Auaust
CURRENT
1898.]
TOPICS.
301
HOW DID THE PLAGUE REACH BOMBAY?
(Iut[pt ?OJJtCii. THE DIRECT INFECTIVENESS OF PLAGUE.
That plague is directly infectious cannot now admit of any doubt. In this issue are recorded two more fatal cases of plague contracted by cuts received whilst examining the bodies of individuals who had died from bubonic plague. They occurred in the persons of Bengalees who have been doing the menial duties of the post mortem room for many years ; and who almost every day were in the habit of cutting or scratching their fingers with knives or splinters of bone saturated with cadaveric juices, so that they had become quite immune against ordinary post mortem infection. All three cases present several points of resemblance to the historic case of the Japanese professor of pathology, who worked with Kitasato at Hongkong. They should serve as a warning of the danger which attends the examination of plague bodies, as well as the probability of infection by contact with patients suffering from the disease. And thej' raise the question whether it is wise to treat plague patients in other than special hospitals. Here may be mentioned the recent deaths of two nursing sisters at Hongkong from plague contracted in the course of their hospital work. The first of these victims to duty was Miss Elizabeth Frances Higgin (Sister Frances). One of the plague patients in his delirium coughed in her face on April 20th, she became ill on April 25th, and it was soon found that she was suffering from pneumonic plague, the worst form of the disease. In spite of devoted care and attention on the part of the sisters and the principal medical officer, she succumbed early on the morning of April 29th. Sister Frances was a native of Carrick-on-Fergus and received her training at Guy's Hospital. Miss Emma Gertrude Ireland (Sister Gertrude), one of those who attended Sister Frances in her illness, complained of feeling unwell on the evening of Ma}7 2nd, and was admitted to hospital early next morning, when the typical bacilli were found in her sputum. She died on May 5th, and was buried the same day next to Sister Frances. Sister Gertrude was the daughter of Mr. Ireland, of Salle Repham, Norfolk, and was trained at the London Hospital, where she held the posts of " night sister and Sister Blizard." Both of the late sisters went to Hongkong in 1890 and served all through the plague epidemic of 1894. Miss Macintosh (Sister Catherine) became ill on the same day as that on which Sister Gertrude was attacked and was found to have plague bacilli in her sputum, but the most recent information as to her condition is favourable. She suffered from plague in 189G and was saved as if by "
"
miracle.
In his
report on the health of the Port of Bombay, Surgeon-Major Crimmin, v.c., who recently relinquished the position of Acting Health Officer, makes a reference to the interesting question of the source "whence the plague was brought to Bombaj', says the Times of India. The question has been discussed many times during the last two years, but on no
occasion has it been brought nearer a settlement. Dr. Crimmin does not appear to attach much importance to the theories that the disease was imported from China, or that it was from the Himalayas. He remarks that brought " it has escaped notice that plague is endemic in the Persian Gulf and the Red Sea Coast, places much nearer home than China." Quarantine. he tells us, is imposed almost yearly in Egypt and Aden against the obscure port of Assyr in the Red Sea, which lies between Litli and Loheia. The records show that plague was epidemic in Assyr in October, 1893, July, 1894, August, 1895, and October, 1896. It would be interesting to know by what means the information regarding the existence of plague in Assyr was conveyed to the keepers of these records, and we should like to know further whether Assyr has been visited by a European medical man.
MILD FEVERLESS PLAGUE.
It is alleged that the bubonic plague in Mesopotamia, where it is almost endemic, assumes a
mild non-febrile form on the advent of the hot weather, and recrudesces virulently in the autumn and winter. In this mild form or pestis ambulans, the affected persons walk freely about and exhibit no symptom other than the glandular enlargement. If this be really true, it might explain some of the sporadic outbreaks in India which cannot be traced to any recent importation from an infected locality. Dr. Dickson's note on this pestis ambulans is worthy of record:? Two or three months previous to the manifestation of plague in Mesopotamia glandular swellings free from fever prevailed in that country. The}7 showed themselves in the groin, armpit or neck, and were not accompanied by other symptoms. They began to appear amongst the inhabitants about the end of autumn, and continued through the winter, but towards the end of it plague broke out and reached its acme of intensity in the spring, and died out suddenly during the summer season when the great heat declared itself and the thermometer rose to 45 or 50 degrees of centigrade scale (118? or 122? F.). During the prevalence of the plague the thermometer ranged between 5 and 30 degrees, and when it rose to 30? (86? F.), the disease had reached its maximum of intensity t "
302
THE INDIAN MEDICAL GAZETTE.
As the
temperature increased from 30? to 45? F.), the epidemic began to diminish, and as soon as the thermometer got lip to 45? (113? F.), it ceased abruptly. On the cessation of plague apyretic glandular swellings re-appeared again, precisely similar to those which had preceded the outbreak, and they continued to (86?
to 113?
manifest
themselves for about two months These longer. glandular swellings were frequently met with, and were distinct from the chronic adenitic swellings met with in subjects of a scrofulous tendenc}7, and evidently unconnected with any special diathesis." THE HYDERABAD CHLOROFORM COMMISSION.
Thu serious charges brought against this Commission by Mr. Leonard Hill, of prejudice, carelessness, ignorance of scientific methods and incompetence, have been categorically replied to by Professor Lauder Brunton in the British Medical Journal for May 21st. In a rejoinder I sought to show that a great Mr. Hill says: part of the work of the Hyderabad Commission could not be accepted in the face of the contrary results obtained by Snow, the Glasgow Commission, Ringer,Macwilliam,Hare and Thornton, Gaskell and Shore. To this view my own researches lent support. The deaths from chloroform chronicled year by year have not fallen, but risen since the report of the Commission was published. Thus is justified my protest against the final acceptance of the dangerous doctrine that chloroform does not paralyse the heart." "
MADRAS MEDICAL COLLEGE.
We are in receipt of the Government order reviewing the report on the Madras Medical College for the year 1897. The total number
of students educated in the College during the year was 482. Out of these 90 were studying for University degrees, 86 for the Apothecary Department, 220 for the Hospital Assistant Department, and 85 for the Sanitary Inspector's certificate. Owing to the standard of admission having been raised to the F. A. Examination, the numbers of candidates for the Licentiate of Medicine and Surgery are gradually dwindling away ; whilst, on the other hand, the numbers entering for the M. B. degree are yearly increasing. It is also satisfactory to learn that of students are now a more intelligent class The coming forward for medical degrees. Government congratulates the Principal and the staff of professors and assistants on the efficient and creditable administration of the College. HARDSHIPS OF TRANSFER TO PLAGUE AND FAMINE DUTY.
In
a
recent number of a
contemporary
we are
told that the Civil Assistant Surgeons in the Madias Presidency complain that many of their
[August
1898.
number have been ousted from their comfortable posts as District Surgeons and sent on famine work, thereby losing pay and private practice. They are also said to complain that they have been replaced in their district appointments by medical men sent out from England. The article in question calls this action, on the part of Government, jobbery, and maintains that it has caused great dissatisfaction. We doubt, however, if the majority of these Assistant Surgeons, who are sensible men, would endorse this opinion. Government specially selected these men as well as some commissioned medical officers for plague duty, on account of their knowledge of the people and the language. The duty is no doubt unpleasant, but men who enter Government service must be prepared to take their chance of such work, when called upon to do so. As well might those commissioned medical officers complain who were taken away last year for plague and frontier dutjr, and whose places were taken by these very Civil Assistant
Surgeons.
THE ROENTGEN RAYS IN WARFARE.
Surgeon-Major W. C. Beevor, m.b., Army Medical Staff, gave an address on this subject at a meeting of the Royal United Service Institution on May 20th. The chair was taken by the Director-General, and the paper was concerned especially with the employment of the Roentgen rays during the recent operations on the frontier of India. Surgeon-Major Beevor observed, sa}Ts the Lancet, that one of the greatest desiderata in the construction of all apparatus for military work was that every portion of the apparatus should be easy of access, so that repairs could be made, while at the same time the whole could be quickly packed and unpacked in cases suitable for transport under the very rough conditions of actual warIt appears that fare in mountainous countries. the apparatus used during the frontier expedition consisted of a 10-inch spark coil, a primary battery, three tubes, a screen, and some Paget photographic plates. The lecturer showed a compact and portable wooden box, into which a serviceable folding tube holder and a screen could be packed. He showed also a vulcanite box with a handle to take a Crookes's tube, to which insulated electrodes could be attached. This could be freely moved about and placed in any position necessary for the examination of the patient with the screen. Surgeon-Major Beevor contended that it was the duty of every civilised nation to supply apparatus for the Roentgen base hospitals, but also at every rays not only at point where soldiers were fighting and exposing themselves to injury in the performance of their hazardous duties. The portable apparatus should not weigh more than 80 to 100 lbs., and could then be carried slung from a pole by two men.
August
wheeled vehicles was too uncertain a means of conveyance for delicate apparatus except where there were good roads. A difficulty which had been met with was that a hot sun might melt the wax which insulated the wire of the secondary coil. It was found that a mixture of paraffin wax and resin which did not melt under 150? F. was enough for all practical purposes, while a covering of felt protected the coil from The screen, which sun, rain, snow, and frost. was a most important part of the apparatus for urgent cases, could be enclosed in an aluminium case and protected from accidental scratches by a layer of celanite, as suggested by M. Laconteur, of the London Photographic Association. Surgeon-Major Beevor's paper was a valuable contribution towards the practical working out of the best apparatus for use in emergencies in the field, and those who have had experience of the difficulties which arise even in the bestappointed laboratories will be best able to form an opinion as to the serious character of the obstacles likely to be encountered under limited conditions.
Transport by mules, camels,
or
TROPICAL DISEASES AT THE BRITISH MEDICAL ASSOCIATION.
As evidence of the
increasing attention which is being paid to Tropical Diseases, it is to be noted that for the first time Tropical Disease is given a section all to itself at the British Medical Association Meeting, which was to be held a few days ago at Edinburgh ; and the published list of the papers which were to be read is full and varied. "
"
THERAPEUTIC TREATMENT OF CHOLERA.
We invite the attention of readers with practical experience of cholera to the important question of the treatment of this disease as asked by Dr. Hayman Thornhill in our April issue. Strange to say, in regard to such an elementary question as this, there is practically no evidence worthy of the name on record. Yet there must be man)7 of our readers, especially in the areas where this disease is endemic, who have come by experience to find that a certain form of treatment yields in their practice results less unsatisfactory than others. If this experience were recorded collectively it would go a long way towards forming a basis for a more generally satisfactory line of treatment than at present exists. For such a collective investigation, the form proposed by Dr. Hayman Thornhill is excellent, and we will be glad to receive and publish the results.. THE
808
CURRENT. TOPICS.
1898.]
MOSQUITO-MALARIAL THEORY. Ouit readers will remember that SurgeonMajor Ronald Ross described certain pigmented
cells found embedded in the stomach wall of certain mosquitos which had fed on the malarial patient whose blood contained the crescent Plasmodium; and that after prolonged feeding these pigmented cells increased in size, as if they exhibited one of the evidences of lifegrowth. Dr. Ross has lately turned his attention to the corresponding parasites in birds, as the not favourable for procuring a was season steady supply of human malaria, and his interesting results are summarized in a paper by Dr. Manson in the British Medical Journal. He examined especially the proteosoma (Labbe) of sparrows, larks and crows, and his results " goto show that certain phases of the hjBmatozoal intracorpuscular parasites of man and birds, after entering the stomach of special species of mosquito, pass into the tissues of the stomach wall of the insect, rapidljr increase in size, and probably, towards the termination of the life of the mosquito, sporulate, and leave the capsule which, by that time, has formed around them." To quote his own words:? " 1. Pigmented cells are found in the stomach wall of grey mosquitos fed 011 crows, larks, and sparrows with proteosoma. "2. Pigmented cells are not found in control grey mosquitos fed on healthy men, or men with crescent plasmodia, on healthy sparrows, on crows and larks or 011 crows and pigeons with halteridiuin. These pigmented cells are found in the 3. external coat of the stomach, and grow from a size of 6 /x in thirty hours to 60 fx at six days, and are probably coccidia. 4. Successive feeds by the same mosquito on the same bird are followed by fresh crops of young coccidia. Similar pigmented cells have been found "5. in mosquitos fed 011 human gymnosporidia "
"
(Labbe)."
"
As evidence of the And adds Dr. Manson: and scientific precision of Ross's work, I may cite the following experiment. He raised thirty grey mosquitos from a batch of grubs procured at the same time and from the same puddle. Ten of these mosquitos he fed 011 a sparrow in whose blood proteosoma was exceedingly plentiful; ten he fed on a sparrow in whose blood proteosoma was only moderately abundant ; and ten he fed on a sparrow in whose blood he could find no proteosoma. Fifty hours later these thirty mosquitos were dissected and mounted for microscopical examination, and the pigmented cells counted in each mosquito and noted 011 the label on the slide." care
THE TRANSPORT OF SICK AND WOUNDED SOLDIERS BY RAIL.
The to the
trying present
and often injurious effects due want of invalid trains in India,
304
TttE INDIAN MEDICAL GAZETTE.
where the long distances entail many weary of railway travelling, formed the subject of a letter addressed by Surgeon-Major C. J. Addison, a.m.s., to the Times of India. The subject is of considerable military medical importance. Surgeon-Captain 0. H. Melville, A.M.S., has an instructive paper on the same subject in the Journal of the Royal United Service Institution for May. He gives the regulations-for the transport of sick and wounded as existing in the four great continental armies. In the French Service there are three classes of hospital trains, 'permanent,' ' improvised and 'ordinary.' For India, Surgeon-Major Addison recommends the formation of invalid trains with separate carriages for the medical staff and sub-medical staff doing duty with the wounded and invalids; second, the provision of a separate carriage as a kitchen properly fitted up, so that meals or luxuries could be cooked at any hour; third, the desirability of wounded men and invalids seriously ill not being moved at all during the journey to their destination at Deolali?(it is obvious that to a wounded or sick man the constant removal from troop trains to rest camps and then back from each rest camp to troop train must be a great discomfort, if not actually haza rdous in no small number of cases); and fourth, that a trcop siding running right alongside of the hospital at Deolali should be erected.
days
'
GOVERNMENT DAIRY FARMS.
In view of the perennial and increasing prevalence of enteric fever amongst young Europeans and especially the British troops in India, the question of opening more Government dairy farms has been raised, so as to secure a pure supply of milk and butter for the soldiers. At present there are such farms at Umballa, Mhow, K-irkee, and a few other cantonments ; but these are said to be insufficient even for the wants of these places. An extension of this system to th3 chief garrison towns thoroughout India would doubtless tend to diminish the risks from enteric fever. CONDIMENTS AS
ANTISEPTICS.
condiments appear to owe their Many of beneficial dietetic action to their being in reality germicides which check unwholesome fermentations in the alimentary tract. In an interesting article in the Practitioner, Dr. G. V. Poore says that the vegetable bodies containing 'allyl' are of this class, and the use of these is widespread our
?assafoetida,
garlic,
onions,
leeks,
chives,
mustard and horse-radish. It is the universal employment of garlic in Spain, Southern Italy ar;d France which he believes keeps internal parasites in abeyance in these countries; and that probably assafoetida and hot condiments in
[August
1898.
climates serves a similar purpose. Our aromatic herbs, so largely used in cookery, are also antiseptic, and it is noticeable that they are employed precisely with those articles of diet which are slow of digestion and peculiarly liable to undergo fermentative changes in the stomach, such as duck or pork. Salads and oysters, which when raw, are liable to contain the germs of disease, are universally eaten with vinegar, which represses the growth and kills the bacillus entericns. Dill water, Kummel,ginger, are generally successful cajeput, or peppermint ' for the cure of wind due to mixed fermentations.
tropical
'
Attention is drawn in the Bombay papers to the Nasik sanitarium for women and children which Dr. Pechey-Phipson founded a few years ago. Several of the detached cottages comprising the institution are available for poor Europeans as well as for Hindoos and the women and children of other races. The cottages are all comfortably, if simply furnished, but it is necessary for occupants to carry their own cooking utensils and necessaries. An abundance of water is to be found in the grounds, while provisions are obtainable at cheap rates in the bazaar. Firewood and kerosene are obtainable on the premises. The institution is not nearly so well-known as it should be. There are at present 110 European families taking advantage of it, although the climate at this time of the year is so excellent. The Queen has been pleased to sanction the selection of the Rev. Mother St. Katherine, Superioress, Convent of Jesus and Mary, Bombay ; the Rev. Mother St. John, Superioress, Convent of Jesus and Mary, Parel; the Rev. Mother Theodorina, Superioress, St. Joseph's Convent, Bandra; also Mrs. Mabel Allen, late of the civil plague hospital, Kurrachee, to be honorary serving sisters of the Order of the Hospital of St. John of Jerusalem. This is a mark of appreciation of the valuable services rendered by these ladies during the plague. An officer who
was recently on reconnaissance in the Shan States, reports that he has found a capital site for a hill sanitarium for Burmah at Namsan, about 30 miles from Thibaw. It is over 5,000 feet high, and has abundance of water. The principal drawback lies in the fact that the railway does not come nearer to it than Thibaw, and, for the present at least, a hill station to insure success in Burmah must be close to the river or the railway.
duty
The construction at Lahore of a new Central Lunatic Asj'lum for the Punjab, to contain the inmates of the Lahore and Delhi Asylums, which
August
LONDON LETTER.
1898.]
has for a long time been a matter of discussion, will now be commenced. A site on the Mian Mir road lying between the Jail and Canal opposite the race course has been selected, and the work is about to be put in hand. Numerous cases of enteric fever, supposed to have been contracted on the march up, having occurred amongst the troops already arrived at Dalhousie, the attention of Officers Commanding and Medical Officers in charge of parties is directed to the urgent necessity of exercising a strict watch on the water and supplies issued en route.
The Travancore Government is about to establish a medical school, the main object of which will be not only to secure the needful men for the Medical Department, but also to afford the subjects of His Highness the Maharaja facilities for qualifying themselves for an honourable, useful and lucrative profession independently of Government service. The plague in India has not increased during the past month. The cases are few and mostly sporadic, but it still lingers on in Calcutta, despite the hot weather. About 3,000 persons in this city have been injected with Haffkine's pro-
phylactic.
An epidemic of enteric fever at Ootacamund is alleged to be due to the insanitary state of the lake at that local Olympus of Madras. Lord Lister and Dr. Manson are, it is said, endeavouring to get up a Royal Commission to investigate thoroughly the question of malaria and allied
tropical
diseases.
305
CURRENT
1898.]
TOPICS.
301
HOW DID THE PLAGUE REACH BOMBAY?
(Iut[pt ?OJJtCii. THE DIRECT INFECTIVENESS OF PLAGUE.
That plague is directly infectious cannot now admit of any doubt. In this issue are recorded two more fatal cases of plague contracted by cuts received whilst examining the bodies of individuals who had died from bubonic plague. They occurred in the persons of Bengalees who have been doing the menial duties of the post mortem room for many years ; and who almost every day were in the habit of cutting or scratching their fingers with knives or splinters of bone saturated with cadaveric juices, so that they had become quite immune against ordinary post mortem infection. All three cases present several points of resemblance to the historic case of the Japanese professor of pathology, who worked with Kitasato at Hongkong. They should serve as a warning of the danger which attends the examination of plague bodies, as well as the probability of infection by contact with patients suffering from the disease. And thej' raise the question whether it is wise to treat plague patients in other than special hospitals. Here may be mentioned the recent deaths of two nursing sisters at Hongkong from plague contracted in the course of their hospital work. The first of these victims to duty was Miss Elizabeth Frances Higgin (Sister Frances). One of the plague patients in his delirium coughed in her face on April 20th, she became ill on April 25th, and it was soon found that she was suffering from pneumonic plague, the worst form of the disease. In spite of devoted care and attention on the part of the sisters and the principal medical officer, she succumbed early on the morning of April 29th. Sister Frances was a native of Carrick-on-Fergus and received her training at Guy's Hospital. Miss Emma Gertrude Ireland (Sister Gertrude), one of those who attended Sister Frances in her illness, complained of feeling unwell on the evening of Ma}7 2nd, and was admitted to hospital early next morning, when the typical bacilli were found in her sputum. She died on May 5th, and was buried the same day next to Sister Frances. Sister Gertrude was the daughter of Mr. Ireland, of Salle Repham, Norfolk, and was trained at the London Hospital, where she held the posts of " night sister and Sister Blizard." Both of the late sisters went to Hongkong in 1890 and served all through the plague epidemic of 1894. Miss Macintosh (Sister Catherine) became ill on the same day as that on which Sister Gertrude was attacked and was found to have plague bacilli in her sputum, but the most recent information as to her condition is favourable. She suffered from plague in 189G and was saved as if by "
"
miracle.
In his
report on the health of the Port of Bombay, Surgeon-Major Crimmin, v.c., who recently relinquished the position of Acting Health Officer, makes a reference to the interesting question of the source "whence the plague was brought to Bombaj', says the Times of India. The question has been discussed many times during the last two years, but on no
occasion has it been brought nearer a settlement. Dr. Crimmin does not appear to attach much importance to the theories that the disease was imported from China, or that it was from the Himalayas. He remarks that brought " it has escaped notice that plague is endemic in the Persian Gulf and the Red Sea Coast, places much nearer home than China." Quarantine. he tells us, is imposed almost yearly in Egypt and Aden against the obscure port of Assyr in the Red Sea, which lies between Litli and Loheia. The records show that plague was epidemic in Assyr in October, 1893, July, 1894, August, 1895, and October, 1896. It would be interesting to know by what means the information regarding the existence of plague in Assyr was conveyed to the keepers of these records, and we should like to know further whether Assyr has been visited by a European medical man.
MILD FEVERLESS PLAGUE.
It is alleged that the bubonic plague in Mesopotamia, where it is almost endemic, assumes a
mild non-febrile form on the advent of the hot weather, and recrudesces virulently in the autumn and winter. In this mild form or pestis ambulans, the affected persons walk freely about and exhibit no symptom other than the glandular enlargement. If this be really true, it might explain some of the sporadic outbreaks in India which cannot be traced to any recent importation from an infected locality. Dr. Dickson's note on this pestis ambulans is worthy of record:? Two or three months previous to the manifestation of plague in Mesopotamia glandular swellings free from fever prevailed in that country. The}7 showed themselves in the groin, armpit or neck, and were not accompanied by other symptoms. They began to appear amongst the inhabitants about the end of autumn, and continued through the winter, but towards the end of it plague broke out and reached its acme of intensity in the spring, and died out suddenly during the summer season when the great heat declared itself and the thermometer rose to 45 or 50 degrees of centigrade scale (118? or 122? F.). During the prevalence of the plague the thermometer ranged between 5 and 30 degrees, and when it rose to 30? (86? F.), the disease had reached its maximum of intensity t "
302
THE INDIAN MEDICAL GAZETTE.
As the
temperature increased from 30? to 45? F.), the epidemic began to diminish, and as soon as the thermometer got lip to 45? (113? F.), it ceased abruptly. On the cessation of plague apyretic glandular swellings re-appeared again, precisely similar to those which had preceded the outbreak, and they continued to (86?
to 113?
manifest
themselves for about two months These longer. glandular swellings were frequently met with, and were distinct from the chronic adenitic swellings met with in subjects of a scrofulous tendenc}7, and evidently unconnected with any special diathesis." THE HYDERABAD CHLOROFORM COMMISSION.
Thu serious charges brought against this Commission by Mr. Leonard Hill, of prejudice, carelessness, ignorance of scientific methods and incompetence, have been categorically replied to by Professor Lauder Brunton in the British Medical Journal for May 21st. In a rejoinder I sought to show that a great Mr. Hill says: part of the work of the Hyderabad Commission could not be accepted in the face of the contrary results obtained by Snow, the Glasgow Commission, Ringer,Macwilliam,Hare and Thornton, Gaskell and Shore. To this view my own researches lent support. The deaths from chloroform chronicled year by year have not fallen, but risen since the report of the Commission was published. Thus is justified my protest against the final acceptance of the dangerous doctrine that chloroform does not paralyse the heart." "
MADRAS MEDICAL COLLEGE.
We are in receipt of the Government order reviewing the report on the Madras Medical College for the year 1897. The total number
of students educated in the College during the year was 482. Out of these 90 were studying for University degrees, 86 for the Apothecary Department, 220 for the Hospital Assistant Department, and 85 for the Sanitary Inspector's certificate. Owing to the standard of admission having been raised to the F. A. Examination, the numbers of candidates for the Licentiate of Medicine and Surgery are gradually dwindling away ; whilst, on the other hand, the numbers entering for the M. B. degree are yearly increasing. It is also satisfactory to learn that of students are now a more intelligent class The coming forward for medical degrees. Government congratulates the Principal and the staff of professors and assistants on the efficient and creditable administration of the College. HARDSHIPS OF TRANSFER TO PLAGUE AND FAMINE DUTY.
In
a
recent number of a
contemporary
we are
told that the Civil Assistant Surgeons in the Madias Presidency complain that many of their
[August
1898.
number have been ousted from their comfortable posts as District Surgeons and sent on famine work, thereby losing pay and private practice. They are also said to complain that they have been replaced in their district appointments by medical men sent out from England. The article in question calls this action, on the part of Government, jobbery, and maintains that it has caused great dissatisfaction. We doubt, however, if the majority of these Assistant Surgeons, who are sensible men, would endorse this opinion. Government specially selected these men as well as some commissioned medical officers for plague duty, on account of their knowledge of the people and the language. The duty is no doubt unpleasant, but men who enter Government service must be prepared to take their chance of such work, when called upon to do so. As well might those commissioned medical officers complain who were taken away last year for plague and frontier dutjr, and whose places were taken by these very Civil Assistant
Surgeons.
THE ROENTGEN RAYS IN WARFARE.
Surgeon-Major W. C. Beevor, m.b., Army Medical Staff, gave an address on this subject at a meeting of the Royal United Service Institution on May 20th. The chair was taken by the Director-General, and the paper was concerned especially with the employment of the Roentgen rays during the recent operations on the frontier of India. Surgeon-Major Beevor observed, sa}Ts the Lancet, that one of the greatest desiderata in the construction of all apparatus for military work was that every portion of the apparatus should be easy of access, so that repairs could be made, while at the same time the whole could be quickly packed and unpacked in cases suitable for transport under the very rough conditions of actual warIt appears that fare in mountainous countries. the apparatus used during the frontier expedition consisted of a 10-inch spark coil, a primary battery, three tubes, a screen, and some Paget photographic plates. The lecturer showed a compact and portable wooden box, into which a serviceable folding tube holder and a screen could be packed. He showed also a vulcanite box with a handle to take a Crookes's tube, to which insulated electrodes could be attached. This could be freely moved about and placed in any position necessary for the examination of the patient with the screen. Surgeon-Major Beevor contended that it was the duty of every civilised nation to supply apparatus for the Roentgen base hospitals, but also at every rays not only at point where soldiers were fighting and exposing themselves to injury in the performance of their hazardous duties. The portable apparatus should not weigh more than 80 to 100 lbs., and could then be carried slung from a pole by two men.
August
wheeled vehicles was too uncertain a means of conveyance for delicate apparatus except where there were good roads. A difficulty which had been met with was that a hot sun might melt the wax which insulated the wire of the secondary coil. It was found that a mixture of paraffin wax and resin which did not melt under 150? F. was enough for all practical purposes, while a covering of felt protected the coil from The screen, which sun, rain, snow, and frost. was a most important part of the apparatus for urgent cases, could be enclosed in an aluminium case and protected from accidental scratches by a layer of celanite, as suggested by M. Laconteur, of the London Photographic Association. Surgeon-Major Beevor's paper was a valuable contribution towards the practical working out of the best apparatus for use in emergencies in the field, and those who have had experience of the difficulties which arise even in the bestappointed laboratories will be best able to form an opinion as to the serious character of the obstacles likely to be encountered under limited conditions.
Transport by mules, camels,
or
TROPICAL DISEASES AT THE BRITISH MEDICAL ASSOCIATION.
As evidence of the
increasing attention which is being paid to Tropical Diseases, it is to be noted that for the first time Tropical Disease is given a section all to itself at the British Medical Association Meeting, which was to be held a few days ago at Edinburgh ; and the published list of the papers which were to be read is full and varied. "
"
THERAPEUTIC TREATMENT OF CHOLERA.
We invite the attention of readers with practical experience of cholera to the important question of the treatment of this disease as asked by Dr. Hayman Thornhill in our April issue. Strange to say, in regard to such an elementary question as this, there is practically no evidence worthy of the name on record. Yet there must be man)7 of our readers, especially in the areas where this disease is endemic, who have come by experience to find that a certain form of treatment yields in their practice results less unsatisfactory than others. If this experience were recorded collectively it would go a long way towards forming a basis for a more generally satisfactory line of treatment than at present exists. For such a collective investigation, the form proposed by Dr. Hayman Thornhill is excellent, and we will be glad to receive and publish the results.. THE
808
CURRENT. TOPICS.
1898.]
MOSQUITO-MALARIAL THEORY. Ouit readers will remember that SurgeonMajor Ronald Ross described certain pigmented
cells found embedded in the stomach wall of certain mosquitos which had fed on the malarial patient whose blood contained the crescent Plasmodium; and that after prolonged feeding these pigmented cells increased in size, as if they exhibited one of the evidences of lifegrowth. Dr. Ross has lately turned his attention to the corresponding parasites in birds, as the not favourable for procuring a was season steady supply of human malaria, and his interesting results are summarized in a paper by Dr. Manson in the British Medical Journal. He examined especially the proteosoma (Labbe) of sparrows, larks and crows, and his results " goto show that certain phases of the hjBmatozoal intracorpuscular parasites of man and birds, after entering the stomach of special species of mosquito, pass into the tissues of the stomach wall of the insect, rapidljr increase in size, and probably, towards the termination of the life of the mosquito, sporulate, and leave the capsule which, by that time, has formed around them." To quote his own words:? " 1. Pigmented cells are found in the stomach wall of grey mosquitos fed 011 crows, larks, and sparrows with proteosoma. "2. Pigmented cells are not found in control grey mosquitos fed on healthy men, or men with crescent plasmodia, on healthy sparrows, on crows and larks or 011 crows and pigeons with halteridiuin. These pigmented cells are found in the 3. external coat of the stomach, and grow from a size of 6 /x in thirty hours to 60 fx at six days, and are probably coccidia. 4. Successive feeds by the same mosquito on the same bird are followed by fresh crops of young coccidia. Similar pigmented cells have been found "5. in mosquitos fed 011 human gymnosporidia "
"
(Labbe)."
"
As evidence of the And adds Dr. Manson: and scientific precision of Ross's work, I may cite the following experiment. He raised thirty grey mosquitos from a batch of grubs procured at the same time and from the same puddle. Ten of these mosquitos he fed 011 a sparrow in whose blood proteosoma was exceedingly plentiful; ten he fed on a sparrow in whose blood proteosoma was only moderately abundant ; and ten he fed on a sparrow in whose blood he could find no proteosoma. Fifty hours later these thirty mosquitos were dissected and mounted for microscopical examination, and the pigmented cells counted in each mosquito and noted 011 the label on the slide." care
THE TRANSPORT OF SICK AND WOUNDED SOLDIERS BY RAIL.
The to the
trying present
and often injurious effects due want of invalid trains in India,
304
TttE INDIAN MEDICAL GAZETTE.
where the long distances entail many weary of railway travelling, formed the subject of a letter addressed by Surgeon-Major C. J. Addison, a.m.s., to the Times of India. The subject is of considerable military medical importance. Surgeon-Captain 0. H. Melville, A.M.S., has an instructive paper on the same subject in the Journal of the Royal United Service Institution for May. He gives the regulations-for the transport of sick and wounded as existing in the four great continental armies. In the French Service there are three classes of hospital trains, 'permanent,' ' improvised and 'ordinary.' For India, Surgeon-Major Addison recommends the formation of invalid trains with separate carriages for the medical staff and sub-medical staff doing duty with the wounded and invalids; second, the provision of a separate carriage as a kitchen properly fitted up, so that meals or luxuries could be cooked at any hour; third, the desirability of wounded men and invalids seriously ill not being moved at all during the journey to their destination at Deolali?(it is obvious that to a wounded or sick man the constant removal from troop trains to rest camps and then back from each rest camp to troop train must be a great discomfort, if not actually haza rdous in no small number of cases); and fourth, that a trcop siding running right alongside of the hospital at Deolali should be erected.
days
'
GOVERNMENT DAIRY FARMS.
In view of the perennial and increasing prevalence of enteric fever amongst young Europeans and especially the British troops in India, the question of opening more Government dairy farms has been raised, so as to secure a pure supply of milk and butter for the soldiers. At present there are such farms at Umballa, Mhow, K-irkee, and a few other cantonments ; but these are said to be insufficient even for the wants of these places. An extension of this system to th3 chief garrison towns thoroughout India would doubtless tend to diminish the risks from enteric fever. CONDIMENTS AS
ANTISEPTICS.
condiments appear to owe their Many of beneficial dietetic action to their being in reality germicides which check unwholesome fermentations in the alimentary tract. In an interesting article in the Practitioner, Dr. G. V. Poore says that the vegetable bodies containing 'allyl' are of this class, and the use of these is widespread our
?assafoetida,
garlic,
onions,
leeks,
chives,
mustard and horse-radish. It is the universal employment of garlic in Spain, Southern Italy ar;d France which he believes keeps internal parasites in abeyance in these countries; and that probably assafoetida and hot condiments in
[August
1898.
climates serves a similar purpose. Our aromatic herbs, so largely used in cookery, are also antiseptic, and it is noticeable that they are employed precisely with those articles of diet which are slow of digestion and peculiarly liable to undergo fermentative changes in the stomach, such as duck or pork. Salads and oysters, which when raw, are liable to contain the germs of disease, are universally eaten with vinegar, which represses the growth and kills the bacillus entericns. Dill water, Kummel,ginger, are generally successful cajeput, or peppermint ' for the cure of wind due to mixed fermentations.
tropical
'
Attention is drawn in the Bombay papers to the Nasik sanitarium for women and children which Dr. Pechey-Phipson founded a few years ago. Several of the detached cottages comprising the institution are available for poor Europeans as well as for Hindoos and the women and children of other races. The cottages are all comfortably, if simply furnished, but it is necessary for occupants to carry their own cooking utensils and necessaries. An abundance of water is to be found in the grounds, while provisions are obtainable at cheap rates in the bazaar. Firewood and kerosene are obtainable on the premises. The institution is not nearly so well-known as it should be. There are at present 110 European families taking advantage of it, although the climate at this time of the year is so excellent. The Queen has been pleased to sanction the selection of the Rev. Mother St. Katherine, Superioress, Convent of Jesus and Mary, Bombay ; the Rev. Mother St. John, Superioress, Convent of Jesus and Mary, Parel; the Rev. Mother Theodorina, Superioress, St. Joseph's Convent, Bandra; also Mrs. Mabel Allen, late of the civil plague hospital, Kurrachee, to be honorary serving sisters of the Order of the Hospital of St. John of Jerusalem. This is a mark of appreciation of the valuable services rendered by these ladies during the plague. An officer who
was recently on reconnaissance in the Shan States, reports that he has found a capital site for a hill sanitarium for Burmah at Namsan, about 30 miles from Thibaw. It is over 5,000 feet high, and has abundance of water. The principal drawback lies in the fact that the railway does not come nearer to it than Thibaw, and, for the present at least, a hill station to insure success in Burmah must be close to the river or the railway.
duty
The construction at Lahore of a new Central Lunatic Asj'lum for the Punjab, to contain the inmates of the Lahore and Delhi Asylums, which
August
LONDON LETTER.
1898.]
has for a long time been a matter of discussion, will now be commenced. A site on the Mian Mir road lying between the Jail and Canal opposite the race course has been selected, and the work is about to be put in hand. Numerous cases of enteric fever, supposed to have been contracted on the march up, having occurred amongst the troops already arrived at Dalhousie, the attention of Officers Commanding and Medical Officers in charge of parties is directed to the urgent necessity of exercising a strict watch on the water and supplies issued en route.
The Travancore Government is about to establish a medical school, the main object of which will be not only to secure the needful men for the Medical Department, but also to afford the subjects of His Highness the Maharaja facilities for qualifying themselves for an honourable, useful and lucrative profession independently of Government service. The plague in India has not increased during the past month. The cases are few and mostly sporadic, but it still lingers on in Calcutta, despite the hot weather. About 3,000 persons in this city have been injected with Haffkine's pro-
phylactic.
An epidemic of enteric fever at Ootacamund is alleged to be due to the insanitary state of the lake at that local Olympus of Madras. Lord Lister and Dr. Manson are, it is said, endeavouring to get up a Royal Commission to investigate thoroughly the question of malaria and allied
tropical
diseases.
305
