THE AKA EXPEDITION.
April, 1385.]
^tisinuts
and (fetrarfa.
EXTRACT PROM THE
MEDICAL HISTORY OF THE AKA EXPEDITIONARY FIELD
FORCE, 1883-1884. By Surgeon-Major E. R. JOHNSON. Hospitals.?At the beginning of the expedition, it was directed that all camp equipages should be left at Tezpur, but after a good supply of provisions had been forwarded to the front, this order, to some extent, relaxed, and some tents and sepoys' pals were eventually brought as far as Dijumukh. As, however, this could not have been foreseen, the various hospitals along the line had to be constructed by the troops with such materials as was available. At Tezpur the hospital was in two sections, about a mile apart. That for the troops was in the old Native Infantry lines, and consisted of six sepoys' double pals ; with the old Native Infantry hospital forming a dispensary, store-room and office.
The pals were fitted with machans, 9 inches the men of the 43rd Regiment, maximum number of men in these tents was G7, and there was always ample room. The hospital for the transport coolies and followers at Tezpur consisted of two large grass huts, 54x18 feet. The ridgepole was 9 feet high, and side-walls 6 feet. Each hut had a row of raised machans, 15 inches high, down each Bide. These made comfortable temporary hospitals, and were warm and dry during two days' heavy rain. The hospital huts for the transport coolies were supplemented by three sepoys' half pals. The transport hospital was never overcrowded. At Balipara there was a small grass hut capable of holding 12 to 15 men. but it was only used for patients on their When way from the front to the hospital at Tezpur. patients were temporarily in excess of accommodation in this hospital, they were sheltered in sepoys' pals. At Dijumukh, which formed the most advanced post, where stores, &c., could be taken otherwise than by coolie carriage, the field hospital was established. This was built to accommodate 50 patients, as only a small number of men could be spared to construct it. It consisted of one large Ward 80X18 feet, the ridge-pole 10 feet, and the side-walls 5 feet. At one eud was a dispensary GXS feet; a room for the hospital assistant on duty 6x8 feet, and a store-room 8x18 feet. The sides of the main ward were lined by a continuous machan. 3 feet 6 inches high. The roof was thatched with coarse grass, and the walls were of the same material. 'I'he labour of building this hospital was very considerable, as bamboos were not obtainable at Dijumukh, and the posts, supports for machan, and all parts of the structure which required strength, had to be made from trees selected out of the jungle as suitable for the different parts of the building. The other hospitals Advanced and outpost hospitals. along the line were of the simplest description, being little more than ordinary lean-tos of grass and bamboo where obtainable, and at other places of plantain leaves. The front of the lean-to was, as a rule, partly shut in for additional protection against the cold. The floors were thickly lined with grass or bamboo leaves. At Labi's and Medhi's villages, Aka huts were appropriated as hospitals, and made 118 comfortable as possible by lining the floors with the stems, leaves of a species of warm wood, which grew in great near the abundance in the fallow villages. At
high,
neatly made by Assam Light Infantry. The very
jhooms
Labi's village, the hospital was supplemented by a lean-to, made of wooden boards, covered outside with warmwood ^alks. Patients in front of Dijumukh 'were in all cases sent to the field hospital as fast as possible, for the difficulty of transporting many men, incapable of walking over 8uch a country, would have been very great, and would have greatly hampered the return of the troops. Huts?The huts used for officers and men were similar to those figured on page 233 of the Medical History of the l^uffla Expedition. At Dijumukh and Labi's village the officers' huts were somewhat more elaborate, and each officer had a separate hut. The excellent hutting of all ranks was f ue to the 43rd Assam Light Infantry, a regiment which is unrivalled in its knowledge of woodcraft and use of the ukri. The transport coolies were hutted in lean-tos like those of the sepoys.
Conservancy.?The
127 conservancy of the various camps was
subject of the greatest importance, for a post once occupied would remain so until the return of the troops along the line of communication, and during the early part of the expedition, when the only sweepers obtainable were the a
company sweepers of the troops, it was a matter of some difficulty to keep the camps clean. In a damp country, overgrown with rank jungle, any want of care with regard
to conservancy is much more
apparent
than in
a
drier
climate. On service in the Eastern Frontier, with a transport mainly consisting of coolies, difficulties are much in-
as these men will not understand or obey an order in the same way that soldiers do. The Khasi and Mikir coolies, who came with the survey party, and the Assamese boatmen, were less easily managed even than the Hindustani coolies. The greatest difficulty was always experienced for the first few days after a camp was occupied. The plan adopted was, on arrival at a camp, to ask for a working party, which was at once set to work to clear a suitable spot and dig long trenches. These were screened by brushwood fences, and white flags were put up on tall poles or bamboos to indicate the place. The officer commanding was asked to tell off a non-commissioued officer, whose sole duty was to see that the orders of the senior medical officer with regard to sanitation were carried out. Trenches were filled in by sweepers, and At some of the camps new latrines dug as required. where the latrines had to be placed within the pickets, it was a matter of difficulty to select a suitable spot, as the ground generally consist of large boulders, overlaid with a thin covering of sand, or else rock, with a scanty layer of light soil. By the careful supervision of medical officers and the public infliction of,a few punishments, the sanitary state of the various camps was, up to the close of the expedition, most satisfactory. Water-supply.?The water-supply of the various camps was not usually a matter of difficulty. At No. Ill camp at Labi's village, the supply was rather scanty, and a guard had to be posted to prevent the water from being wasted or disturbed, but at the other camps water was obtained from fast running streams of considerable volume, and less care was required. The water at all the camps was of excellent quality. Bedding.?Bach soldier and coolie carried one blanket and a waterproof sheet. It appears doubtful whether it would not be more advantageous if each soldier were allowed two blankets in addition to the waterproof sheet. Of course, every man slept in all the clothing he had, but even so, the cold at night must have been severe, and the sickness, especially from bowel-complaints, would have been less if the amount of bedding had been more liberal. These are most admirably adapted for the carriage of sick over difficult ground, and for nearly all cases of wounds except those of the lower extremity. Thappas.?They consist of a conical basket, made of canes and split bamboos, the upper part of one side being left open, and a small seat of split and flattened bamboo woven across it. The thappa is carried on the back and shoulders of a Khasi coolie, its back resting on the back of the carrier, the patient being in a half sitting, half reclining position. It is supported by a flat band of woven cane or bamboo, one end of the band supporting the thappa below the beat, aud the other end passing round the head and across the forehead of the carrier. A strong Khasi coolie will, in this way, carry a man of ordinary weight up or down the steepest pathways, as both his hands and arms are free to assist him in difficult places. Carriage of medical stores.?All cases of medical stores which were used beyond Dijumukh had to be carried by coolies, and in the indents sent in to the medical depot, it was requested that no package should weigh more than 40 lbs. Medicines and equipment.?Medicines, equipment, and establishments were provided according to the scale given in the General and Field Hospital Regulations, for a general hospital of 100 beds, and a field hospital of 50 beds. Each corps brought with it its own field equipment and hospital establishment, and, in addition an extra pair of field panniers, two field companions, and four haversacks were taken. As the expedition was so quickly concluded, hospital supplies were considerably in excess of requirements. The field panniers, companions and haversacks, when practically tested were found most serviceable, and the selection of
creased,
THE INDIAN MEDICAL GAZETTE.
128
instruments and medicines they contained very suitable. In this expedition, it was found that, in the field panniers and companions, medicines used iu the treatment of diarrhoea, dysentery, and ague were expended long before the other drugs. The following is a list of these medicines : Ipecacuanha ; mistura pro diarrhoea ; oleum terebinthiuje ; acetate of lead and opium pills; camphor, opium and
pulvis ipecacuanhoe co.; quiuias sulphas ; spiritus setheris nitrosi ; tinctura camphorae co. ; tinctura opii ; pulvis kino co. ; pulvis cretas aromaticus cum opio. Suggestions regarding field panniers.?I would venture to suggest that the usefulness of the field panniers, companions, and haversacks might be increased if a selected reserve supply of medicines and dressings were kept suitable to the diseases likely to be prevalent in any expedition These reserves could be packed in small or campaign. inexpensive tin boxes of three kinds, and each box should contain a selection of medicines and dressings, which would replenish a pair of panniers, a field companion or a haverBack. The panniers are decidedly over-packed, and the extreme neatness of their fittings makes it difficult to repack them when once they have been used in the field. A few empty phials are much needed in the field panniers, as there is a difficulty about giving a patient a fluid mixture, the few stoppered phials being evidently intended to replace breakages. The want of some ointment in the field panniers for the treatment of parasitic skin disease was felt; and I would suggest sulphur ointment with the capsicum pills
;
addition of one dram of borax to the ounce as a suitable one, this being efficacious in the treatment of both scabies and skin disease associated with a vegetable parasite.
DIABETES IN INDIA. By Norman Glycosuria is
Calcutta, many
moderately
Chevees, frequent among
c.i.e., m.d.
elderly natives in
rich
of whom are fat and indolent and imI heard of several fatal
fond of sweetmeats.
of carbuncle in such diabetic
patients.* Writing in 1871 f the Editor of the Indian Medical Gazette remarked, that he believed that among the upper and middle classes of natives in Calcutta, almost every family had lost one or more of its members from diabetes." Baboo Satcory Dutt had informed him that, in one of the most respectable and influential native families in Calcutta, cases
"
No. 1 died of acute diabetes at the age of 60 ; No 2, his eldest son, of chronic diabetes ; No. 3, his third son, had chronic diabetes; No. 4, his fourth son, died of acute diabetes ; No. 5, daughter of No. 1, now aged 65, has diabetes ; No. 6, eldest son of No. 2, grandson of No. 1, died of chronic diabetes ; No. 7, second son of No. 2, has diabetes ; No. 8, eldest
son
of No. 4, has diabetes.
In
addition,
the wife of
No. 3 died of diabetes. I saw, in India, three European gentlemen this disease. These cases were very chronic.
number attained advanced ages. lian, was found to be diabetic by
The one
third,
suffering from Two of their a
Bengal civiauthorities,
of our best
about sixteen years ago. As he is now a very robust man in green old age, it appears likely that the glycosuria was due to a transient cause. This case is probably explained
by the
Dr. Wilks's observation that, in young diabetic patients, tendency is sooner or later towards a fatal termination ;
whilst, in the old, the presence of sugar in the urine is often found in those who are suffering from mere dyspepsia or
gout.
India
Case3 of diabetes have
by noticing
been detected in
frequently large
that flies and trains of
black ants
* Baboo Kamikha Nath Aclierjee gives, in vol. ii, p. 201 of tlie Indian Medical Gazette, two cases of carbuncle and boils in well-todo natives, in which the characters of these diseases led hint to
discover that diabetes was present. f Indian Medical Gazette for December, p. 259.
[April,
1885.
visit the utensil. Morehead gives an account of six cases of saccharine diabetes in natives?all the instances of that disease of which he had personal knowledge in India. Dr. Cayley relates* a case of removal of a scrotal tumour in
a
native, which terminated successfully, although diabetes three weeks after the
operation, and recovery secondary haemorrhage. In 1874, when the milk system iu glycosuria was much under discussion, I showed, in the Indian Medical Gazette, that, in his Phthisiologia, or a Treatise of Consumptions, Dr. Richard Morton, who died iu 1698, gave histories of appeared was
retarded
by repeated
attacks of
milk treatmeut in diabetes.?Medical Times.
THERAPEUTICS : Enemata of Nitrate of Silver in Chronic Dysentery. ?Dr.
Stephen
Mackenzie
before the Clinical
Society
read of
a
paper
London,
on
on
this
subject
November 14th.
a former series of cases he had brought society, and stated that extended experience had strengthened his belief in the value of large enemata of nitrate of silver in the treatmeut of cases of chronic dysentery or dysenteric diarrhoea. The mode of procedure he adopted was as follows: The quantity of nitrate of silver to be used was dissolved in three pints of tepid water in a Leiter's irrigating funnel, which was connected by India-rubber tubing with an oesophageal tube with lateral openings. The patient was brought to the edge of the bed, and made to lie on his left side, with his hips well raised by a hard pillow. The terminal tube, well oiled, was passed about eight or ten inches
He alluded
to
before another
into the rectum, and the fluid allowed to force its way into the bowel by gravitation. The injection rarely caused much and often none. It usually promptly returned ; but, long retained, it was advisable to inject chloride of sodium to prevent absorption of the silver-salt. Various strengths had been used, from thirty to ninety grains to three pints of water ; but usually one drachm of nitrate of silver was employed. The treatment was based on the view that, whatever the nature of dysentery, whether constitutional or local, in the first instance, the latter effects were
pain,
when
due to inflammation or ulceration
of the colon, which was
effectually treated, as similar conditions elsewhere, by topical measures. Sometimes one, sometimes two, injections were required, and in some cases numerous injections were necessary ; but in all the cases thus treated, many of which had been unsuccessfully treated iu other ways previously,
most
the disease had been cured. In most cases other treatment was suspended, but in some, Dover's powder or perchloride
of
iron,
tinued
or
which had been
previously administered, subsequently prescribed.
was con-
1. One in which the The cases narrated were these: disease had lasted several years on and off ; two injections 2. Second were used, and the case was cured in six weeks.
attack, duration uncertain; four injections used; cured in five weeks.
3. Duration two months ; two injections used ; 4. Duration five years;
cured in three Weeks and-a-half.
injection used ; cured in three weeks. 5. Duration, eighteen months ; two injections used ; cured of dysenteric symptoms, but remaining under treatment for diabetes. 6. Duration fourteen months ; one injection used ; cured in seven weeks. The treatment, which laid no claim to novelty was brought forward to elicit the experience of others who had tried it, or to induce others to employ it in suitable cases one
*
Indian Medical Gazette for August, 1875,
April, 1885.]
THERAPEUTICS?MYX(EDEMA
Dr. Oullimore asked for information as to the duration of allied cases of disease treated in the hospital by other methods than that
practised by
Dr.
whether the author of the paper ?uch treatment to
others cases
as
well.
cases
of rectal
He commented
recorded were those of
was
inclined to confine
dysentery,
on
and also
Mackenzie, or
to
apply
it to
the fact that most of the
sailors,
and
suggested
that the
favorable result might be, in great part, due to the improved
surroundings of the patients, the physiological rest and appropriate diet, etc., afforded in hospital, as compared with the depressing surroundings of an existence on board-ship. In his own experience of the treatment, he found that pain was produced in one case, on injection of two pints of water, holding forty grains of silver-nitrate in solution, In another case of dysentery, due to famine, he injected half a pint of water containing iodoform, but without effecting any good result. Opium and krameria were, in his opinion, the most Useful remedies in this class of
cases.
Dr. S. Mackenzie said he purposely used the term chronic dysentery, or dysenteric diarrhoea, in writing his paper, as heing most appropriate to the kind of cases under discussion, these being characterized by teasing diarrhoea and considerable constitutional disturbance. In a previous paper, he had explained that the physicians at the Seamen's Hospital had spoken hopelessly of all kinds of treatment; but, at the
London Hospital, greater opportunities existed for making observations in this respect than at any similar institution, with the exception of the one just named ; and in all his own cases, the effects of rest, opium, etc., had been tried in vain before resort was had to the injection-method of treatment. He alleged that rebellious cases were cured by the enema, and that it was, therefore, a resource to be adopted whenever the ordinary remedies failed. He himself would adopt it in ordinarily severe cases at the outset of treatment.
He had no definite statement to make as to the permanence of the cure, the class of patients concerned being the most difficult of any to keep under observation; but, in this con-
to the Society to know that patient cured by him had returned twelve months after being discharged, not on his own account, he being still "Well, but to solicit Dr. Mackenzie's good offices in behalf of ft friend who was suffering, as he had been, from chronic dysentery.?British Medical Journal, November 22, 1881.
nection, it might be interesting
one
Astringent.?A
"
glycerialuminis," prepared by dissolving 5 ounces of glycerine by means of a gentle heat, is recommended by Mr. R. W. Parker (British Medical Journal, January 24, p. 178) as useful where a powerful local astringent is required. It is described as having the advant"9c over tannix in being far less disagreeably equally astringent. and quite compatible with the administration of 1,-on. In cases of chronic pharyngetis, it is said to be efficacious, and, when diluted with water, to form a useful ffargle, injection, or lotion. Glycerinum Aluminis
as an
n?m
one ounce
of alum in
?
A
Temperature.?Stephan (" Allgem. med. Centr.-Ztg." ; St. Petersburg, med. Woch.") eays, that the application of ice-bags over the supra-clavicular regions during fever is followed by a marked reduction of the temperature. In several cases of typhoid fever treated in this manner, he was able to control the fever Method
of
Reducing "
while the sensorium remained clear. The explanation offer-
ed is, that many large superficial veins are situated in neck, and that, by the direct application of heat to them,
temperature
of the blood is lowered
rapidly.
the the
AND GOITRE.
129
OBSTETRICS. Diagnosis of Pregnancy in the Early Months.?Professor Hegar, of Freiburg, in ati article on this subject (Pray. Med. Wochenschrift, No. 26, 1884), says that the usual diagnostic signs of pregnancy, a change in the general state, suppression of the menstrual flow, changes in the breasts and genital orgaus, the enlargement of the uterus and changes in the cervix, are, as wo know, uncertain in many cases. It is. therefore, important to know some constant symptom. This constant symptom, he says, consists in a particular softness, a certain suppleness and thinness of the lower segment of the uterus, that is to say, the part immediately above the insertion of the sacro-uterine ligament. This may be easily determined, not only when the uterus is resistant, but even when it is soft and elastic. In the latter case, it is possible, by depressing the uterus, to distinguish the upper portions and the rigid cervix. This portion is so soft that it seems as though the cervix is in contact with a pelvic or abdominal tumour. There seems to be no pathological state which gives rise to this sign, not The cause of this sign even hydro- and hasmatometritis. lies in the fact that the lower segment of the uterus becomes the thinnest part during pregnancy, and consequently softer and more elastic ; and by combined rectal and vaginal examination, it is possible to distinguish this part, with its It should be characteristic feel, between the fingers. remarked that the absence of this sign is not a proof that pregnancy does not exist.?Annales de Gyneoologie. Erysipelas as a Complication of Pregnancy and Labor.?In The American Journal of the Medical Sciences for January, Dr. G-. R. Balleray records two cases of labor with concurrent erysipelas without untoward result. He points out that the management of labor in the case of a woman suffering from erysipelas does not materially differ, other things being equal, from the management of a case of normal labor. The accoucheur should abstain from frequent vaginal examinations during labor; and such examinations as are necessary should be made with clean hands. The placenta should, if possible, be delivered by Crede's method ; thus avoiding the introduction of the finger or hand within the genital canal. A full dose of ergot should be given after the delivery of the placenta ; and the uterus should be gently manipulated until it is firmly contracted. In the aftertreatment. the nurse should be forbidden to touch the genitals of the patient, without having previously washed her hands thoroughly with hot water and soap. The use of antiseptic vaginal injections should be commenced within twelve hours after delivery, and continued as long as there is any indication for their employment. Influences Determining Sex.?Prof. "W. K. Brooks, of the Johns Hopkins University, contributes a paper on this subject to the January number of the Popular Science Monthly, in which he discusses the views lately advanced by Carl During in some articles on the laws which determine the sex of the embryo in mankind, in animals, and in " From these observations and from many others plants. " quoted by During," Professor Brooks says, we may safely conclude that among animals and plants, as well as in mankind, a favorable environment causes an excess of female births, and an unfavorable environment an excess of male births. " I have tried to show, in another place, from evidence of another kind, that the female is the conservative factor in reproduction, and that new variations are caused by the influence of the male. " That this is the true view is shown, I think, by the contrast between domesticated animals and captive animals. The fact that an animal has become domesticated shows that it finds in captivity a favorable environment, and During says that domesticated animals are unusually fertile, and that they produce an excess of females. Animals which are kept as captives in menageries and gardens have, as a rule, no fitness for domestication, and their conditions of life are unfavorable. Geoffroy Saint-Hilaire says that individuals born in menageries are usually male, while skins sent to museums are usually female, and that the attempt to domesticate a wild animal increases the number of male births. During states that captive birds of prey and carnivorous mammals are very infertile, and that the young are
nearly always males."
April, 1385.]
^tisinuts
and (fetrarfa.
EXTRACT PROM THE
MEDICAL HISTORY OF THE AKA EXPEDITIONARY FIELD
FORCE, 1883-1884. By Surgeon-Major E. R. JOHNSON. Hospitals.?At the beginning of the expedition, it was directed that all camp equipages should be left at Tezpur, but after a good supply of provisions had been forwarded to the front, this order, to some extent, relaxed, and some tents and sepoys' pals were eventually brought as far as Dijumukh. As, however, this could not have been foreseen, the various hospitals along the line had to be constructed by the troops with such materials as was available. At Tezpur the hospital was in two sections, about a mile apart. That for the troops was in the old Native Infantry lines, and consisted of six sepoys' double pals ; with the old Native Infantry hospital forming a dispensary, store-room and office.
The pals were fitted with machans, 9 inches the men of the 43rd Regiment, maximum number of men in these tents was G7, and there was always ample room. The hospital for the transport coolies and followers at Tezpur consisted of two large grass huts, 54x18 feet. The ridgepole was 9 feet high, and side-walls 6 feet. Each hut had a row of raised machans, 15 inches high, down each Bide. These made comfortable temporary hospitals, and were warm and dry during two days' heavy rain. The hospital huts for the transport coolies were supplemented by three sepoys' half pals. The transport hospital was never overcrowded. At Balipara there was a small grass hut capable of holding 12 to 15 men. but it was only used for patients on their When way from the front to the hospital at Tezpur. patients were temporarily in excess of accommodation in this hospital, they were sheltered in sepoys' pals. At Dijumukh, which formed the most advanced post, where stores, &c., could be taken otherwise than by coolie carriage, the field hospital was established. This was built to accommodate 50 patients, as only a small number of men could be spared to construct it. It consisted of one large Ward 80X18 feet, the ridge-pole 10 feet, and the side-walls 5 feet. At one eud was a dispensary GXS feet; a room for the hospital assistant on duty 6x8 feet, and a store-room 8x18 feet. The sides of the main ward were lined by a continuous machan. 3 feet 6 inches high. The roof was thatched with coarse grass, and the walls were of the same material. 'I'he labour of building this hospital was very considerable, as bamboos were not obtainable at Dijumukh, and the posts, supports for machan, and all parts of the structure which required strength, had to be made from trees selected out of the jungle as suitable for the different parts of the building. The other hospitals Advanced and outpost hospitals. along the line were of the simplest description, being little more than ordinary lean-tos of grass and bamboo where obtainable, and at other places of plantain leaves. The front of the lean-to was, as a rule, partly shut in for additional protection against the cold. The floors were thickly lined with grass or bamboo leaves. At Labi's and Medhi's villages, Aka huts were appropriated as hospitals, and made 118 comfortable as possible by lining the floors with the stems, leaves of a species of warm wood, which grew in great near the abundance in the fallow villages. At
high,
neatly made by Assam Light Infantry. The very
jhooms
Labi's village, the hospital was supplemented by a lean-to, made of wooden boards, covered outside with warmwood ^alks. Patients in front of Dijumukh 'were in all cases sent to the field hospital as fast as possible, for the difficulty of transporting many men, incapable of walking over 8uch a country, would have been very great, and would have greatly hampered the return of the troops. Huts?The huts used for officers and men were similar to those figured on page 233 of the Medical History of the l^uffla Expedition. At Dijumukh and Labi's village the officers' huts were somewhat more elaborate, and each officer had a separate hut. The excellent hutting of all ranks was f ue to the 43rd Assam Light Infantry, a regiment which is unrivalled in its knowledge of woodcraft and use of the ukri. The transport coolies were hutted in lean-tos like those of the sepoys.
Conservancy.?The
127 conservancy of the various camps was
subject of the greatest importance, for a post once occupied would remain so until the return of the troops along the line of communication, and during the early part of the expedition, when the only sweepers obtainable were the a
company sweepers of the troops, it was a matter of some difficulty to keep the camps clean. In a damp country, overgrown with rank jungle, any want of care with regard
to conservancy is much more
apparent
than in
a
drier
climate. On service in the Eastern Frontier, with a transport mainly consisting of coolies, difficulties are much in-
as these men will not understand or obey an order in the same way that soldiers do. The Khasi and Mikir coolies, who came with the survey party, and the Assamese boatmen, were less easily managed even than the Hindustani coolies. The greatest difficulty was always experienced for the first few days after a camp was occupied. The plan adopted was, on arrival at a camp, to ask for a working party, which was at once set to work to clear a suitable spot and dig long trenches. These were screened by brushwood fences, and white flags were put up on tall poles or bamboos to indicate the place. The officer commanding was asked to tell off a non-commissioued officer, whose sole duty was to see that the orders of the senior medical officer with regard to sanitation were carried out. Trenches were filled in by sweepers, and At some of the camps new latrines dug as required. where the latrines had to be placed within the pickets, it was a matter of difficulty to select a suitable spot, as the ground generally consist of large boulders, overlaid with a thin covering of sand, or else rock, with a scanty layer of light soil. By the careful supervision of medical officers and the public infliction of,a few punishments, the sanitary state of the various camps was, up to the close of the expedition, most satisfactory. Water-supply.?The water-supply of the various camps was not usually a matter of difficulty. At No. Ill camp at Labi's village, the supply was rather scanty, and a guard had to be posted to prevent the water from being wasted or disturbed, but at the other camps water was obtained from fast running streams of considerable volume, and less care was required. The water at all the camps was of excellent quality. Bedding.?Bach soldier and coolie carried one blanket and a waterproof sheet. It appears doubtful whether it would not be more advantageous if each soldier were allowed two blankets in addition to the waterproof sheet. Of course, every man slept in all the clothing he had, but even so, the cold at night must have been severe, and the sickness, especially from bowel-complaints, would have been less if the amount of bedding had been more liberal. These are most admirably adapted for the carriage of sick over difficult ground, and for nearly all cases of wounds except those of the lower extremity. Thappas.?They consist of a conical basket, made of canes and split bamboos, the upper part of one side being left open, and a small seat of split and flattened bamboo woven across it. The thappa is carried on the back and shoulders of a Khasi coolie, its back resting on the back of the carrier, the patient being in a half sitting, half reclining position. It is supported by a flat band of woven cane or bamboo, one end of the band supporting the thappa below the beat, aud the other end passing round the head and across the forehead of the carrier. A strong Khasi coolie will, in this way, carry a man of ordinary weight up or down the steepest pathways, as both his hands and arms are free to assist him in difficult places. Carriage of medical stores.?All cases of medical stores which were used beyond Dijumukh had to be carried by coolies, and in the indents sent in to the medical depot, it was requested that no package should weigh more than 40 lbs. Medicines and equipment.?Medicines, equipment, and establishments were provided according to the scale given in the General and Field Hospital Regulations, for a general hospital of 100 beds, and a field hospital of 50 beds. Each corps brought with it its own field equipment and hospital establishment, and, in addition an extra pair of field panniers, two field companions, and four haversacks were taken. As the expedition was so quickly concluded, hospital supplies were considerably in excess of requirements. The field panniers, companions and haversacks, when practically tested were found most serviceable, and the selection of
creased,
THE INDIAN MEDICAL GAZETTE.
128
instruments and medicines they contained very suitable. In this expedition, it was found that, in the field panniers and companions, medicines used iu the treatment of diarrhoea, dysentery, and ague were expended long before the other drugs. The following is a list of these medicines : Ipecacuanha ; mistura pro diarrhoea ; oleum terebinthiuje ; acetate of lead and opium pills; camphor, opium and
pulvis ipecacuanhoe co.; quiuias sulphas ; spiritus setheris nitrosi ; tinctura camphorae co. ; tinctura opii ; pulvis kino co. ; pulvis cretas aromaticus cum opio. Suggestions regarding field panniers.?I would venture to suggest that the usefulness of the field panniers, companions, and haversacks might be increased if a selected reserve supply of medicines and dressings were kept suitable to the diseases likely to be prevalent in any expedition These reserves could be packed in small or campaign. inexpensive tin boxes of three kinds, and each box should contain a selection of medicines and dressings, which would replenish a pair of panniers, a field companion or a haverBack. The panniers are decidedly over-packed, and the extreme neatness of their fittings makes it difficult to repack them when once they have been used in the field. A few empty phials are much needed in the field panniers, as there is a difficulty about giving a patient a fluid mixture, the few stoppered phials being evidently intended to replace breakages. The want of some ointment in the field panniers for the treatment of parasitic skin disease was felt; and I would suggest sulphur ointment with the capsicum pills
;
addition of one dram of borax to the ounce as a suitable one, this being efficacious in the treatment of both scabies and skin disease associated with a vegetable parasite.
DIABETES IN INDIA. By Norman Glycosuria is
Calcutta, many
moderately
Chevees, frequent among
c.i.e., m.d.
elderly natives in
rich
of whom are fat and indolent and imI heard of several fatal
fond of sweetmeats.
of carbuncle in such diabetic
patients.* Writing in 1871 f the Editor of the Indian Medical Gazette remarked, that he believed that among the upper and middle classes of natives in Calcutta, almost every family had lost one or more of its members from diabetes." Baboo Satcory Dutt had informed him that, in one of the most respectable and influential native families in Calcutta, cases
"
No. 1 died of acute diabetes at the age of 60 ; No 2, his eldest son, of chronic diabetes ; No. 3, his third son, had chronic diabetes; No. 4, his fourth son, died of acute diabetes ; No. 5, daughter of No. 1, now aged 65, has diabetes ; No. 6, eldest son of No. 2, grandson of No. 1, died of chronic diabetes ; No. 7, second son of No. 2, has diabetes ; No. 8, eldest
son
of No. 4, has diabetes.
In
addition,
the wife of
No. 3 died of diabetes. I saw, in India, three European gentlemen this disease. These cases were very chronic.
number attained advanced ages. lian, was found to be diabetic by
The one
third,
suffering from Two of their a
Bengal civiauthorities,
of our best
about sixteen years ago. As he is now a very robust man in green old age, it appears likely that the glycosuria was due to a transient cause. This case is probably explained
by the
Dr. Wilks's observation that, in young diabetic patients, tendency is sooner or later towards a fatal termination ;
whilst, in the old, the presence of sugar in the urine is often found in those who are suffering from mere dyspepsia or
gout.
India
Case3 of diabetes have
by noticing
been detected in
frequently large
that flies and trains of
black ants
* Baboo Kamikha Nath Aclierjee gives, in vol. ii, p. 201 of tlie Indian Medical Gazette, two cases of carbuncle and boils in well-todo natives, in which the characters of these diseases led hint to
discover that diabetes was present. f Indian Medical Gazette for December, p. 259.
[April,
1885.
visit the utensil. Morehead gives an account of six cases of saccharine diabetes in natives?all the instances of that disease of which he had personal knowledge in India. Dr. Cayley relates* a case of removal of a scrotal tumour in
a
native, which terminated successfully, although diabetes three weeks after the
operation, and recovery secondary haemorrhage. In 1874, when the milk system iu glycosuria was much under discussion, I showed, in the Indian Medical Gazette, that, in his Phthisiologia, or a Treatise of Consumptions, Dr. Richard Morton, who died iu 1698, gave histories of appeared was
retarded
by repeated
attacks of
milk treatmeut in diabetes.?Medical Times.
THERAPEUTICS : Enemata of Nitrate of Silver in Chronic Dysentery. ?Dr.
Stephen
Mackenzie
before the Clinical
Society
read of
a
paper
London,
on
on
this
subject
November 14th.
a former series of cases he had brought society, and stated that extended experience had strengthened his belief in the value of large enemata of nitrate of silver in the treatmeut of cases of chronic dysentery or dysenteric diarrhoea. The mode of procedure he adopted was as follows: The quantity of nitrate of silver to be used was dissolved in three pints of tepid water in a Leiter's irrigating funnel, which was connected by India-rubber tubing with an oesophageal tube with lateral openings. The patient was brought to the edge of the bed, and made to lie on his left side, with his hips well raised by a hard pillow. The terminal tube, well oiled, was passed about eight or ten inches
He alluded
to
before another
into the rectum, and the fluid allowed to force its way into the bowel by gravitation. The injection rarely caused much and often none. It usually promptly returned ; but, long retained, it was advisable to inject chloride of sodium to prevent absorption of the silver-salt. Various strengths had been used, from thirty to ninety grains to three pints of water ; but usually one drachm of nitrate of silver was employed. The treatment was based on the view that, whatever the nature of dysentery, whether constitutional or local, in the first instance, the latter effects were
pain,
when
due to inflammation or ulceration
of the colon, which was
effectually treated, as similar conditions elsewhere, by topical measures. Sometimes one, sometimes two, injections were required, and in some cases numerous injections were necessary ; but in all the cases thus treated, many of which had been unsuccessfully treated iu other ways previously,
most
the disease had been cured. In most cases other treatment was suspended, but in some, Dover's powder or perchloride
of
iron,
tinued
or
which had been
previously administered, subsequently prescribed.
was con-
1. One in which the The cases narrated were these: disease had lasted several years on and off ; two injections 2. Second were used, and the case was cured in six weeks.
attack, duration uncertain; four injections used; cured in five weeks.
3. Duration two months ; two injections used ; 4. Duration five years;
cured in three Weeks and-a-half.
injection used ; cured in three weeks. 5. Duration, eighteen months ; two injections used ; cured of dysenteric symptoms, but remaining under treatment for diabetes. 6. Duration fourteen months ; one injection used ; cured in seven weeks. The treatment, which laid no claim to novelty was brought forward to elicit the experience of others who had tried it, or to induce others to employ it in suitable cases one
*
Indian Medical Gazette for August, 1875,
April, 1885.]
THERAPEUTICS?MYX(EDEMA
Dr. Oullimore asked for information as to the duration of allied cases of disease treated in the hospital by other methods than that
practised by
Dr.
whether the author of the paper ?uch treatment to
others cases
as
well.
cases
of rectal
He commented
recorded were those of
was
inclined to confine
dysentery,
on
and also
Mackenzie, or
to
apply
it to
the fact that most of the
sailors,
and
suggested
that the
favorable result might be, in great part, due to the improved
surroundings of the patients, the physiological rest and appropriate diet, etc., afforded in hospital, as compared with the depressing surroundings of an existence on board-ship. In his own experience of the treatment, he found that pain was produced in one case, on injection of two pints of water, holding forty grains of silver-nitrate in solution, In another case of dysentery, due to famine, he injected half a pint of water containing iodoform, but without effecting any good result. Opium and krameria were, in his opinion, the most Useful remedies in this class of
cases.
Dr. S. Mackenzie said he purposely used the term chronic dysentery, or dysenteric diarrhoea, in writing his paper, as heing most appropriate to the kind of cases under discussion, these being characterized by teasing diarrhoea and considerable constitutional disturbance. In a previous paper, he had explained that the physicians at the Seamen's Hospital had spoken hopelessly of all kinds of treatment; but, at the
London Hospital, greater opportunities existed for making observations in this respect than at any similar institution, with the exception of the one just named ; and in all his own cases, the effects of rest, opium, etc., had been tried in vain before resort was had to the injection-method of treatment. He alleged that rebellious cases were cured by the enema, and that it was, therefore, a resource to be adopted whenever the ordinary remedies failed. He himself would adopt it in ordinarily severe cases at the outset of treatment.
He had no definite statement to make as to the permanence of the cure, the class of patients concerned being the most difficult of any to keep under observation; but, in this con-
to the Society to know that patient cured by him had returned twelve months after being discharged, not on his own account, he being still "Well, but to solicit Dr. Mackenzie's good offices in behalf of ft friend who was suffering, as he had been, from chronic dysentery.?British Medical Journal, November 22, 1881.
nection, it might be interesting
one
Astringent.?A
"
glycerialuminis," prepared by dissolving 5 ounces of glycerine by means of a gentle heat, is recommended by Mr. R. W. Parker (British Medical Journal, January 24, p. 178) as useful where a powerful local astringent is required. It is described as having the advant"9c over tannix in being far less disagreeably equally astringent. and quite compatible with the administration of 1,-on. In cases of chronic pharyngetis, it is said to be efficacious, and, when diluted with water, to form a useful ffargle, injection, or lotion. Glycerinum Aluminis
as an
n?m
one ounce
of alum in
?
A
Temperature.?Stephan (" Allgem. med. Centr.-Ztg." ; St. Petersburg, med. Woch.") eays, that the application of ice-bags over the supra-clavicular regions during fever is followed by a marked reduction of the temperature. In several cases of typhoid fever treated in this manner, he was able to control the fever Method
of
Reducing "
while the sensorium remained clear. The explanation offer-
ed is, that many large superficial veins are situated in neck, and that, by the direct application of heat to them,
temperature
of the blood is lowered
rapidly.
the the
AND GOITRE.
129
OBSTETRICS. Diagnosis of Pregnancy in the Early Months.?Professor Hegar, of Freiburg, in ati article on this subject (Pray. Med. Wochenschrift, No. 26, 1884), says that the usual diagnostic signs of pregnancy, a change in the general state, suppression of the menstrual flow, changes in the breasts and genital orgaus, the enlargement of the uterus and changes in the cervix, are, as wo know, uncertain in many cases. It is. therefore, important to know some constant symptom. This constant symptom, he says, consists in a particular softness, a certain suppleness and thinness of the lower segment of the uterus, that is to say, the part immediately above the insertion of the sacro-uterine ligament. This may be easily determined, not only when the uterus is resistant, but even when it is soft and elastic. In the latter case, it is possible, by depressing the uterus, to distinguish the upper portions and the rigid cervix. This portion is so soft that it seems as though the cervix is in contact with a pelvic or abdominal tumour. There seems to be no pathological state which gives rise to this sign, not The cause of this sign even hydro- and hasmatometritis. lies in the fact that the lower segment of the uterus becomes the thinnest part during pregnancy, and consequently softer and more elastic ; and by combined rectal and vaginal examination, it is possible to distinguish this part, with its It should be characteristic feel, between the fingers. remarked that the absence of this sign is not a proof that pregnancy does not exist.?Annales de Gyneoologie. Erysipelas as a Complication of Pregnancy and Labor.?In The American Journal of the Medical Sciences for January, Dr. G-. R. Balleray records two cases of labor with concurrent erysipelas without untoward result. He points out that the management of labor in the case of a woman suffering from erysipelas does not materially differ, other things being equal, from the management of a case of normal labor. The accoucheur should abstain from frequent vaginal examinations during labor; and such examinations as are necessary should be made with clean hands. The placenta should, if possible, be delivered by Crede's method ; thus avoiding the introduction of the finger or hand within the genital canal. A full dose of ergot should be given after the delivery of the placenta ; and the uterus should be gently manipulated until it is firmly contracted. In the aftertreatment. the nurse should be forbidden to touch the genitals of the patient, without having previously washed her hands thoroughly with hot water and soap. The use of antiseptic vaginal injections should be commenced within twelve hours after delivery, and continued as long as there is any indication for their employment. Influences Determining Sex.?Prof. "W. K. Brooks, of the Johns Hopkins University, contributes a paper on this subject to the January number of the Popular Science Monthly, in which he discusses the views lately advanced by Carl During in some articles on the laws which determine the sex of the embryo in mankind, in animals, and in " From these observations and from many others plants. " quoted by During," Professor Brooks says, we may safely conclude that among animals and plants, as well as in mankind, a favorable environment causes an excess of female births, and an unfavorable environment an excess of male births. " I have tried to show, in another place, from evidence of another kind, that the female is the conservative factor in reproduction, and that new variations are caused by the influence of the male. " That this is the true view is shown, I think, by the contrast between domesticated animals and captive animals. The fact that an animal has become domesticated shows that it finds in captivity a favorable environment, and During says that domesticated animals are unusually fertile, and that they produce an excess of females. Animals which are kept as captives in menageries and gardens have, as a rule, no fitness for domestication, and their conditions of life are unfavorable. Geoffroy Saint-Hilaire says that individuals born in menageries are usually male, while skins sent to museums are usually female, and that the attempt to domesticate a wild animal increases the number of male births. During states that captive birds of prey and carnivorous mammals are very infertile, and that the young are
nearly always males."
