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ARMY MEDICAL DEPARTMENT REPORT FOR THE YEAR 1895.1

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616 the length was 16,723 yards. The total length of pipes on ’Dec. 31st, 1896, was 480 miles. NMmbe’l’ of hydrants.-The number of hydrants erected in ’1895 was 156, and in 1896 was 204. The total number on Dec. 31st, 1896, was 942. Comnzzcnicrztion with other companies’ mains.-Filte1’ed water-Grand Junction : (1) at the junction of Edgware- road and Bayswater-road ; and (2) at Kilburn. New River: (1) at the junction of Tottenham-court-road with Oxford- street ; and (2) at the junction of Tottenham-court-road with Euston-road. Unfiltered water-Southwark and Vauxhall: at Marsh-gate, near Richmond. Houses under constant supply.-The number of houses receiving constant supply on Dec. 31st, 1894, was 50 985 ; on Dec. 31st, 1895, 55,933; and on Dec. 31st, 1896, 64,701. Total number of houses supplied.-The total number of houses supplied on Dec. 31st, 1894, was 78,486; in December, 1895, 79,644 ; and in December, 1896, 80,697. Percentage of hoitses under constant snpply.-On Dec. 31st, 1896, the percentage of houses under constant supply was 80. Average daily s1lpply.-In 1895 the average daily supply per head was 35-66 gallons. In June the maximum was attained, the amount per head being 40’59 gallons, and the minimum occurred in the month of February the amount per head being 31’52 gallons. In the year 1896 the average daily supply was 34’5 gallons. The maximum supply was given in July and amounted to 39’8 gallons per head. The minimum supply was given in December and amounted to 31’3 gallons per head. Area of Szcpply. The Act of 1852 authorises the West Middlesex Company to supply the following places :- Partly supplied.-Chelsea (St. Luke, west of the boundary defined in the Act2), Chiswick (St. Nicholas), Ealing (St. Mary), Fulham (All Saints), Hammersmith (St. Paul), Ken- sington, (St. Mary Abbott), Paddington, Soho (St. Anne), St. Marylebone, St. Pancras (south of Fig-lane), Westminster (St. Margaret), and so much as lies within the town of ,Kensington. Not supplied.-Barnes (St. Mary), Battersea (St. Mary), Bloomsbury (St. George), Brentford (Old), Brentford (New), Hanwell (St. Mary), Heston, Hounslow, Isleworth, Kew (St. Anne), Mortlake, Putney (St. Mary), Richmond (St. Mary Magdalene), Strand (St. Mary-le-), St. Clement Danes, St. Giles-in-the-Fields, St. Paul (Covent-garden), I ’Westminster (St. James), and Wandsworth (St. Mary). I The Act of 1866 authorises the supply of Willesden, which is wholly supplied. Partly supplied: Acton (north of Great Western Railway), Hendon, and St. John (Hampstead). New Works in Progress and Projected. Reservoirs.-At Barn Elms two large reservoirs are in course of construction and will be completed in the early spring. They are situated near to the new ones described and are constructed on the same plan. They will be capable of storing 133,000,000 gallons of water. Tunnel1lnder the Thames at -ffaftt,2)tersfttith.-It is proposed to make a tunnel under the Thames between Barnes and Hammersmith for the conveyance of the mains which carry the filtered water under the Thames. ERRATUM.-By an obvious error the word " Chelsea " was written for Lambeth" " in the description of the map on page 543 of THE LANCET in last week’s issue. The map is perfectly correct. 2 Section 32 of the West Middlesex Waterworks Act, 1852, is so framed as to enable the Chelsea Company to exact a penalty from the West Middlesex Company in the event of the latter supplying within a certain defined part of the eastern portion of the parish of Chelsea. THE ANTI - TOBACCO LEAGUE AND JUVENILE SMOKING. - The members of the English Anti-Tobacco Society and Anti-Narcotic League met recently in Man- chester to the number of about a score. A letter of apology for absence was read from Mr. S. Smith, M.P., in which he said that he thought there would be no chance of passing the Bill suggested by the League to prevent juvenile smoking, but if any member liked to introduce it he would be glad to put his name to the back of the Bill. Dr. Martin of Manchester read a paper on Juvenile Smoking, in which he dealt with the injurious physical effects of the habit. ARMY MEDICAL DEPARTMENT REPORT FOR THE YEAR 1895.1 [CONCLUDING NOTICE.2] Among the diseases that were unduly prevalent during the year 1895 among the troops stationed in the colonies may be mentioned enteric fever at Bermuda, malarial fever at Mauritius, and venereal diseases in the Straits Settlements. At Bermuda in an average strength of 1447 enteric fever caused 107 admissions and 20 deaths, equal to ratios of 73’9 and 13’82 per 1000, considerably higher than the average rates for the previous nine years. The disease appeared early in June at Warwick Camp, being conveyed thence, it is believed, to other stations in the command. At St. George’s, where the drains were defective and the drainage works had been suspended owing to the great heat, the disease seems to have partaken of the nature of a severe outbreak, for there were 46 admissions to the station hospital there and 13 deaths. There should not be any great difficulty, with proper attention to water-supply and to the prevention of the leakage of sewage from drains and cesspits into the soil, in preventing the frequent recurrence of those outbreaks of enteric fever in Bermuda. We suspect, from what we have heard, that much of the disease of the digestive system at this station is attributable to food and cooking ; the supply of food is not sufficiently good and varied ; it is also apt to become tainted in such a hot, moist climate and the cooking is far from the best imaginable. , The Mauritius is a very unhealthy station owing to malarial fevers. Happily, the average strength (657) is small. Enteric fever caused 15 admissions and 6 deaths during 1895, but malarial fevers were the greatest cause of sickness. There were 460 admissions and 3 deaths-equal to ratios of 700’1 and 4’57 per 1000 respectively. The cases were returned as follows : ague 294, remittent fever 159, and malarial cachexia 7 ; 2 of the deaths were due to remittent fever and 1 to malarial cachexia. The invaliding-rate was also a heavy one. For very many years past the Mauritius has been a most unhealthy station as regards malaria-a very marked change in this respect having taken place since the severe and fatal epidemic of malarial fever that occurred over a quarter of a century ago at the time when Sir Henry Barkly was governor. Port Louis is particularly bad in this respect, and will continue so, it is feared, until extensive works are undertaken for subsoil drainage. Curepipe, in the uplands, is far healthier, and the troops are as far as possible quartered at this and other stations in the island. As regards the Straits Settlements the amount of venereal disease among the troops is deplorable. Including all its forms the admissions amounted to 853, the number con- stantly sick to 62’55, more than half the admissions and con- stantly sick from all causes. The admission ratio was 623’5 per 1000 in 1895, which is higher by 257’6 than the corresponding rate of the previous year and above the average rate by 210’0, A good deal of this increase, it should be.remarked, was attributable to a battalion having arrived during the year from India, bringing the disease with it. The reports of the medical officers make no allusion to anything else affecting the health of the troops. As regards India our comments and remarks must be brief. Enteric fever caused 1544 admissions into hospital, 383 deaths, and the constant sickness of 219077 men, being in the ratios of 22’6, 5 61, and 3’22 per 1000 respectively. This disease was rife among the troops, by the way, on the route to and from Chitral. A good deal is being said at the present time about the large prevalence of venereal diseases in India. Taking all forms together, the ratio of admission amounts to 536-9 per 1000, which is more than that of the preceding year by 25 2, and in excess of the average rate by 127’6, while for constantly sick the ratio was 46’31, repre- senting a loss of 3164-84 men to the efficient strength of the force from these diseases, higher than the rate in 1894 by 3’17, and above the average by 14’39. The reports of several medical officers dwell upon the virulent type of the disease, 1 Army Medical Department Report for the Year 1895, with Appendix. Vol. xxxvii. London : Printed for Her Majesty’s Stationery Office by Harrison and Sons, Printers to Her Majesty. 1896. Price 4s. 2 The first and second notices appeared in THE LANCET of Jan. 30th, and Feb. 13th, respectively.
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Page 1: ARMY MEDICAL DEPARTMENT REPORT FOR THE YEAR 1895.1

616

the length was 16,723 yards. The total length of pipes on’Dec. 31st, 1896, was 480 miles.

NMmbe’l’ of hydrants.-The number of hydrants erected in’1895 was 156, and in 1896 was 204. The total number onDec. 31st, 1896, was 942.

Comnzzcnicrztion with other companies’ mains.-Filte1’edwater-Grand Junction : (1) at the junction of Edgware-road and Bayswater-road ; and (2) at Kilburn. New River:

(1) at the junction of Tottenham-court-road with Oxford-street ; and (2) at the junction of Tottenham-court-road withEuston-road. Unfiltered water-Southwark and Vauxhall:at Marsh-gate, near Richmond.Houses under constant supply.-The number of houses

receiving constant supply on Dec. 31st, 1894, was 50 985 ;on Dec. 31st, 1895, 55,933; and on Dec. 31st, 1896, 64,701.

Total number of houses supplied.-The total number ofhouses supplied on Dec. 31st, 1894, was 78,486; inDecember, 1895, 79,644 ; and in December, 1896, 80,697.

Percentage of hoitses under constant snpply.-On Dec. 31st,1896, the percentage of houses under constant supplywas 80.Average daily s1lpply.-In 1895 the average daily supply

per head was 35-66 gallons. In June the maximum wasattained, the amount per head being 40’59 gallons, and theminimum occurred in the month of February the amountper head being 31’52 gallons. In the year 1896 the averagedaily supply was 34’5 gallons. The maximum supply wasgiven in July and amounted to 39’8 gallons per head. Theminimum supply was given in December and amounted to31’3 gallons per head.

Area of Szcpply.The Act of 1852 authorises the West Middlesex Company

to supply the following places :-Partly supplied.-Chelsea (St. Luke, west of the boundary

defined in the Act2), Chiswick (St. Nicholas), Ealing (St.Mary), Fulham (All Saints), Hammersmith (St. Paul), Ken-sington, (St. Mary Abbott), Paddington, Soho (St. Anne),St. Marylebone, St. Pancras (south of Fig-lane), Westminster(St. Margaret), and so much as lies within the town of,Kensington.

Not supplied.-Barnes (St. Mary), Battersea (St. Mary),Bloomsbury (St. George), Brentford (Old), Brentford (New),Hanwell (St. Mary), Heston, Hounslow, Isleworth, Kew(St. Anne), Mortlake, Putney (St. Mary), Richmond(St. Mary Magdalene), Strand (St. Mary-le-), St. ClementDanes, St. Giles-in-the-Fields, St. Paul (Covent-garden), I’Westminster (St. James), and Wandsworth (St. Mary). I

The Act of 1866 authorises the supply of Willesden, whichis wholly supplied. Partly supplied: Acton (north of GreatWestern Railway), Hendon, and St. John (Hampstead).

New Works in Progress and Projected.Reservoirs.-At Barn Elms two large reservoirs are in

course of construction and will be completed in the earlyspring. They are situated near to the new ones describedand are constructed on the same plan. They will be capableof storing 133,000,000 gallons of water.

Tunnel1lnder the Thames at -ffaftt,2)tersfttith.-It is proposedto make a tunnel under the Thames between Barnes andHammersmith for the conveyance of the mains which carrythe filtered water under the Thames.

ERRATUM.-By an obvious error the word " Chelsea " waswritten for Lambeth" " in the description of the map onpage 543 of THE LANCET in last week’s issue. The map is

perfectly correct.2 Section 32 of the West Middlesex Waterworks Act, 1852, is so framed

as to enable the Chelsea Company to exact a penalty from the WestMiddlesex Company in the event of the latter supplying within acertain defined part of the eastern portion of the parish of Chelsea.

THE ANTI - TOBACCO LEAGUE AND JUVENILESMOKING. - The members of the English Anti-Tobacco

Society and Anti-Narcotic League met recently in Man-chester to the number of about a score. A letter of apologyfor absence was read from Mr. S. Smith, M.P., in which hesaid that he thought there would be no chance of passingthe Bill suggested by the League to prevent juvenilesmoking, but if any member liked to introduce it he wouldbe glad to put his name to the back of the Bill. Dr. Martinof Manchester read a paper on Juvenile Smoking, in whichhe dealt with the injurious physical effects of the habit.

ARMY MEDICAL DEPARTMENT REPORTFOR THE YEAR 1895.1

[CONCLUDING NOTICE.2]

Among the diseases that were unduly prevalent during theyear 1895 among the troops stationed in the colonies maybe mentioned enteric fever at Bermuda, malarial fever atMauritius, and venereal diseases in the Straits Settlements.At Bermuda in an average strength of 1447 enteric fevercaused 107 admissions and 20 deaths, equal to ratios of 73’9and 13’82 per 1000, considerably higher than the averagerates for the previous nine years. The disease appeared earlyin June at Warwick Camp, being conveyed thence, it is

believed, to other stations in the command. At St. George’s,where the drains were defective and the drainage works hadbeen suspended owing to the great heat, the disease seemsto have partaken of the nature of a severe outbreak, for therewere 46 admissions to the station hospital there and 13deaths. There should not be any great difficulty, with properattention to water-supply and to the prevention of theleakage of sewage from drains and cesspits into the soil, inpreventing the frequent recurrence of those outbreaks ofenteric fever in Bermuda. We suspect, from what we haveheard, that much of the disease of the digestive system atthis station is attributable to food and cooking ; the supplyof food is not sufficiently good and varied ; it is also apt tobecome tainted in such a hot, moist climate and the cookingis far from the best imaginable.

, The Mauritius is a very unhealthy station owing to malarialfevers. Happily, the average strength (657) is small. Entericfever caused 15 admissions and 6 deaths during 1895, butmalarial fevers were the greatest cause of sickness. Therewere 460 admissions and 3 deaths-equal to ratios of 700’1and 4’57 per 1000 respectively. The cases were returned asfollows : ague 294, remittent fever 159, and malarialcachexia 7 ; 2 of the deaths were due to remittent feverand 1 to malarial cachexia. The invaliding-rate was also aheavy one. For very many years past the Mauritius has been amost unhealthy station as regards malaria-a very markedchange in this respect having taken place since the severe andfatal epidemic of malarial fever that occurred over a quarterof a century ago at the time when Sir Henry Barkly wasgovernor. Port Louis is particularly bad in this respect, andwill continue so, it is feared, until extensive works are

undertaken for subsoil drainage. Curepipe, in the uplands,is far healthier, and the troops are as far as possible quarteredat this and other stations in the island.As regards the Straits Settlements the amount of venereal

disease among the troops is deplorable. Including all itsforms the admissions amounted to 853, the number con-

stantly sick to 62’55, more than half the admissions and con-stantly sick from all causes. The admission ratio was

623’5 per 1000 in 1895, which is higher by 257’6 than thecorresponding rate of the previous year and above the

average rate by 210’0, A good deal of this increase, it shouldbe.remarked, was attributable to a battalion having arrivedduring the year from India, bringing the disease with it.The reports of the medical officers make no allusion toanything else affecting the health of the troops.As regards India our comments and remarks must be brief.

Enteric fever caused 1544 admissions into hospital, 383deaths, and the constant sickness of 219077 men, being inthe ratios of 22’6, 5 61, and 3’22 per 1000 respectively. Thisdisease was rife among the troops, by the way, on the routeto and from Chitral. A good deal is being said at thepresent time about the large prevalence of venereal diseasesin India. Taking all forms together, the ratio of admissionamounts to 536-9 per 1000, which is more than that of thepreceding year by 25 2, and in excess of the average rate by127’6, while for constantly sick the ratio was 46’31, repre-senting a loss of 3164-84 men to the efficient strength of theforce from these diseases, higher than the rate in 1894 by3’17, and above the average by 14’39. The reports of severalmedical officers dwell upon the virulent type of the disease,

1 Army Medical Department Report for the Year 1895, withAppendix. Vol. xxxvii. London : Printed for Her Majesty’s StationeryOffice by Harrison and Sons, Printers to Her Majesty. 1896. Price 4s.

2 The first and second notices appeared in THE LANCET of Jan. 30th,and Feb. 13th, respectively.

Page 2: ARMY MEDICAL DEPARTMENT REPORT FOR THE YEAR 1895.1

617

the severity of the constitutional infection, and the veryserious extent and nature of the inefficiency to which it givesrise.

Passing on to the appendices to the report we come to thaton the progress of hygiene for the year 1896, by Surgeon-Colonel J. L. Notter, the Professor of Military Hygiene at theArmy Medical School, Netley, which summarises and reviewsthe chief points of hygiene that have attracted attention

during the past year. The information contained in thesearticles is considerable and must obviously be valuable andvery useful to medical officers. All kinds of subjects bearingon sanitation are touched upon, and under the head of specialpoints of hygiene Ehrlich’s test and the so-called serumdiagnosis for enteric fever are briefly described.Under the head of a list of operations performed at the

Royal Victoria Hospital, Netley, during 1896 we find an

epitome of the surgery at that institution, with some excel-lent comments and remarks on the cases from the Professorof Military Surgery and the late assistant professor at Netley.The cases of abscess of the liver are well worth reading-indeed, the whole report is instructive. The highly im-portant and successful case of ligature of the common iliacartery by laparotomy for diffuse aneurysm of the external- iliac and common femoral vessels, the details of which werepublished in THE LANCET of Jan. 25th, 1896, is alluded to,together with that of a death from chloroform published inTHE LANCET of Sept. 26th, 1896.The report on the Ashanti Expedition, 1895-96, by Surgeon-

Major-General W. Taylor, M.D., late Principal MedicalOfficer of the expedition, strikes us as uncommonly good.The material is well arranged, the description and remarksare to the point, lucidly expressed, and of an eminentlypractical character. Surgeon-Major-General Taylor beginshis report by saying that the experience gained in theAshanti Expedition of 1874 was of the greatest assistance inplanning the medical part of the present one, and rendered- it comparatively easy to decide on what lines the arrange-ments should be made in view of the prevention and treatmentof disease. He lays down in general terms what were thepreventive measures followed; they were, in our opinion, wiseand good, and, what is more, they were eminently successful.As regards the selection of men we quite concur in thinkingthat men who have been previously exposed to and sufferedfrom malarious disease should not be sent on such an expedi-tion. Touching clothing, he remarks that drill is neither ascool nor as warm as serge; putties, such as worn in India, are,without doubt, more comfortable and suitable than leggingsor gaiters. With regard to the issue of a spirit ration,his remarks are very judicious and sensible ; used, as every-thing else containing a potency for good or evil must be, withcare and discretion it is good. The Pasteur-Chamberlandfilters sent out to the expedition were not a success. Theirconstruction was defective and they did not deliver more ’,than an average of five or six gallons in the field. Ice wasfound of the very greatest service for hospital use. Quinine I,was issued prophylactically, but, like Surgeon GeneralSir A. D. Home’s experience in the last expedition, was not Iffound to be of much, if any, good; officers and men who Ihad taken the drug for weeks (as much as 300 grs.) were ’apparently as liable to fever as those who had not takenany. Arsenic was found to be of service in cutting shortague and remittent fevers. It was given in very bold doses-as much as forty minims or one drachm of liquor arsenicaliswere given for a dose without, it is stated, any bad result,provided the precaution were taken of giving a cupfulof milk, barley water, or soup immediately beforehand.There are a great many excellent hints and practicalobservations in the report which may. be very usefullyread. Not only companies and sections, but individuals,were looked after by officers personally, who saw that eachman rubbed himself down and changed into dry under-clothing at the end of each march ; that he had his tea,cocoa, or soup before starting and immediately on arrivalin camp, and that he drank no water that had not beenboiled. That the expedition was, from a hygienic andmedical point of view, well designed and admirably carriedout is the opinion both here and on the Continent.There is a very good reporb by Surgeon-Captain H. N.

Thompson on the cholera camp at Kokrail, Lucknow, fromJuly 31st to Aug. 27th, 1894. It will be rememberedthat the severe outbreak was traced to the use ofMacnamara’s filters. Surgeon-Captain Thompson says thatthe weak link in the chain of evidence for thetruth of the filter theory is that the epidemic decreased

immediately after the water-supply was changed, even

though it was still passed through the filters, and italso decreased simultaneously in the neighbouring cityand district. If the filters were breeding the microbes whydid they not, he asks, continue to do so ?

Dr. A. E. Wright, the Professor of Pathology at Netley,has an elaborate and well-reasoned paper on the Pathologyand Therapeutics of Scurvy, in which he works out the viewthat all the symptoms of scurvy are perfectly consistent withthe theory that the disease consists essentially in an acidintoxication. The article is an acutely and exhaustivelyreasoned one and will repay careful perusal.

BUBONIC PLAGUE IN INDIA.

WE are glad to begin our report and chronicle this weekby the statement that there is at length, according to tele-graphic intelligence from Bombay of the 23rd inst., sign ofimprovement in the epidemic, the mortality tables for

Bombay during the preceding six days showing a distinctdecrease as compared with the past few weeks.According to the official returns telegraphed to the

Secretary of State for India, in continuation of those

already published, it appears that the deaths fromall causes in Bombay city for the week endingFeb. 19th were 1772 and the reported deaths from plague843. The disease continues to show greatest activity innorthern portions of the city. Two new hospitals are beingprepared. Poona city returns show no increase ; one

indigenous case occurred in the cantonment during the week.In Coorla, Bandora, Bhiwandi, and the rest of the Thanadistrict the cases have somewhat increased in numbers, butthe disease has not spread to fresh places. In Karachithe deaths from plague for the week ending Feb. 19thhave been 235; the disease has shown a slighttendency to spread, but it is diminishing in thosequarters where it was formerly worst, except in the poorestMahommedan quarters. Six indigenous cases have occurredin Sind, outside Karachi. Notwithstanding the free egressof the population which has taken place from Bombay inthe past and that some of the fugitives have carriedthe disease with them, so that cases have occurredas far to the south as Bangalore and Belgaum andnorthward as far as Delhi, the disease has not acquiredany firm foothold in the country. Up to the present therehave been no cases in Calcutta and the plague has notsucceeded in effecting any lodgment in Upper India. Underthe Epidemic Diseases Act local officers have full powers ofaction, and the efforts to deal with the disease generally, toprevent or limit its spread, and to evacuate and improve thesanitation of infected towns and places have been of themost radical, strenuous, and energetic kind and are beingsystematically carried out. One Indian paper, the Bombay6azette, we may parenthetically remark, has entered a strongprotest against the sensational telegrams that have been sentto, and published in, this country, giving rise to an unnecessaryamount of alarm both here and on the Continent. There is,no doubt, a natural tendency during times of more or lesspanic to exaggerate and to "pile up" the figures anddetails. Be this as it may, the effect of the prevailingepidemic on the material interests of Bombay has been veryconsiderable ; but we hope that the worst is now over, and wemay also hope and believe that it has not been without somecompensatory advantages in that the epidemic has compelledattention to the sanitary state of the city and has led toimprovements in this direction not only in Bombay but inmany of the other cities and large towns of India.

Dr. Yersin of the Pasteur Institute, whose scientific andbacteriological work in connexion with the plague in Chinais well known, has left for Bombay, and we may soon expectto hear of the employment of his anti-plague serum in thattown and elsewhere in India. Meanwhile Professor Haffkinehas been preparing and using in India a prophylacticlymph. Rogers Pasha, the Director-in-Chief of the EgyptianSanitary Department, has arrived in India, and has beeninterviewed by one of the staff of the Times of India. It

appears that in many respects Bombay does not compare atall unfavourably with Cairo and other towns of Egypt asregards sanitation.


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