organisation of the Japanese by LieutenantColonel W. G. MACPHERSON, R.A.M.C., who was officially attached to the Japanese army (vide Journal of the Royal Army Medical Corps for March). The same journal for December contains the translation of a very important address on the medical services in the Russo-Japanese war delivered before the Japanese Medical Association at Tokio by Surgeon-Lieutenant-General M. KOIKE, M.D., Director-General of the Japanese Army Medical Service. But notwithstanding this somewhat pessimistic retrospect, One of the most striking features of that war was forced upon us as it is by the bard logic of facts, there are, the enormous number of killed and wounded. Some 20 we venture to hope, signs that the country is slowly making battles, big and small, were fought, causing 220,812 casualties; its mind to grapple in a broad, statesmanlike fashion up whereas the total number of sick is given as 236,223, of with some of the conditions which are seriously, and in a which 27,158 were infectious cases. The Japanese medical which is not materially diminishing, sapping the and sanitary preparations in persoranel and matériel were on a degree of the nation and, perhaps, on the whole, the most strength colossal scale. The proportionate ratio of deaths from wounds indication of this awakening is the interest which significant as compared with the ratio of deaths from disease is unprehas been recently manifested in the subject of cedented in war and speaks volumes for the completeness and Infantile Mortality. efficiency of the Japanese sanitary and medical arrangements. It is somewhat difficult, however, to get at the facts conThe important conference which took place upon this nected with the hygienic state of all the Japanese armies in subject in the month of June under the presidency of Mr. the field. According to some accounts (that published by JOHN BURNS should have the effect of stimulating local Mr. ASHMEAD BARTLETT on the siege and capitulation of authorities throughout the country to further and more comPort Arthur for example), the insanitary state of affairs prehensive action. Mr. BURNS told his audience that, in the camps of the besieging Japanese outside Port roughly speaking, 100,000 infant lives were being sacrificed Arthur is very adversely remarked upon, and Mr. RICHMOND every year through neglect, carelessness, and ignorance, and SMITH, in his work on "The Siege and Fall of Port that in the first year of child life there are as many deaths Arthur," while extolling the skill of the Japanese as in all the other years taken together up to the age of 18. surgeons and the fine equipment of their hospital, says If, he added, men and women were able to extend the The individual hygiene working period of their lives it devolved upon them to help in effect much the same thing. of the Japanese soldier is admirable ; he is naturally very those whom they brought into the world. While wealth cleanly as to his person and extremely careful about his increased and prosperity extended, the weakest, the smallest, drinking-water. In these respects, too, he is well looked and the most dear bear the burden of death. Whatever after and the regulations are strictly enforced. That there might be the chief cause of infantile mortality, not the was something racial or dietetic in the absence of enteric infant but society was to blame. Fortunately, from the fever and other camp diseases in the army around Port point of view of etiology, there is administratively almost Arthur seems probable. The Russians inside Port Arthur unanimity of opinion that improper feeding and maternal appear to have suffered severely from enteric fever. neglect are at least two of the most important factors in the problem. The introduction of the milk depot has been a force which is gradually in some places bringing about a PUBLIC HEALTH. better state of affairs, not so much by the supply of In many ways the year that has passed has been a dis- sterilised milk, concerning the merits of which there is a appointing one in a public health sense, although it is con- difference of opinion, but, as Dr. G. F. MCCLEARY pointed ceivable that the future may show it to have been a period out at the June conference, by directing public attention of latency or incubation antecedent to an eruption of to the necessity for a proper milk-supply for infants. Such legislative measures. The year has been characterised— .a supply in its natural state is alone to be derived from the if, indeed, it can reasonably be held to have presented anysource where nature has placed it-from the human mother’s 1 breast-and the more that the milk depot can succeed in special features-by the diffusion of certain health all the without whose this public, cooperation elementary truth home to the mother the ciples amongst bringing will our aspirations are not unlikely to hang fire or to abort.greater 3 prove its power for good If, as Dr. McOLBART

prin-