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ARMY MEDICAL SCHOOL, NETLEY

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312 and at the latter 158 and 4 52 per 1000 of strength. Up- wards of half the cases occurred in the third quarter of the year, and nearly one in three proved fatal. It is noteworthy that in Upper Burmah only 3 8 cases and 1 62 deaths per 1000 occurred. "The administrative medical officer reports that the cause was in no instance traceable, and he adds that the general freedom from enteric fever throughout the country is most remarkable, considering its insanitary condition; in- deed, sanitation may be said to be practically non-existent." There were 54 cases and 40 deaths of cholera in the com- mand, being in the ratio of 3’9 and 2 84 per 1000, but all except two, of which one proved fatal, occurred in Burmah. In Upper Burmah the cases amounted to 25 9 and the deaths to 19-94 per 1000 of strength. The cases, however, are understated, as 5 deaths on the march have not been entered among the admissions. These would raise the ratio to 28-6 per 1000; four-fifths of the cases occurred in the second quarter of the year. There was a marked increase in malarial fevers, but this also was due to Upper Burmah, where the admissions for this class amounted to 961 per 1000. Venereal diseases were the cause of 359 admissions and a constant inefficiency of 26’41 per 1000 of strength, being almost identical vith the results of the preceding year. In the class of injuries 33 deaths appear, of which 2 were from wounds received in action ; of the others, 9 were by heat apoplexy and 3 by sunstroke, 3 were suicidal and 7 by accidental drowning. Of 365 officers, 6 died and 40 were invalided to England, being in the ratio of 16’44 and 109 4 respectively. Of the deaths, 1 was from gunshot wound received in action, 1 from snake bite, 2 from hepatitis, 1 from cholera, and 1 from enteric fever at Bellary. The death-rate of the women was 13 05 per 1000. There were 3 deaths from tubercular phthisis, 1 from cancer, and 1 from hydrophobia at St. Thomas’s Mount. In an average strength of 1627 children there were 70 deaths, or 43’02 per 1000. One of the deaths among them also was from hydrophobia. The average strength of European troops in Bombay was 11,925. The admissions were 1371, the deaths 12-24, the mean sick 68’43, and the invalids sent to England 24 82 per 1000; the admissions and mean sick being higher and the deaths and invaliding lower than in 1887, and all except the mean sick considerably under the decennial average. The highest ratio of admissions was at Satara and the lowest at Deesa, and at neither of these did a death occur; the highest ratio of deaths was at Ahmedabad, chiefly due to enteric fever. There were 137 cases of enteric fever and 48 deaths, being 11 ’5 and 4 02 per 1000. The stations at which it was most prevalent and fatal were Ahmedabad, Poona, Ahmed- nagar, Nasirabad, and Neemuch. At none of these could any special cause for the disease be traced, but the principal medical officer remarks that " at Poona there has been great reason to complain of the inadequacy of the conserv- ancy arrangements as carried out by the municipality, and possibly the greater prevalence of enteric fever may have been influenced by the defective sanitation, but elsewhere there have not been any such defects to notice." Bom- bay was remarkably free from cholera among the troops, only 10 cases and 7 deaths having been reported. Of these, 7, including 5 of the fatal cases, occurred pt t Poona where the disease was prevalent in the city and surrounding country. All the cases were admitted in the first half of August. At Ahmedabad, although a severe epidemic prevailed among the civil population for some months, there was only one fatal case among the British troops. The admission rate for all forms of venereal disease was 315 and the constant inefficiency 23’48 per 1000, both above the average. In the class of injuries, of a total of 24 deaths there were 9 from heat apoplexy, 3 from sunstroke, 6 from gunshot (of which 5 were suicidal), and 2 by accidental drowning. The strength of the officers was 375, of whom 6 died and 16 were invalided to England, or 16-0 and 42 7 per 1000 ; 2 of the deaths were from small- pox, 2 from accidental drowning, and I from fracture of the base of the skull, the result of a fall; the other death was from enteric fever. The death-rate among 564 women was 30’14 per 1000, and among 1075 children it was 60 46. The relative sickness, mortality, and invaliding by arms of the service in India during the year were as follows :- Admissions per 1000 of mean strength : Cavalry 1320, Royal Artillery 1471, Infantry 1410. Deaths in India, exclusive of dep6ts, garrison staff and departments, and troops on the march : Cavalry 15 ’76, Royal Artillery 16 46, Infantry 14 26. Invalids sent home : Cavalry 16’70, Royal Artillery 2361, I and Infantry 2L 85. It would appear, therefore, that the Artillery furnish the highet proportion of admissions, deaths, and invalids ; the Cavalry the lowest of admissions. and invalids ; and the Infantry the lowest death-rate. The average strength of British troops employed in Egypt was 3346. The admissions into hospital were in the ratio. of 1024, the deaths of 14 64, the mean ick of 64 58, and the invaliding of 22’41 per 1000. The principal stations occupied were Cairo and Alexandria, the average strength at the former being 2183 and at the latter 1061 ; the admissions at each closely corresponded, but the death-rate at Cairo was highest, amounting to 16’4 per 1000 as against 94 at Alexandria There were 14 cases of srinall-pox, with 4 deaths, all at Cairo. Enteric fever caused 96 admissions and 20 deaths, being 28 7 and 5 98 per 1000 of strength, both slightly under the amount in the preceding year. Its prevalence and mortality were nearly identical at Alexandria, and Cairo. It is stated that "the death-rate of the civil population in Egypt is very high, but enteric fever does not appear to be at all common among the civil community, & fact which has its parallel in India and elsewhere." Dysentery gave rise to 50 admissions and 2 39 deaths per 1000. It was nearly twice as prevalent at Alexandria as at Cairo. The principal medical officer reported that the treat- ment by sulphate of magnesia was found to be the most efficient, combined with milk diet ana bland fluids, such as barley water. The admissions by all classes of venereal ciseases amounted to 265 and the constant inefficiency to 18 52 per 1000. There were only 3 deaths from injuries; 1 resulting from falling from a window, 1 from rupture of viscera (the man having fallen off a transport waggon), and 1 fracture of skull from a fall from a horse. One officer died of diphtheria, a1Jd 2 women died, one of enteric fever and the other of nephritis. Of 195 children, 21 died, or 107’7 per 1000; diarrhoea, teething, and debility being the most frequent causes of death. The principal medical officer states that, notwithstanding all efforts to keep and maintain the barracks in " a wholesome and salubrious state, the cities of Cairo and Alexandria in which the troops are stationed are very insanitary places, and their inhabitants very unhealthy. In the year 1887, for example, the death- rate in London was 19’5 per 1000, whereas in Cairo it was 46’8, an excess of 27’3 per 1000. At Alexandria the mor. tality was 43 per 1000 for the same year. The mortality in Cairo is about 15’7 per 1000 over that of the most unhealthy European town." Dr. Marston suggests quartering the troops in the upper and best rooms of the barracks at Abassiyeh, which are structurally excellent, and capable of affording ample accommodation. The health of the troops on board ship appears to have been satisfactory, with the exception that 6 deaths, or 5.22 per 1000 of strength, occurred from pneumonia on the passage out, and that venereal diseases were very prevalent. Among troops proceeding on foreign service they gave an annual ratio of 599, among those returning home from abroad 445, and among those proceeding from one station abroad to another 486 per 1000; but it must be remembered that these annual ratios are calculated from observations extending over short periods of time. ARMY MEDICAL SCHOOL, NETLEY. THE summer session of the Army Medical School was brought to a close on Thursday, the 31st ult., when the positions taken by the surgeons on probation of the British and Indian Medical Services were announced, and the ceremony of distributing the prizes gained in the final examination took place. Ten surgeons on probation of the Medical Staff and seventeen of the Indian Medical Service had gone through the courses of instruction. The session had also been attended by a non-commissioned officer of the Medical Staff Corps, first-class Staff-Sergeant Fredk. Smith, who had been specially nominated by the Right Hon. the Secretary of State for War, at the recommendation of the King and Queen’s College of Physicians and Royal College of Surgeons, Ireland, of which Colleges Sergeant Smith wa a licentiate. A medical officer of the Imperial Japanese Service, Surgeon Yamomoto, had also, by permission of H. M.’s Government, attended the lectures and gone through the practical woik of the School during the session. Dr. W. M. ORD, of St. Thomas’s Hospital, distubuted the
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and at the latter 158 and 4 52 per 1000 of strength. Up-wards of half the cases occurred in the third quarter of theyear, and nearly one in three proved fatal. It is noteworthythat in Upper Burmah only 3 8 cases and 1 62 deaths per 1000occurred. "The administrative medical officer reports thatthe cause was in no instance traceable, and he adds that thegeneral freedom from enteric fever throughout the countryis most remarkable, considering its insanitary condition; in-

deed, sanitation may be said to be practically non-existent."There were 54 cases and 40 deaths of cholera in the com-mand, being in the ratio of 3’9 and 2 84 per 1000, but allexcept two, of which one proved fatal, occurred in Burmah.In Upper Burmah the cases amounted to 25 9 and thedeaths to 19-94 per 1000 of strength. The cases, however,are understated, as 5 deaths on the march have not beenentered among the admissions. These would raise the ratioto 28-6 per 1000; four-fifths of the cases occurred in thesecond quarter of the year. There was a marked increasein malarial fevers, but this also was due to Upper Burmah,where the admissions for this class amounted to 961 per1000. Venereal diseases were the cause of 359 admissionsand a constant inefficiency of 26’41 per 1000 of strength,being almost identical vith the results of the precedingyear. In the class of injuries 33 deaths appear, of which2 were from wounds received in action ; of the others, 9were by heat apoplexy and 3 by sunstroke, 3 were suicidaland 7 by accidental drowning. Of 365 officers, 6 diedand 40 were invalided to England, being in the ratioof 16’44 and 109 4 respectively. Of the deaths, 1 was fromgunshot wound received in action, 1 from snake bite,2 from hepatitis, 1 from cholera, and 1 from enteric feverat Bellary. The death-rate of the women was 13 05 per1000. There were 3 deaths from tubercular phthisis, 1 fromcancer, and 1 from hydrophobia at St. Thomas’s Mount.In an average strength of 1627 children there were 70 deaths,or 43’02 per 1000. One of the deaths among them also wasfrom hydrophobia.The average strength of European troops in Bombay was11,925. The admissions were 1371, the deaths 12-24, themean sick 68’43, and the invalids sent to England 24 82 per1000; the admissions and mean sick being higher and thedeaths and invaliding lower than in 1887, and all except themean sick considerably under the decennial average. Thehighest ratio of admissions was at Satara and the lowest atDeesa, and at neither of these did a death occur; the highestratio of deaths was at Ahmedabad, chiefly due to entericfever. There were 137 cases of enteric fever and 48 deaths,being 11 ’5 and 4 02 per 1000. The stations at which it wasmost prevalent and fatal were Ahmedabad, Poona, Ahmed-nagar, Nasirabad, and Neemuch. At none of these couldany special cause for the disease be traced, but the principalmedical officer remarks that " at Poona there has beengreat reason to complain of the inadequacy of the conserv-ancy arrangements as carried out by the municipality, andpossibly the greater prevalence of enteric fever may havebeen influenced by the defective sanitation, but elsewherethere have not been any such defects to notice." Bom-bay was remarkably free from cholera among the troops,only 10 cases and 7 deaths having been reported. Ofthese, 7, including 5 of the fatal cases, occurred pt tPoona where the disease was prevalent in the city andsurrounding country. All the cases were admitted in thefirst half of August. At Ahmedabad, although a severeepidemic prevailed among the civil population for somemonths, there was only one fatal case among the Britishtroops. The admission rate for all forms of venerealdisease was 315 and the constant inefficiency 23’48 per 1000,both above the average. In the class of injuries, of a totalof 24 deaths there were 9 from heat apoplexy, 3 fromsunstroke, 6 from gunshot (of which 5 were suicidal), and2 by accidental drowning. The strength of the officers was375, of whom 6 died and 16 were invalided to England, or16-0 and 42 7 per 1000 ; 2 of the deaths were from small-pox, 2 from accidental drowning, and I from fracture of thebase of the skull, the result of a fall; the other death wasfrom enteric fever. The death-rate among 564 women was30’14 per 1000, and among 1075 children it was 60 46.The relative sickness, mortality, and invaliding by arms of

the service in India during the year were as follows :-Admissions per 1000 of mean strength : Cavalry 1320, RoyalArtillery 1471, Infantry 1410. Deaths in India, exclusive ofdep6ts, garrison staff and departments, and troops on themarch : Cavalry 15 ’76, Royal Artillery 16 46, Infantry 14 26.Invalids sent home : Cavalry 16’70, Royal Artillery 2361, I

and Infantry 2L 85. It would appear, therefore, that theArtillery furnish the highet proportion of admissions,deaths, and invalids ; the Cavalry the lowest of admissions.and invalids ; and the Infantry the lowest death-rate.The average strength of British troops employed in Egypt

was 3346. The admissions into hospital were in the ratio.of 1024, the deaths of 14 64, the mean ick of 64 58, and theinvaliding of 22’41 per 1000. The principal stations occupiedwere Cairo and Alexandria, the average strength at theformer being 2183 and at the latter 1061 ; the admissions ateach closely corresponded, but the death-rate at Cairo washighest, amounting to 16’4 per 1000 as against 94 atAlexandria There were 14 cases of srinall-pox, with 4deaths, all at Cairo. Enteric fever caused 96 admissionsand 20 deaths, being 28 7 and 5 98 per 1000 of strength,both slightly under the amount in the preceding year. Itsprevalence and mortality were nearly identical at Alexandria,and Cairo. It is stated that "the death-rate of the civilpopulation in Egypt is very high, but enteric fever does notappear to be at all common among the civil community, &

fact which has its parallel in India and elsewhere."Dysentery gave rise to 50 admissions and 2 39 deaths per1000. It was nearly twice as prevalent at Alexandria as atCairo. The principal medical officer reported that the treat-ment by sulphate of magnesia was found to be the mostefficient, combined with milk diet ana bland fluids, such asbarley water. The admissions by all classes of venerealciseases amounted to 265 and the constant inefficiency to18 52 per 1000. There were only 3 deaths from injuries;1 resulting from falling from a window, 1 from rupture ofviscera (the man having fallen off a transport waggon),and 1 fracture of skull from a fall from a horse. Oneofficer died of diphtheria, a1Jd 2 women died, one of entericfever and the other of nephritis. Of 195 children, 21 died,or 107’7 per 1000; diarrhoea, teething, and debility beingthe most frequent causes of death. The principal medicalofficer states that, notwithstanding all efforts to keep andmaintain the barracks in " a wholesome and salubrious state,the cities of Cairo and Alexandria in which the troops arestationed are very insanitary places, and their inhabitantsvery unhealthy. In the year 1887, for example, the death-rate in London was 19’5 per 1000, whereas in Cairo it was46’8, an excess of 27’3 per 1000. At Alexandria the mor.tality was 43 per 1000 for the same year. The mortality inCairo is about 15’7 per 1000 over that of the most unhealthyEuropean town." Dr. Marston suggests quartering thetroops in the upper and best rooms of the barracks atAbassiyeh, which are structurally excellent, and capable ofaffording ample accommodation.The health of the troops on board ship appears to have

been satisfactory, with the exception that 6 deaths, or 5.22per 1000 of strength, occurred from pneumonia on thepassage out, and that venereal diseases were very prevalent.Among troops proceeding on foreign service they gave anannual ratio of 599, among those returning home fromabroad 445, and among those proceeding from one stationabroad to another 486 per 1000; but it must be rememberedthat these annual ratios are calculated from observationsextending over short periods of time.

ARMY MEDICAL SCHOOL, NETLEY.

THE summer session of the Army Medical School wasbrought to a close on Thursday, the 31st ult., when thepositions taken by the surgeons on probation of the Britishand Indian Medical Services were announced, and the

ceremony of distributing the prizes gained in the finalexamination took place. Ten surgeons on probation of theMedical Staff and seventeen of the Indian Medical Servicehad gone through the courses of instruction. The sessionhad also been attended by a non-commissioned officer of theMedical Staff Corps, first-class Staff-Sergeant Fredk. Smith,who had been specially nominated by the Right Hon. theSecretary of State for War, at the recommendation of theKing and Queen’s College of Physicians and Royal Collegeof Surgeons, Ireland, of which Colleges Sergeant Smith waa licentiate. A medical officer of the Imperial JapaneseService, Surgeon Yamomoto, had also, by permission ofH. M.’s Government, attended the lectures and gone throughthe practical woik of the School during the session.Dr. W. M. ORD, of St. Thomas’s Hospital, distubuted the

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prizes and delivered an address to the surgeons about toreceive commissions in the two public services. He wasaccompanied by Mrs. Ord; by Surgeon-General Sir J Fayrer,K.C.S.1., F.R.S , Physician to the Secretary of State forIndia in Council ; Surgeon-General Sir J. H. Ker-Innes,K.C.B., Q.H.S ; the Itev. Robert Whiston, and others.Director-General W. A. Mackinnon, C.B., was preventedby official business from leaving London. The militaryand medical staff of the Royal Victoria Hospital, theprofessors of the Army Medical School, and a largenumber of visitors, including many ladies, assembled inthe lecture theatre of the Royal Victoria Hospital. Here,after the arrival of the visitors from London about noon,the usual official correspondence on the results of thesession, together with the lists of the surgeons on pro-bation as finally arranged, were read, and the names ofthe surgeons who had gained prizes or other marks ofdistinction announced. The lists and names of prizemenare printed elsewhere.

Dr. ORD, after handing the prizes with a few appropriateobservations to each recipient, then delivered his address,the chief topic of it being the proper relations betweenmedical attendants and their patients whether in militaryor in civil life. Dr. Ord was followed by Sir J. Fayrer,who referred principally to the Indian Medical Service, andshowed by numerous illustrations its great advantages as afield of professional practice, and the vast variety of open-ings afforded by it to diligent students in all departmentsof science. Sir J. Fayrer incidentally remarked that thedanger of separation of the Indian Medical Service fromNetley, which had been threatened for the last year or two,’had passed away for the present. He mentioned that hewas one of those who held firmly the conviction that the- connexion with Netley was of paramount importance forensuring the best interests, as well as for advancing theefficiency, of the medical department in England and inIndia; and he confidently looked to those who were nowleaving Netley, and shortly going to India, to maintain thathis conviction was a just one. After other observations,Sir Joseph concluded by congratulating Mr. Fred. Smith,who, though not gazetted, was no longer a non-com-missioned officer-on the special merits he had displayedduring the past session. He trusted that his examplewould serve as an honourable incentive to others of hiscorps, who, probably remembering that in the Frencharmy it had been said that every French soldier carried aleetle hackneyed marshal’s baton in his knapsack, mighthenceforth say that every non-commissioned officer of theMedical Staff Corps carried with him the emblem of officeof an Army Medical officer, however high might be hisgrade.

After a few concluding proceedings, the large party ofladies and gentlemen present adjourned to the spaciousmess-room in the officers’ quarters, where they were enter-tained at luncheon.

ARMY VETERINARY DEPARTMENT.THE ANNUAL STATISTICAL AND GENERAL REPORT FOR

THE YEAR ENDING DEC. 31ST, 1889.

THE report of the Principal Veterinary Surgeon showsthe average strength of the army horses in the United

Kingdom to have been 13,091, the admissions to treatment7693, the deaths 308, the number cast 1398, and constantlyunder treatment 496’4. These figures give the ratios ofB88 cases, 23-53 deaths, 106’8 cast, and 37 9 constantlysick, per 1000 of strength. The admissions were 10 per1000 lower, but the deaths, castings, and mean sick werehigher than in 1888. The highest proportion of cases

occurred in the Royal Horse Artillery and the ArmyRemount Department, and of deaths in the Heavy Cavalry.The infantry transport, in a strength of 147, had no death.Surgical diseases and accidents were much the most frequentcause of admissions, follo wed by diseases of the locomotoryapparatus and of the respiratory organs. The last gave the’highest proportion of deaths, amounting to 5’58 per 1000.Diseases of the locomotory apparatus and those of thedigestive organs were next in order. Of 56 deaths in thelocomotory class 52 were returned in the column of

"destroyed," and of these, 32 were in consequence of

fracture; 6 more appear under that head in the clas ofaccidents as destroyed, and 5 in the column " died," makinga total loss of 43 from fractures. Not a single case ofglanders or farcy occurred during the year.

In the class of zymotic diseases there were 362 adrnis-sions for strangles, 125 for epizootic fever, and 80 for in-fluenza ; their greatest prevalence was in the 2nd LifeGuards in Regent’s-park Barracks, where the ratio amountedto 400 per 1000; in Leeds it was 140, in Dublm 121,and in Hyde Park Barracks 103 per 1000. There were 223cases under treatment for laryngismus paralyticus (roaring),with the result of 7 cured, 103 relieved, 14 destroyed, 86returned as incurable, and 13 remaining in hospital. Inthe return of "cast and sold," 199 appear under this head.On this subject Dr. Fleming says: "Uf those reported curedand relieved, a number have undergone the summer drills oflast year, and performed long marches, while others whichwere cast and sold-some for causes other than roaring-realised a much larger average price than usual. As a detailedstatement of the results of surgical treatment for this con-dition would occupy too much space here, a special reporton the subject is being prepared." We cannot but regretthat Dr. Fleming did not publish before his retirementfrom the service a complete official statistical summaryof the results of his operations for this disability. Wetrust that he will use every means in his power to havea careful numerical analysis of the cases prepared andpublished. The most frequent causes assigned for castingwere old age, for which 383 horses were sold, being 29 3per 1000 of strength ; roaring 199; physically unfit 192;and prematurely worn out 114. The average price obtainedfor the animals cast and sold was £14 2s. 2d., and theaverage length of their service had been about seven yearsand a half. There were 238 mules employed, of which 101came under treatment ; none died, and ten were cast. Ofthe cases, 48 were diseases or injuries of the locomotoryapparatus and 47 surgical diseases and accidents. Dr.

, Fleming has again called attention to the risks attendingthe purchase of remounts at too early an age. " I may beaiioweu to repeac lJlla,1J mere would be mucii less mortalityand undoubtedly less casting, while horses could be retainedlonger in the service if they were excluded from the rankstill they were at least five years old. Until they haveattainedthat age they should not be considered effective.......The presence of so many immature horses in regiments isalso a source of embarrassment and expense, as they requireso much attention, medical and otherwise, and hampertroops in their movements."The average strength of the horses employed in Egypt was

329, and of mules 174. Of the former, the cases of diseaseand injury were 778 and the deaths 79’03, and of the latter471 and 5’75 per 1000 of strength. Of the 26 death of horses,8 were from diseases of the digestive apparatus, and ofthese 6 were returned as scrotal hernia; 6 were destroyedon account of glanders and farcy, 6 for injuries of the loco-motory apparatus, 4 died of pulmonary disease, 1 of syncope,and 1 was destroyed on account of lymphangitis. The onlydeath among the mules was from metritis.

In Natal the strength of horses and mules, the details ofwhich are not stated separately, was 661 ; the admissionswere 480, the total deaths 23, and the cast and sold 44, ex-elusive of 61 of the Mounted Infantry on reduction ofestablishment. These give the proportions of 726 cases,34.80 deaths, and 66-57 cast and sold per 1000 of strength.There was only one fatal case of horse sickness returned underthe head of " fever specitie,," but there were 7 fatal cases ofanthrax. No remark is made regarding these, and it ispossible that, as pointed out by Mr. Nunn in the Reportfor 1888, cases of "horse sickness" may still be returnedunder this head. Five deaths were from diseases of therespiratory, and 6 from those of the digestive organs, Itis worthy of note that no death was recorded under theclass of locomotory apparatus, and only 1, from fracture ofvertebrae, under surgical diseases and accidents.The army veterinary school at Aldershot continues to do

good work. During the year 112 officers attended, of whom107 received certificates. At the two courses for farriersand shoeing smiths and "cold shoers" 132 attended, ofwhom 128 were examined, and 118 passed. "rhe numberof men at present in the ranks competent to shoe is 586.There are also under instruction as cold shoers’ 166 men."The arrangement noticed in last year’s report for obtain-

ing a supply of animal vaccine for the army has beencarried out successfully. The amount of lymph procured


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