INDIAN MEDICAL GAZETTE.
232
[cditilt
2}ciU!i.
THE PAY OP ARMY MEDICAL OFFICERS IN INDIA.
The Medical Press and Circular drawing attention to this subject says :?The Government of India has now tixed the salaries of the staff and commands of the Army in India from April 1st. The Principal Medical Officers of Ann}' Corps will get only Rs. 2,000 per mensem, which at the present rate of exchange is equivalent to about ?1,200 a year, while a Surgeon-MajorGeneral at home draws witli pay and allowances ?1,400 per annum; and in Gibraltar or Malta ?1,500. Hitherto the Principal Medical Officers of Madras and Bombay have drawn Rs. 2,500 a month. Again, the Commissary-General and Inspector-General of Ordnance, one a lieutenantcolonel and the other a colonel, have their pay fixed at Rs. 2,200. In other words, a SurgeonMajor-General, British Service, Principal Medical Officer of an Army Corps, while holding the rank of a major-general, will draw less pay than a lieutenant-colonel and colonel respectively. Long ago it was reported that the Principal Medical Officers of Corps would receive Rs. 2,200 a month, but this turns out to be wrong. Thus the Army Medical Staff has now to face a loss of income of Rs. 500 a month.
[June
1895v
be stormed and the Cliitralis driven out at the of the bayonet. Captain Baird in his dying moment asked Surgeon-Major Robertson to bring Surgeon-Captain Whitchurch's bravery to the notice of the authorities. There can be no doubt that these deeds of gallantry will be rewarded, and that Colonel Kelly, Surgeon-Major Robertson, and SurgeonCaptain Whitchurch will receive the honours they deserve. To the medical profession, it must be a source of great satisfaction to see two of their members among those who have conspicuously distinguished themselves.
point
SALE OP QUININE IN PICE PACKETS IN BENGAL.
The authorities are to be congratulated on the success which has attended the scheme of creating a demand for pure quinine among the poor by selling it in small quantities at a large number of centres for the smallest coin in comthe sellers an interest mon use, and by giving in pushing the sale. The packets contain 5 grains of quinine and the price is fixed at one pice. A Resolution has been recently issued on the subject by. the Bengal Government, in which the progress of the movement is traced. The experiment was commenced through the agency of the post office. The most feverstricken districts were taken up first, and in a short time 34,986 pice packets had been supplied; the following month 160,854? packets within THE CHITRAL EXPEDITION. were sent out to all districts except those of The Chitral Expedition has been full of inBehar and Chota Nagpur, and in the next month cidents which have aroused the admiration of 201,144 packets were distributed. Later, civil everyone. The fine defence made for seven station masters, private employers surgeons, his Robertson and weeks, by Surgeon-Major of labour, zamindars and indigo and tea small beleaguered garrison against an enemy to have been made use of in the which pressed so sorely that the besieged lost a planters, appear sale of the quinine, but the main source of disthird of their number in killed and wounded is tribution is the postal agency. In two years, felt to be a splendid achievement; the relief of 3,211,266 packets have been issued to the post the garrison by Colonel Kelly, after performing a offices and civil surgeons, and 2,391,594 have been journey across passes which had been declared sold. Owing to representations from some of the the of to be impassable at the season year, civil surgeons as to the undesirability of selling demonstrates once more the conspicuous deterat dispensaries where patients quinine expect to mination, pluck and resource of the British officer all medicines the Lieutenant-Governor free, get of while the in times of difficulty ; bravery has ordered its discontinuance, which we consider Surgeon-Captain Whitchurch in rescuing Cap- a very wise procedure on the part of Sir Charles tain Baird, who was mortally wounded from the Elliot. The subordinates of the Vaccination hands of the enemy, is an example of indiviare, however, to be entrusted with dual gallantry which has elicited from all the Department the sale of this drug as a supplement to the The was reconnaisance which highest praise. postal agenc}\ being made by the British forces was attacked The success of the scheme is most gratifying, by superior numbers and had to retire under a and its results will the undoubtedly be far-reaching. fire. Commandant, Captain Baird, o-alling In the feverish districts of Bengal it is a health was wounded, and with him, Surgeon-Captain measure of the first importance and one which Whitchurch and a small party of soldiers were will be more appreciated as the anti-malarial of main the the force. from body separated properties of the quinine become better known. Surgeon-Captain Whitchurch, with his small This simple measure will, we believe, be ultimateand officer succeedwounded band, defended the ed in carrying him into the fort. But in doing ly the means of saving much suffering and mortality, and the originators of the scheme are so several walled defences of the enemy had to
June 1895.1 to be
heartily congratulated both on the brilliancy of the conception and the manner in which it is being carried out. DEATHS FOLLOWING THE INJECTION OF ANTITOXIN. The British Medical Journal of May 4th draws attention to the following cases:? A young lady of Brooklyn, who wTas treated for diphtheria with antitoxin, died lately, and Dr. John M. Clayland, the coroner's physician, who made a post-mortem examination, reported as Puncture on the left side of the abdofollows : men, not penetrating the cavity ; brain congested, lungs normal, blood fluid, left heart emptv, right heart containing a small amount of fluid blood, liver and kidneys congested, especially the latter. No oedema. Larynx normal. The fauces contained diphtheritic false membrane. Cause of death, convulsion, due to the injection of diphtheria antitoxin." On the other hand, Dr. Wilson, the Chief Bacteriologist to the Brooklyn Board of Health, has presented an official report in which he says : " Speculative theories may be advanced as to the cause of death in this case, the true cause not having yet been determined; but my experiments, conforming as nearly as possible to the actual condition, demonstrate that it was not inherent in the antitoxin." Dr. Wm. H. Park, of the Bacteriological Department of the New York Board of Health, has also reported to the following effect: " My experience led me to express the opinion that the unfortunate results which followed its administration in this specified case cannot be attributed in any way to the antitoxin which It is to be hoped that the was employed." fullest possible details of this case will be published. A case of death following a preventive injection of antitoxin was reported by Dr. Axel Johanessen to the Medical Societ}' of Christiania A boj7-, aged two years, suffering on January 9th. from spastic spinal paralysis, I'eceived an injection of a quarter of a bottle of Behring's serum (600 units) on December 0th. On the four following days lie had sharp diarrhoea, but there was no rise of temperature and no albuminuria. On the 14th there were traces of albumen and indican ; the temperature was 103? F., and there was infiltration .and redness at the side of puncFrom the 15th ture (under the right clavicle). to the 18th the child's condition remained much the same; an incision at the site of puncture Death took place on the gave issue to no pus. 19th. On post-mortem examination no trace of suppuration was found in the infiltrated area about the seat of puncture. The liver was pale, the spleen large and firm, the kidneys rather pale, the intestine dilated, the peritoneum injected, its mucous membrane stained with greyishblack spots, and Peyer's patches were injected "
233
MEDICAL NEWS. and infiltrated.
streptococci received at the
were
On bacteriological examination found. Three other children
preventive injections of
same
the time without ill effect.
same serum
In the Hungarian journal Gydgydaszat, Dr. Alfoldi, of Pancsova, relates the case of a girl aged 3 years, who received a preventive injection of 2 c. cm. of Behring's serum (100 units) on January 16th. This was followed by depression and loss of appetite. On January 18 th the temperature rose to over 104? F.; the child complained of pains in loins, and there was
considerable albuminuria. over the whole the child died.
appeared
On the 19th petechia and on the 20th
body,
THE COMMANDER-IN-CHIEF AND BRAVE CIVILIAN."
"
THAT
The Duke of Cambridge has never been favourable to the granting of military titles to medical men in the army, and it is therefore not surprising that he should speak of Surgeon-Major Robertson as "that brave civilian." The British Medical Journal has the following caustic article on the subject : The Duke of Cambridge was not altogether which he made in happily inspired in the speech ' The Army' at the response to the toast of Royal Academy dinner. Lonis XIV, historians tell us, claimed the victories of his generals as his own, but the Duke of Cambridge goes far beyond the Grand Monarque in the sublime assurance with which he claims credit for the efficiency and success of a force with which he has had no to do than he had with the victorious more advance of the Japanese Army. The British public will stand a good deal from a Royal Duke, and the plain speaking which this unlucky piece of after-dinner oratory has caused shows that the provocation must have been excessive. Certainly if accurate self-knowledge be the aim of the philosopher, His Royal Highness should be grateful to the newspapers which have so assiduously held up to him the mirror of candid criticism during the past week. We should have been glad to have left this unpleasant duty entirely to the lay press, but as the Duke of Cambridge himself went out of his way to offer what we can only characterise as a wanton affront to the medical officers of the army, we feel bound to take notice of this further indiscretion. Whilst pa}dng a well-merited tribute to the heroic defenders and relievers of Fort Chitral, H. R. H. made use of the expression that brave civilian, Dr. Robertson,' as distinguished from certain other equally brave officials. We have read his speech attentively, and we cannot but feel convinced that the phraseology employed if so it is all the more was used advisedly; regrettable, as, no matter what may be the Duke's personal views as to the proper position of medi?
"
"
"
'
INDIAN MEDICAL GAZETTE.
234
cal officers in the
military machine, he, as Comshould and must have known that the Political Agent at Chitral was a surgeonmajor on full pay in the Indian Medical Service, and as such was possessed of a military title, and as much a militaiy man as any other member of the garrison. We feel sure that when this speech is read in India it will arouse feelings of great bitterness in the ranks of the Indian Medical Service. It has been made at a most inopportune time. The military medical services of the Crown are notoriously dissatisfied, and this fresh and apparently wanton blow at the status of officers of the Indian Medical Service from so high a personage as the Commander-inChief will, we fear, cause fresh discontent. Only last week we alluded to the fact that certain changes are to be made in the system of the entrance examination for the Army and Indian Medical Services, with a view to ensuring the best class of candidates for commissions. Surely these publicly-expressed views of the Duke of Cambridge will not tend to encourage the ambition of good class candidates presenting themselves for either the Indian or Army Medical mander-in-Chief,
Service.
"We venture to think this speech of His Royal Highness will have far-reaching effect, and probably in a direction with which he is least in s}7mpathy. If the officers of the medical service
of the Indian army are civilians, let it be authoritatively ruled so; let them no longer wear their distinctive uniform, and no longer be subject to militaiy laws, rules, regulations, and rates of pay. If the responsible military advisers of the Crown honestly and truly consider that medical aid for the army should be furnished by a civilian staff, let them say so openly, so that the individual officers themselves and the profession may know the exact status of the medical officer. The medical, like the engineering, is primarily a civilian profession, but the one as much as the other has its military side. The surgeon-major, endowed with political powers, 110 more loses his army title and rank than the engineer major, detailed to look after irrigation works, loses his. We hope that this matter may not be allowed It establishes a very serious to rest as it is, condition of affairs. If the dictum of the Commander-in-Chief is allowed to pass unchallenged, and by inference is to be interpreted as receiving the approval of the India Office, as defining the true status of the army surgeon in the official community, public opinion will know how to appreciate the position." LONDON LETTER. London has reverted to its normal death-rate. troubles are less common and fatal, and influenza has almost disappeared. Spring has " " season come with all its charms and the is in
Respiratory
full
swing.
The list of
[Jone
big
men
1895.
wlio succumbed
"
malady?" flu as it is called dwindling ; but recovery of strength
to the fashionable
for short?is " flu" is a slow process. and condition after The most remarkable feature of the disease is the depressing effect it exercises upon the nervous system. A man who has gone through a sharp attack looks aged, anxious and shattered. He cannot eat or sleep or take exercise as he used to and is decidedly " down on his luck." Even rest and a change to the seaside are not so beneficial as in convalescence from other acute maladies, and the damage to constitution and health caused by one or several attacks of influenza is sometimes irreparable and permanent. To the aged and infirm it too often proves a death-blow ; but even the young and robust feel its power for long. A new departure in medical education has been made by St. George's Hospital Medical School in appointing Dr. Patrick Manson lecturer on Tropical Medicine. The selection is an admirable Dr. Manson is best known as the discoverer one. of the office performed by the mosquito, in the development and propagation of the filaria sanguinis hominis ; but he has worked at tropical diseases all round, and no man living has a better theoretical and practical knowledge of them. His recent researches regarding the malaria organism indicate that he is diligently pursuing his studies of the complaints peculiar to the tropics by the most scientific methods. As physician to the Greenwich Seamen's Hospital he enjoys special advantages for observing the effects recent and remote of residence in all tropical localities both in white and coloured races, and a long and large practice in China has qualified him to make the The medical student most of his opportunities. of the present day has no light task in mastering the elements and general principles of the numerous subjects which constitute the cardinal and essential constituents of the medical curriculum and the propriety of burdening him with a new speciality may be questioned. Indeed the proper place of specialities in medical education would be post-graduate rather than pre-graduate, and we are not by any means sure that it is wise to burden students with courses of lectures which are not, strictly speaking, necessary. Still it is a good thing to have special subjects taught in medical schools by competent men and to give students and young graduates opportunities for gaining the best available knowledge concerning them, should inclination or interest render it advisable to take them up. Medical employment in the tropics is in these days becoming very common, and a man proceeding to practise in India, China, Central Africa or America ought to be provided with some information regarding the nature of his work and the best methods of accomplishing it. The report of the Opium Commission has, it appears, been completed, but some formalities
June
1895.]
PISANI ON TYPHUS FEVER.
have still to bo gone through, and its publication and distribution are not to take place for some days. The main points of the report have leaked out, and it is satisfactory to find that the violent tirades of missionaries and fanatics have not been justified by the evidence recorded by the Commission, and that no interference with the cultivation of the poppy and commerce in opium, as at present conducted, is considered necessary or advisable. On the other hand, full acknowledgment is made of the great benefits which the moderate consumption of opium confers upon sufferers from distressing ailments in India and China. I shall probably have more to say about this report in my next letter. The question regarding the role which water plays in the dissemination of cholera has been pushed once more to the front by the publication of an English translation of Professor Koch's work " On the Bacteriological Diagnosis of Cholera, Water Filtration and Cholera and the Cholera in Germany during the Winter of 1892-93." Koch, while admitting that there are other media and means by which the cholera organism may obtain access to the intestinal canal of men, considers water as the most common vehicle. An excellent article in the Lancet of 6th April makes it clear that he has x*ather strained the facts of the HamburgAltona outbreak in support of the water theory, and has failed to give sufficient prominence and weight to other factors, more especially altitude, drainage, sewage and general sanitation. Nothing but harm can come of pushing any cholera theory too far, for this leads to neglect of other conditions which may have a considerable? equal or superior?influence in causation. It is quite true that the purity of drinking water is a matter of transcendent sanitary importance, and that the history of cholera has placed this matter in a position of demonstration as regards the prevention of that disease ; but to treat water as the exclusive culprit in cholera causation and look to water purification as the only means of checking cholera epidemics is to take too narrow a view of the requirements of the case unless every other possible sanitary reform is made to converge on the purity of water, but may be endangered by sanitary neglects of any and every sort, appertaining to soil, air, habitation, food, clothiug and the usages of domestic and commercial life. A report has recently been issued by the Local Government Board concerning the prevalence of cholera in England in 1893. There are two curious points in this report. One is the evidence that the disease was conveyed and spread from the coast towns into which it was imported inwards by excursionists and pleasure-seekers, just that pilgrims as it is believed by most people disseminate the disease in India and frequenters of fairs in Russia. The other is the suspicion that the oyster which has got into such bad as a link in the causation of typhoid fever,
repute
235
may also serve to carry the organism or poison of cholera from place to place. Tidings have come of the outbreak of cholera at Kamarin, the quarantine station of Mecca pilgrims. This is a most serious matter and will probably serve to keep alive the praiseworthy agitation which has for its object the prevention of the terrible loss of life which yearly takes place in connection with this great gathering of devout
Moslems. 12th
April
1895.
232
[cditilt
2}ciU!i.
THE PAY OP ARMY MEDICAL OFFICERS IN INDIA.
The Medical Press and Circular drawing attention to this subject says :?The Government of India has now tixed the salaries of the staff and commands of the Army in India from April 1st. The Principal Medical Officers of Ann}' Corps will get only Rs. 2,000 per mensem, which at the present rate of exchange is equivalent to about ?1,200 a year, while a Surgeon-MajorGeneral at home draws witli pay and allowances ?1,400 per annum; and in Gibraltar or Malta ?1,500. Hitherto the Principal Medical Officers of Madras and Bombay have drawn Rs. 2,500 a month. Again, the Commissary-General and Inspector-General of Ordnance, one a lieutenantcolonel and the other a colonel, have their pay fixed at Rs. 2,200. In other words, a SurgeonMajor-General, British Service, Principal Medical Officer of an Army Corps, while holding the rank of a major-general, will draw less pay than a lieutenant-colonel and colonel respectively. Long ago it was reported that the Principal Medical Officers of Corps would receive Rs. 2,200 a month, but this turns out to be wrong. Thus the Army Medical Staff has now to face a loss of income of Rs. 500 a month.
[June
1895v
be stormed and the Cliitralis driven out at the of the bayonet. Captain Baird in his dying moment asked Surgeon-Major Robertson to bring Surgeon-Captain Whitchurch's bravery to the notice of the authorities. There can be no doubt that these deeds of gallantry will be rewarded, and that Colonel Kelly, Surgeon-Major Robertson, and SurgeonCaptain Whitchurch will receive the honours they deserve. To the medical profession, it must be a source of great satisfaction to see two of their members among those who have conspicuously distinguished themselves.
point
SALE OP QUININE IN PICE PACKETS IN BENGAL.
The authorities are to be congratulated on the success which has attended the scheme of creating a demand for pure quinine among the poor by selling it in small quantities at a large number of centres for the smallest coin in comthe sellers an interest mon use, and by giving in pushing the sale. The packets contain 5 grains of quinine and the price is fixed at one pice. A Resolution has been recently issued on the subject by. the Bengal Government, in which the progress of the movement is traced. The experiment was commenced through the agency of the post office. The most feverstricken districts were taken up first, and in a short time 34,986 pice packets had been supplied; the following month 160,854? packets within THE CHITRAL EXPEDITION. were sent out to all districts except those of The Chitral Expedition has been full of inBehar and Chota Nagpur, and in the next month cidents which have aroused the admiration of 201,144 packets were distributed. Later, civil everyone. The fine defence made for seven station masters, private employers surgeons, his Robertson and weeks, by Surgeon-Major of labour, zamindars and indigo and tea small beleaguered garrison against an enemy to have been made use of in the which pressed so sorely that the besieged lost a planters, appear sale of the quinine, but the main source of disthird of their number in killed and wounded is tribution is the postal agency. In two years, felt to be a splendid achievement; the relief of 3,211,266 packets have been issued to the post the garrison by Colonel Kelly, after performing a offices and civil surgeons, and 2,391,594 have been journey across passes which had been declared sold. Owing to representations from some of the the of to be impassable at the season year, civil surgeons as to the undesirability of selling demonstrates once more the conspicuous deterat dispensaries where patients quinine expect to mination, pluck and resource of the British officer all medicines the Lieutenant-Governor free, get of while the in times of difficulty ; bravery has ordered its discontinuance, which we consider Surgeon-Captain Whitchurch in rescuing Cap- a very wise procedure on the part of Sir Charles tain Baird, who was mortally wounded from the Elliot. The subordinates of the Vaccination hands of the enemy, is an example of indiviare, however, to be entrusted with dual gallantry which has elicited from all the Department the sale of this drug as a supplement to the The was reconnaisance which highest praise. postal agenc}\ being made by the British forces was attacked The success of the scheme is most gratifying, by superior numbers and had to retire under a and its results will the undoubtedly be far-reaching. fire. Commandant, Captain Baird, o-alling In the feverish districts of Bengal it is a health was wounded, and with him, Surgeon-Captain measure of the first importance and one which Whitchurch and a small party of soldiers were will be more appreciated as the anti-malarial of main the the force. from body separated properties of the quinine become better known. Surgeon-Captain Whitchurch, with his small This simple measure will, we believe, be ultimateand officer succeedwounded band, defended the ed in carrying him into the fort. But in doing ly the means of saving much suffering and mortality, and the originators of the scheme are so several walled defences of the enemy had to
June 1895.1 to be
heartily congratulated both on the brilliancy of the conception and the manner in which it is being carried out. DEATHS FOLLOWING THE INJECTION OF ANTITOXIN. The British Medical Journal of May 4th draws attention to the following cases:? A young lady of Brooklyn, who wTas treated for diphtheria with antitoxin, died lately, and Dr. John M. Clayland, the coroner's physician, who made a post-mortem examination, reported as Puncture on the left side of the abdofollows : men, not penetrating the cavity ; brain congested, lungs normal, blood fluid, left heart emptv, right heart containing a small amount of fluid blood, liver and kidneys congested, especially the latter. No oedema. Larynx normal. The fauces contained diphtheritic false membrane. Cause of death, convulsion, due to the injection of diphtheria antitoxin." On the other hand, Dr. Wilson, the Chief Bacteriologist to the Brooklyn Board of Health, has presented an official report in which he says : " Speculative theories may be advanced as to the cause of death in this case, the true cause not having yet been determined; but my experiments, conforming as nearly as possible to the actual condition, demonstrate that it was not inherent in the antitoxin." Dr. Wm. H. Park, of the Bacteriological Department of the New York Board of Health, has also reported to the following effect: " My experience led me to express the opinion that the unfortunate results which followed its administration in this specified case cannot be attributed in any way to the antitoxin which It is to be hoped that the was employed." fullest possible details of this case will be published. A case of death following a preventive injection of antitoxin was reported by Dr. Axel Johanessen to the Medical Societ}' of Christiania A boj7-, aged two years, suffering on January 9th. from spastic spinal paralysis, I'eceived an injection of a quarter of a bottle of Behring's serum (600 units) on December 0th. On the four following days lie had sharp diarrhoea, but there was no rise of temperature and no albuminuria. On the 14th there were traces of albumen and indican ; the temperature was 103? F., and there was infiltration .and redness at the side of puncFrom the 15th ture (under the right clavicle). to the 18th the child's condition remained much the same; an incision at the site of puncture Death took place on the gave issue to no pus. 19th. On post-mortem examination no trace of suppuration was found in the infiltrated area about the seat of puncture. The liver was pale, the spleen large and firm, the kidneys rather pale, the intestine dilated, the peritoneum injected, its mucous membrane stained with greyishblack spots, and Peyer's patches were injected "
233
MEDICAL NEWS. and infiltrated.
streptococci received at the
were
On bacteriological examination found. Three other children
preventive injections of
same
the time without ill effect.
same serum
In the Hungarian journal Gydgydaszat, Dr. Alfoldi, of Pancsova, relates the case of a girl aged 3 years, who received a preventive injection of 2 c. cm. of Behring's serum (100 units) on January 16th. This was followed by depression and loss of appetite. On January 18 th the temperature rose to over 104? F.; the child complained of pains in loins, and there was
considerable albuminuria. over the whole the child died.
appeared
On the 19th petechia and on the 20th
body,
THE COMMANDER-IN-CHIEF AND BRAVE CIVILIAN."
"
THAT
The Duke of Cambridge has never been favourable to the granting of military titles to medical men in the army, and it is therefore not surprising that he should speak of Surgeon-Major Robertson as "that brave civilian." The British Medical Journal has the following caustic article on the subject : The Duke of Cambridge was not altogether which he made in happily inspired in the speech ' The Army' at the response to the toast of Royal Academy dinner. Lonis XIV, historians tell us, claimed the victories of his generals as his own, but the Duke of Cambridge goes far beyond the Grand Monarque in the sublime assurance with which he claims credit for the efficiency and success of a force with which he has had no to do than he had with the victorious more advance of the Japanese Army. The British public will stand a good deal from a Royal Duke, and the plain speaking which this unlucky piece of after-dinner oratory has caused shows that the provocation must have been excessive. Certainly if accurate self-knowledge be the aim of the philosopher, His Royal Highness should be grateful to the newspapers which have so assiduously held up to him the mirror of candid criticism during the past week. We should have been glad to have left this unpleasant duty entirely to the lay press, but as the Duke of Cambridge himself went out of his way to offer what we can only characterise as a wanton affront to the medical officers of the army, we feel bound to take notice of this further indiscretion. Whilst pa}dng a well-merited tribute to the heroic defenders and relievers of Fort Chitral, H. R. H. made use of the expression that brave civilian, Dr. Robertson,' as distinguished from certain other equally brave officials. We have read his speech attentively, and we cannot but feel convinced that the phraseology employed if so it is all the more was used advisedly; regrettable, as, no matter what may be the Duke's personal views as to the proper position of medi?
"
"
"
'
INDIAN MEDICAL GAZETTE.
234
cal officers in the
military machine, he, as Comshould and must have known that the Political Agent at Chitral was a surgeonmajor on full pay in the Indian Medical Service, and as such was possessed of a military title, and as much a militaiy man as any other member of the garrison. We feel sure that when this speech is read in India it will arouse feelings of great bitterness in the ranks of the Indian Medical Service. It has been made at a most inopportune time. The military medical services of the Crown are notoriously dissatisfied, and this fresh and apparently wanton blow at the status of officers of the Indian Medical Service from so high a personage as the Commander-inChief will, we fear, cause fresh discontent. Only last week we alluded to the fact that certain changes are to be made in the system of the entrance examination for the Army and Indian Medical Services, with a view to ensuring the best class of candidates for commissions. Surely these publicly-expressed views of the Duke of Cambridge will not tend to encourage the ambition of good class candidates presenting themselves for either the Indian or Army Medical mander-in-Chief,
Service.
"We venture to think this speech of His Royal Highness will have far-reaching effect, and probably in a direction with which he is least in s}7mpathy. If the officers of the medical service
of the Indian army are civilians, let it be authoritatively ruled so; let them no longer wear their distinctive uniform, and no longer be subject to militaiy laws, rules, regulations, and rates of pay. If the responsible military advisers of the Crown honestly and truly consider that medical aid for the army should be furnished by a civilian staff, let them say so openly, so that the individual officers themselves and the profession may know the exact status of the medical officer. The medical, like the engineering, is primarily a civilian profession, but the one as much as the other has its military side. The surgeon-major, endowed with political powers, 110 more loses his army title and rank than the engineer major, detailed to look after irrigation works, loses his. We hope that this matter may not be allowed It establishes a very serious to rest as it is, condition of affairs. If the dictum of the Commander-in-Chief is allowed to pass unchallenged, and by inference is to be interpreted as receiving the approval of the India Office, as defining the true status of the army surgeon in the official community, public opinion will know how to appreciate the position." LONDON LETTER. London has reverted to its normal death-rate. troubles are less common and fatal, and influenza has almost disappeared. Spring has " " season come with all its charms and the is in
Respiratory
full
swing.
The list of
[Jone
big
men
1895.
wlio succumbed
"
malady?" flu as it is called dwindling ; but recovery of strength
to the fashionable
for short?is " flu" is a slow process. and condition after The most remarkable feature of the disease is the depressing effect it exercises upon the nervous system. A man who has gone through a sharp attack looks aged, anxious and shattered. He cannot eat or sleep or take exercise as he used to and is decidedly " down on his luck." Even rest and a change to the seaside are not so beneficial as in convalescence from other acute maladies, and the damage to constitution and health caused by one or several attacks of influenza is sometimes irreparable and permanent. To the aged and infirm it too often proves a death-blow ; but even the young and robust feel its power for long. A new departure in medical education has been made by St. George's Hospital Medical School in appointing Dr. Patrick Manson lecturer on Tropical Medicine. The selection is an admirable Dr. Manson is best known as the discoverer one. of the office performed by the mosquito, in the development and propagation of the filaria sanguinis hominis ; but he has worked at tropical diseases all round, and no man living has a better theoretical and practical knowledge of them. His recent researches regarding the malaria organism indicate that he is diligently pursuing his studies of the complaints peculiar to the tropics by the most scientific methods. As physician to the Greenwich Seamen's Hospital he enjoys special advantages for observing the effects recent and remote of residence in all tropical localities both in white and coloured races, and a long and large practice in China has qualified him to make the The medical student most of his opportunities. of the present day has no light task in mastering the elements and general principles of the numerous subjects which constitute the cardinal and essential constituents of the medical curriculum and the propriety of burdening him with a new speciality may be questioned. Indeed the proper place of specialities in medical education would be post-graduate rather than pre-graduate, and we are not by any means sure that it is wise to burden students with courses of lectures which are not, strictly speaking, necessary. Still it is a good thing to have special subjects taught in medical schools by competent men and to give students and young graduates opportunities for gaining the best available knowledge concerning them, should inclination or interest render it advisable to take them up. Medical employment in the tropics is in these days becoming very common, and a man proceeding to practise in India, China, Central Africa or America ought to be provided with some information regarding the nature of his work and the best methods of accomplishing it. The report of the Opium Commission has, it appears, been completed, but some formalities
June
1895.]
PISANI ON TYPHUS FEVER.
have still to bo gone through, and its publication and distribution are not to take place for some days. The main points of the report have leaked out, and it is satisfactory to find that the violent tirades of missionaries and fanatics have not been justified by the evidence recorded by the Commission, and that no interference with the cultivation of the poppy and commerce in opium, as at present conducted, is considered necessary or advisable. On the other hand, full acknowledgment is made of the great benefits which the moderate consumption of opium confers upon sufferers from distressing ailments in India and China. I shall probably have more to say about this report in my next letter. The question regarding the role which water plays in the dissemination of cholera has been pushed once more to the front by the publication of an English translation of Professor Koch's work " On the Bacteriological Diagnosis of Cholera, Water Filtration and Cholera and the Cholera in Germany during the Winter of 1892-93." Koch, while admitting that there are other media and means by which the cholera organism may obtain access to the intestinal canal of men, considers water as the most common vehicle. An excellent article in the Lancet of 6th April makes it clear that he has x*ather strained the facts of the HamburgAltona outbreak in support of the water theory, and has failed to give sufficient prominence and weight to other factors, more especially altitude, drainage, sewage and general sanitation. Nothing but harm can come of pushing any cholera theory too far, for this leads to neglect of other conditions which may have a considerable? equal or superior?influence in causation. It is quite true that the purity of drinking water is a matter of transcendent sanitary importance, and that the history of cholera has placed this matter in a position of demonstration as regards the prevention of that disease ; but to treat water as the exclusive culprit in cholera causation and look to water purification as the only means of checking cholera epidemics is to take too narrow a view of the requirements of the case unless every other possible sanitary reform is made to converge on the purity of water, but may be endangered by sanitary neglects of any and every sort, appertaining to soil, air, habitation, food, clothiug and the usages of domestic and commercial life. A report has recently been issued by the Local Government Board concerning the prevalence of cholera in England in 1893. There are two curious points in this report. One is the evidence that the disease was conveyed and spread from the coast towns into which it was imported inwards by excursionists and pleasure-seekers, just that pilgrims as it is believed by most people disseminate the disease in India and frequenters of fairs in Russia. The other is the suspicion that the oyster which has got into such bad as a link in the causation of typhoid fever,
repute
235
may also serve to carry the organism or poison of cholera from place to place. Tidings have come of the outbreak of cholera at Kamarin, the quarantine station of Mecca pilgrims. This is a most serious matter and will probably serve to keep alive the praiseworthy agitation which has for its object the prevention of the terrible loss of life which yearly takes place in connection with this great gathering of devout
Moslems. 12th
April
1895.
