would pay for these detailed reports as the Insurance Companies do, then much subsequent trouble to candidates and their parents would be avoided. Government would be saved the risk of bad lives being hastily "passed by an overworked board, and parents would often be saved the expense of coaching fees for boys who could not pass the medical tests. This, of course, only to or candidates for commissions applies appointments in the superior ranks of the services, civil and military. "
VACCINATION IN
ENGLAND.
In spite of the "tremendous experiment" of last year, it is very satisfactory to see that at the recent B. M. A. discussion on vaccination, there was a very general opinion that there had been in the past year a largely increased amount of protection against small-pox. Not only had more children been vaccinated, but the vaccination was better done. One speaker pointed out one drawback to the new glycerinated lymph; viz., that it took 45 minutes to dry. Bj7-the" by the law allows a certificate of successful vaccination" for one mark only. In Bengal six points are now directed to be used. military titles.
All medical officers
directed to invariably or service after their names or signature, as R. A. M. C., I. M. S., in accordance with Queen's Regulations, para. 2074 (No. 3676, P. M. O. H. M.'s Forces, India, dated 12th August 1899). add their corps,
(Jhu;i;cn( topics. TESTS FOR THE PUBLIC SERVICES.
It cannot be said that the discussion of medical iests required for admission to the public services at the recent British Medical Association meeting have advanced the
question very much, and as Deputy Surgeon-General Cayley pointed out, the unfortunate difference of opinion between the section of medicine and the section of ophthalmology, as to whether the physical examination candidates
should follow or precede the not tend to give weight to the diametrically opposite resolutions arrived at. A little management would, we think, have prevented such a contretemps. One point in Sir Dyce Duckworth's introductory remarks will surely be agreed upon by every one, viz., the necessity for sending up the candidates in batches To expect a board of medical to be examined. to officers carefully examine fifty or sixty young men in one day is absurd and only leads to of
educational tests, will
mistakes. If the War Office or Navy were to issue papers on the same lines as the Insurance Offices do,and appoint leadingcivilian or military medical men as examiners in all the leading .military or naval centres, and if Government
are
department
QUININE IN MALARIAL FEVERS.
The American Medical Association recently engaged in a discussion on the well-worn subject of the use of quinine in malarial fevers. It was agreed that, in distinctly intermitting 1111 attacks, quinine should be given several hours before the next expected attack; but in irregular or remittent types, the drug should be given in the period of decline of the fever. It was also universally agreed, and in this we thoroughly agree, that a mercurial or other hepatic stimulant should precede the quinine. It was pointed out that quinine given hypodermically was often " precipitated by the alkaline juices of the One tissues." speaker strongly advocated Bacelli's method of intravenous injection. On the whole, the American practitioners were against the hypodermic use of quinine. We believe, on the other hand, this method is becoming increasingly usual in India, and we believe it the best method in many cases. was
?
?
PLAGUE DUTY IN THE MAURIT1U8.
last issue that plague with much opposition in the Mauritius. We now learn from the U. S. Consul's report, dated 29th June, that "the people We mentioned in
measures
were
our
meeting
Nov.
MALARIAL AND ENTERIC INFECTION.
1899.]
the disease
became
417
known.
Captain Rogers
have stoned the medical expert brought here devoted some time to testing tlie conclusions of from India, and beaten, bruised and torn the the Royal Society's Tsetse-fly Report, as it is clothes of his medical colleagues and bolted, andalmost certain that the Surra of Indian horses barred their doors against the entrance of theis identical with the South African disease. As sanitary inspectors." already announced in our columns, a supply of "
Quare fremuerunt gent.es ? The medical ex-locust-killing fungus was kept at the laboratory. is, as we have said, Captain J. S. Steven-The preparation of horses for a supply of tetanus son, I.M.S, antitoxin was begun, and also the examination of the spinal cords of dogs suspected of having had rabies was being arranged for. However, the THE LAVERAN BODY IN BIRDS. We have much pleasure in publishing in thisimportant rinderpest experiments took up most issue the results of a long series of careful ex-of the time and attention of the bacteriologist. The report gives a clear and critical summary of periments done in the laboratory of the Hydeia-all the various methods in use to fight this disease, bad Medical School under the direction of The bile method of Koch ; (2) the glycer(1) the Lieut.-Colonel E. Lawrie, I.M.S. Though inated bile of ; (3) the defebrinated mosquito malarial theory is fascinating and hasblood of salted Edington animals ; (4) the simultaneous been accepted more or less by many medica method of Turner and Rolle. Rinderpest has that men, it is no reflection on them if we say and owing to an the majority of medical men are not in a posi-existed for centuries in India, far from it is acquired being so fatal a lias immunity, tion to judge for themselves; for instance, it been already pointed out in these columns t 1a disease as when introduced within recent years into South Africa. It would appear, therefore,, assumptions are not facts, and it is well known writes Dr. that the serum method or a or that, although there are many facts in favour modificationRogers, of it, so as to give a slight attack s 1 is it the malarial mosquito theory, yet with a sufficiently long immunity, will be best little more than an and there aie hypothesis^ suited to conditions met in India. A full account no are several gaps in the theory which by of very interesting experiments then follows and e o means filled up, even by the researches of inoculation of infected cattle in the Bareilly intelliItalian observers. Therefore, we welcome in fact, the experiments promise to lead gent criticism such as the Hyderabad Laboiatoiy District; | to the of a practical method of diminadoption sends us, and their conclusions deserve the fullest the great mortality from ishing very materially this at workers consideration at the hands of in India. rinderpest fascinating theory. We are sure that Dr. Lawiie In conclusion, we express ahope that thereconwould only be too glad to offer the use of his struction of this invaluable laboratory may be medical men who wish o to pert
"
^
laboratory
any
undertaken at once, and that temporary arrangecarry on the valuable work will be
confirm, or, it may be, confute, his results. In ments to fact, the Government might, with very little cos or trouble, order a small skilled committee o possible. assemble at Hyderabad to examine the speci-
mens and test the results of the work done
in
111s
Such a committee could easily be foii met COMBINED MALARIAL AND ENTERIC INFECTION. from medical officers of both services in Madras , Captain J. G. McNaught, r.a.m.c., sends us a there are several men there who have done woi v of his remarks on a case of in this direction, and who are skilled microscopists. note in continuation combined typhoid and malarial infection in our October issue (page 354). The parasite found THE IMPERIAL BACTERIOLOGIST'S REPORT. in the case given was of the summer-autumn The very da}7 after this interesting report was type and was twice found during the enteric received, news came that the Imperial Labora- attack ; both pigmented and unpigmented amoetory at Muktesar had been accidentally burnt bae were found and also crescents. In another down. case, in same group, during convalescence, an Captain Leonard Rogers, i.m.s., m.d., f.r.c.s., attack of ague occurred, and numerous pigmented who officiates for Dr. Lingard, on leave, submits parasites were found. the report. The work done in the laboratory These cases are interesting, as showing what has been largely preliminary, testing the various real typho-malaria" is, namely, a combined methods of protective inoculation against rin- infection. Many such cases are now on record, derpest. JYlallein has been made, and quantities the malarial parasites being usually found were being kept for use in outbreaks of glan- preceding the enteric attack or during conders. Tuberculin has also been made, but the valescence; during the height of the attack the amount of tuberculous disease among cattle in enteric germ being the more masterful has its India is not known. The disease certainly exists, own way, thus, as we said before, illustrating as Major Raymond, a.v.d., has recently informed the Hippocratic maxim, Duobns morbis simul us, but it was not till the use of tuberculin obsidentibus veliementiov alterum obscurat." became common in England that the extent of
subject.
"
"
THE INDIAN MEDICAL GAZETTE.
418
EXAMPLE AND PRECEPT.
We are very glad to see that His Excellency the Viceroy intends to be inoculated against plague before making his cold-weather tour in the affected areas. reforms in field hospitals
A recent number of the Journal of the U.S. " M. Icontains an article on Field Hospitals by Ch." which merits very careful consideration. He suggests radical changes in the composition of the hospitals to fit them for hill warfare, putting into a concrete form the general recommendations we made on the subject in our issue for July 1898. The Indian field hospital, as far as equipment is concerned, is wonderfully complete ; but in an unknown hill tract, devoid of roads, like Tirah, this very completeness was a source of weakness. Other causes, such as bad transport, helped to disable the hospitals, but their bulk was their great drawback. " M. Ch." when he We are in full accord with advocates the hospitals moving with only indispensable articles. The great object is to get into position to treat the wounded promptly. By so doing their sufferings are lessened, and chances of recovery increased. It is better to be on the spot with only a few necessary articles, than to be struggling, two days behind the main body, with an unwieldy complete hospital. The latter was no uncommon occurrence in Tirah. After Dargai, and on the Bara march, the two occasions on which a large number of wounded had to be treated, the greater part of the work was done with materials from the panniers and companions. The complete three months' equipment was generally hopelessly blocked some Most of those so attended distance in the rear. did well, and we may presume that they would have done even better if they could have been attended to with greater promptitude. There was sometimes a delay, owing to only half the 'personnel of the hospital being available, the other half being employed on transport and
baggage duties. The obvious
for this is to cease carryon the march, and to ing superfluous extend and develop the system of base and advance depots of medical stores. In Tirah there was never any delay in forwarding dressings, etc., from the depots; the only delay was when the articles were not in stock. With regard to the carriage of the reduced
remedy
stores
hospital by coolies,
cannot
entirely agree with M. Ch." Good mule transport in nearly all cases is preferable to coolies. There is no place where a field hospital is required, that mules cmnot go. Over steep, bad ground they are quite as quick as coolies; they are more easily kept together, and stand exposure, hard work, and short rations better. A cooly's load ; is more easily taken up and put down, but this "
we
[Nov.
1899.
an advantage when near the fight" when ing being sniped on the way. M. Ch." has also assisted in the solution of the dhooly problem. We quite agree with him that the present dhooly slmuld be banished entirely, in hill campaigns. It has been tinkered at for ages till now it is apallci, a bed, a tent, and a general godown all in one, and until roads were made in Tirah was about as serviceable as an omnibus would have been in the same place. Any substitute for it will be welcomed, provided it is light and handy. The particular form is practically immaterial. Nothing can be devised, which will be free from faults, under all cond itions, and a multitude of patterns is not desira ble. For the conditions of hill warfare speed is the first consideration, and Where the two cannot be comfort comes next. combined, then let us have speed. Retiring rear guards soon learnt in Tirah to sprint from ridge to ridge over bad ground, and the ambulance must be able to keep out of their wa}7, otherwise one wounded man leads to others, until all are brought to a standstill. We should like to supplement" M. Ch.'s" article by calling attention to the want of a trained ambulance corps in India. Any cooly, caught fresh from the bazaar, is at present considered fit for ambulance work. Untrained, undisciplined, unwilling, he shirks his work 011 every possible occasion, and is never to be found when wanted if he has a chance of hiding. Men for this work should be regularly enlisted and trained, and kept together under the control of the medical department. " M. Ch.'s" We would cordially recommend article to the notice of the medical services in this country. The Tirah campaign tried the field
is not "
always
line,
hospitals
"
or
as
highly
as
they
are
ever
likely
to
and showed clearly that their one grave fault was their want of mobility. His proposals all aim at removing this defect, and they have the advantage of being as reasonable as they are practical and easy of accombe tried
again,
plishment. ANOTHER CASE OF
Since
last note
SCARLATINA IN
this
INDIA.
subject we have very interesting case of scarlatina in an adult in India from Captain Victor E. H. The patient was a welli.m.s. M.B., Lindesay, known medical officer (a Major, I.M.S.) in Multan. The fever begau on 2nd October 1898 in the train en route from Dalhousie to Multan. On 4th October a bright scarlet punctiform rash appeared with local oedema of hands and arms. The rash disappeared on 8th day of illness; there was sharp fever up to the 6th day, and albuminuria from 4th to 9th day ot illness; there was also tonsillitis, pharyngitis, otalgia and strawberry tongue. There was slight articular rheumatism for four da}7s during the earl}7 part of the illness, desquamation from 8th to 13th day. There apreceived
our a
on
Nov.
REVIEWS.
1899.]
110 doubt of the correct diagnosis? No trace of direct infection could be made out, but the patient had come from Dalhousie, and it was known that in the previous months there had been two or three cases diagnosed as scarlet fever in the family of an English officer at that station. They were under the care of Major Sexton, lt.A.M.C. The Multan case was also seen by Major Adie, I.M.S., the Civil Surgeon, who called Captain Lindesay into consultation. A\'hile we are on the subject, we may add that the cases referred to in our last issue as seen by
pears to be
scarlatina.
Captain McNaught,
not in
soldiers.
children,
r.a.m.c.,
as we
at
stated,
Quetta,
were
but in British
419
VACCINATION IN
ENGLAND.
In spite of the "tremendous experiment" of last year, it is very satisfactory to see that at the recent B. M. A. discussion on vaccination, there was a very general opinion that there had been in the past year a largely increased amount of protection against small-pox. Not only had more children been vaccinated, but the vaccination was better done. One speaker pointed out one drawback to the new glycerinated lymph; viz., that it took 45 minutes to dry. Bj7-the" by the law allows a certificate of successful vaccination" for one mark only. In Bengal six points are now directed to be used. military titles.
All medical officers
directed to invariably or service after their names or signature, as R. A. M. C., I. M. S., in accordance with Queen's Regulations, para. 2074 (No. 3676, P. M. O. H. M.'s Forces, India, dated 12th August 1899). add their corps,
(Jhu;i;cn( topics. TESTS FOR THE PUBLIC SERVICES.
It cannot be said that the discussion of medical iests required for admission to the public services at the recent British Medical Association meeting have advanced the
question very much, and as Deputy Surgeon-General Cayley pointed out, the unfortunate difference of opinion between the section of medicine and the section of ophthalmology, as to whether the physical examination candidates
should follow or precede the not tend to give weight to the diametrically opposite resolutions arrived at. A little management would, we think, have prevented such a contretemps. One point in Sir Dyce Duckworth's introductory remarks will surely be agreed upon by every one, viz., the necessity for sending up the candidates in batches To expect a board of medical to be examined. to officers carefully examine fifty or sixty young men in one day is absurd and only leads to of
educational tests, will
mistakes. If the War Office or Navy were to issue papers on the same lines as the Insurance Offices do,and appoint leadingcivilian or military medical men as examiners in all the leading .military or naval centres, and if Government
are
department
QUININE IN MALARIAL FEVERS.
The American Medical Association recently engaged in a discussion on the well-worn subject of the use of quinine in malarial fevers. It was agreed that, in distinctly intermitting 1111 attacks, quinine should be given several hours before the next expected attack; but in irregular or remittent types, the drug should be given in the period of decline of the fever. It was also universally agreed, and in this we thoroughly agree, that a mercurial or other hepatic stimulant should precede the quinine. It was pointed out that quinine given hypodermically was often " precipitated by the alkaline juices of the One tissues." speaker strongly advocated Bacelli's method of intravenous injection. On the whole, the American practitioners were against the hypodermic use of quinine. We believe, on the other hand, this method is becoming increasingly usual in India, and we believe it the best method in many cases. was
?
?
PLAGUE DUTY IN THE MAURIT1U8.
last issue that plague with much opposition in the Mauritius. We now learn from the U. S. Consul's report, dated 29th June, that "the people We mentioned in
measures
were
our
meeting
Nov.
MALARIAL AND ENTERIC INFECTION.
1899.]
the disease
became
417
known.
Captain Rogers
have stoned the medical expert brought here devoted some time to testing tlie conclusions of from India, and beaten, bruised and torn the the Royal Society's Tsetse-fly Report, as it is clothes of his medical colleagues and bolted, andalmost certain that the Surra of Indian horses barred their doors against the entrance of theis identical with the South African disease. As sanitary inspectors." already announced in our columns, a supply of "
Quare fremuerunt gent.es ? The medical ex-locust-killing fungus was kept at the laboratory. is, as we have said, Captain J. S. Steven-The preparation of horses for a supply of tetanus son, I.M.S, antitoxin was begun, and also the examination of the spinal cords of dogs suspected of having had rabies was being arranged for. However, the THE LAVERAN BODY IN BIRDS. We have much pleasure in publishing in thisimportant rinderpest experiments took up most issue the results of a long series of careful ex-of the time and attention of the bacteriologist. The report gives a clear and critical summary of periments done in the laboratory of the Hydeia-all the various methods in use to fight this disease, bad Medical School under the direction of The bile method of Koch ; (2) the glycer(1) the Lieut.-Colonel E. Lawrie, I.M.S. Though inated bile of ; (3) the defebrinated mosquito malarial theory is fascinating and hasblood of salted Edington animals ; (4) the simultaneous been accepted more or less by many medica method of Turner and Rolle. Rinderpest has that men, it is no reflection on them if we say and owing to an the majority of medical men are not in a posi-existed for centuries in India, far from it is acquired being so fatal a lias immunity, tion to judge for themselves; for instance, it been already pointed out in these columns t 1a disease as when introduced within recent years into South Africa. It would appear, therefore,, assumptions are not facts, and it is well known writes Dr. that the serum method or a or that, although there are many facts in favour modificationRogers, of it, so as to give a slight attack s 1 is it the malarial mosquito theory, yet with a sufficiently long immunity, will be best little more than an and there aie hypothesis^ suited to conditions met in India. A full account no are several gaps in the theory which by of very interesting experiments then follows and e o means filled up, even by the researches of inoculation of infected cattle in the Bareilly intelliItalian observers. Therefore, we welcome in fact, the experiments promise to lead gent criticism such as the Hyderabad Laboiatoiy District; | to the of a practical method of diminadoption sends us, and their conclusions deserve the fullest the great mortality from ishing very materially this at workers consideration at the hands of in India. rinderpest fascinating theory. We are sure that Dr. Lawiie In conclusion, we express ahope that thereconwould only be too glad to offer the use of his struction of this invaluable laboratory may be medical men who wish o to pert
"
^
laboratory
any
undertaken at once, and that temporary arrangecarry on the valuable work will be
confirm, or, it may be, confute, his results. In ments to fact, the Government might, with very little cos or trouble, order a small skilled committee o possible. assemble at Hyderabad to examine the speci-
mens and test the results of the work done
in
111s
Such a committee could easily be foii met COMBINED MALARIAL AND ENTERIC INFECTION. from medical officers of both services in Madras , Captain J. G. McNaught, r.a.m.c., sends us a there are several men there who have done woi v of his remarks on a case of in this direction, and who are skilled microscopists. note in continuation combined typhoid and malarial infection in our October issue (page 354). The parasite found THE IMPERIAL BACTERIOLOGIST'S REPORT. in the case given was of the summer-autumn The very da}7 after this interesting report was type and was twice found during the enteric received, news came that the Imperial Labora- attack ; both pigmented and unpigmented amoetory at Muktesar had been accidentally burnt bae were found and also crescents. In another down. case, in same group, during convalescence, an Captain Leonard Rogers, i.m.s., m.d., f.r.c.s., attack of ague occurred, and numerous pigmented who officiates for Dr. Lingard, on leave, submits parasites were found. the report. The work done in the laboratory These cases are interesting, as showing what has been largely preliminary, testing the various real typho-malaria" is, namely, a combined methods of protective inoculation against rin- infection. Many such cases are now on record, derpest. JYlallein has been made, and quantities the malarial parasites being usually found were being kept for use in outbreaks of glan- preceding the enteric attack or during conders. Tuberculin has also been made, but the valescence; during the height of the attack the amount of tuberculous disease among cattle in enteric germ being the more masterful has its India is not known. The disease certainly exists, own way, thus, as we said before, illustrating as Major Raymond, a.v.d., has recently informed the Hippocratic maxim, Duobns morbis simul us, but it was not till the use of tuberculin obsidentibus veliementiov alterum obscurat." became common in England that the extent of
subject.
"
"
THE INDIAN MEDICAL GAZETTE.
418
EXAMPLE AND PRECEPT.
We are very glad to see that His Excellency the Viceroy intends to be inoculated against plague before making his cold-weather tour in the affected areas. reforms in field hospitals
A recent number of the Journal of the U.S. " M. Icontains an article on Field Hospitals by Ch." which merits very careful consideration. He suggests radical changes in the composition of the hospitals to fit them for hill warfare, putting into a concrete form the general recommendations we made on the subject in our issue for July 1898. The Indian field hospital, as far as equipment is concerned, is wonderfully complete ; but in an unknown hill tract, devoid of roads, like Tirah, this very completeness was a source of weakness. Other causes, such as bad transport, helped to disable the hospitals, but their bulk was their great drawback. " M. Ch." when he We are in full accord with advocates the hospitals moving with only indispensable articles. The great object is to get into position to treat the wounded promptly. By so doing their sufferings are lessened, and chances of recovery increased. It is better to be on the spot with only a few necessary articles, than to be struggling, two days behind the main body, with an unwieldy complete hospital. The latter was no uncommon occurrence in Tirah. After Dargai, and on the Bara march, the two occasions on which a large number of wounded had to be treated, the greater part of the work was done with materials from the panniers and companions. The complete three months' equipment was generally hopelessly blocked some Most of those so attended distance in the rear. did well, and we may presume that they would have done even better if they could have been attended to with greater promptitude. There was sometimes a delay, owing to only half the 'personnel of the hospital being available, the other half being employed on transport and
baggage duties. The obvious
for this is to cease carryon the march, and to ing superfluous extend and develop the system of base and advance depots of medical stores. In Tirah there was never any delay in forwarding dressings, etc., from the depots; the only delay was when the articles were not in stock. With regard to the carriage of the reduced
remedy
stores
hospital by coolies,
cannot
entirely agree with M. Ch." Good mule transport in nearly all cases is preferable to coolies. There is no place where a field hospital is required, that mules cmnot go. Over steep, bad ground they are quite as quick as coolies; they are more easily kept together, and stand exposure, hard work, and short rations better. A cooly's load ; is more easily taken up and put down, but this "
we
[Nov.
1899.
an advantage when near the fight" when ing being sniped on the way. M. Ch." has also assisted in the solution of the dhooly problem. We quite agree with him that the present dhooly slmuld be banished entirely, in hill campaigns. It has been tinkered at for ages till now it is apallci, a bed, a tent, and a general godown all in one, and until roads were made in Tirah was about as serviceable as an omnibus would have been in the same place. Any substitute for it will be welcomed, provided it is light and handy. The particular form is practically immaterial. Nothing can be devised, which will be free from faults, under all cond itions, and a multitude of patterns is not desira ble. For the conditions of hill warfare speed is the first consideration, and Where the two cannot be comfort comes next. combined, then let us have speed. Retiring rear guards soon learnt in Tirah to sprint from ridge to ridge over bad ground, and the ambulance must be able to keep out of their wa}7, otherwise one wounded man leads to others, until all are brought to a standstill. We should like to supplement" M. Ch.'s" article by calling attention to the want of a trained ambulance corps in India. Any cooly, caught fresh from the bazaar, is at present considered fit for ambulance work. Untrained, undisciplined, unwilling, he shirks his work 011 every possible occasion, and is never to be found when wanted if he has a chance of hiding. Men for this work should be regularly enlisted and trained, and kept together under the control of the medical department. " M. Ch.'s" We would cordially recommend article to the notice of the medical services in this country. The Tirah campaign tried the field
is not "
always
line,
hospitals
"
or
as
highly
as
they
are
ever
likely
to
and showed clearly that their one grave fault was their want of mobility. His proposals all aim at removing this defect, and they have the advantage of being as reasonable as they are practical and easy of accombe tried
again,
plishment. ANOTHER CASE OF
Since
last note
SCARLATINA IN
this
INDIA.
subject we have very interesting case of scarlatina in an adult in India from Captain Victor E. H. The patient was a welli.m.s. M.B., Lindesay, known medical officer (a Major, I.M.S.) in Multan. The fever begau on 2nd October 1898 in the train en route from Dalhousie to Multan. On 4th October a bright scarlet punctiform rash appeared with local oedema of hands and arms. The rash disappeared on 8th day of illness; there was sharp fever up to the 6th day, and albuminuria from 4th to 9th day ot illness; there was also tonsillitis, pharyngitis, otalgia and strawberry tongue. There was slight articular rheumatism for four da}7s during the earl}7 part of the illness, desquamation from 8th to 13th day. There apreceived
our a
on
Nov.
REVIEWS.
1899.]
110 doubt of the correct diagnosis? No trace of direct infection could be made out, but the patient had come from Dalhousie, and it was known that in the previous months there had been two or three cases diagnosed as scarlet fever in the family of an English officer at that station. They were under the care of Major Sexton, lt.A.M.C. The Multan case was also seen by Major Adie, I.M.S., the Civil Surgeon, who called Captain Lindesay into consultation. A\'hile we are on the subject, we may add that the cases referred to in our last issue as seen by
pears to be
scarlatina.
Captain McNaught,
not in
soldiers.
children,
r.a.m.c.,
as we
at
stated,
Quetta,
were
but in British
419
