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be their sole and only use. They should embody all the essentials of a small and perfectly equipped land hospital, thinfectious fever cases excepted. The propelling power should mbe arranged to leave ample space for wards, yet be strong sic

enough to keep the ship within signalling distance of the fleet, sa

Her tonnage should allow of a lower deck partially below inthe water. with port-holes, a middle deck, a main deck, and acan upper deck. She should be of steel or iron and wood- wcased on the outside for coolness. Large doors should be in se

the ship’s side for transport and a platform outside to act as a to

stage which 6could be hauled up against her side when tonot required. Each deck should be cut off from the decks ofabove and below. Ventilation could be procured by shafts. olEach deck should be approached from the upper deck by a b<

separate companion. Lavatories and water-closets should Hbe provided for each deck and in the "companion" space. tlWards should extend across the ship for purposes of through R

light and draught. Beds and cots should be swung by short ir

slings, but they should be capable of fixation by iron stays. Sl

Operation wards should be on the upper deck and near a lift pwell opening into the surgical ward. The lift should be able Sto take a mattress of the same size as those used in the wards. a:

A special research room should be provided in the immediate rr

vicinity of the operation ward, separated from it by a space. BThe PRESIDENT made a few remarks, commending the g

suggestions of Inspector-General Ninnis, and invited a

discussion. a

Inspector-General TURNBULL deprecated the complication of surgical arrangements and appliances, also a too great o

elaboration of detail in the arrangements of hospital ships; khe advocated the provision of good ventilation and the I

facility of segregating infectious and other special cases. IHe thought that the desired results could be arrived at bin some such simple manner as that suggested by Lord Lister. v

Staff Surgeon W. E. HOME, R.N., contributed paper com- v

posed chiefly of statistical matter on The Healthfulness of Modern Warships, s

and emphasised the following points :-The only source of . a

information was the annual report of the health of the navy; x

early iron ships were, by the experience of the training service, shown to be healthier than wooden ships ; the early

‘

central battery ships were healthier than the early iron-ships; the turret ships were healthier than the central

cbattery ships, shown by experience with Malta fever ; the cnew first-class battleships now in the channel were healthier ‘than were the old channel ships ; and the best way to secure ta healthy ship was to "keep her well ventilated and dry."

"

In the discussion which followed Inspector-General (TURNBULL said that the crews on wooden ships were subject ito sloughing ulcer, and infectious diseases usually spread like wildfire when once they obtained a footing on a wooden ship.Cerebro-spinal fever was not unknown in connexion withwooden ships.

Fleet Surgeon KIRKER did not think that the sanitary conditions on board ship were all that could be desiredchiefly because the necessary cubic space was not obtainable.The greater the reduction of the ship’s complement of men the better the health records became.

THURSDAY, AUGUST 1ST. The proceedings of this section were opened with a paper

contributed by Sir WILLIAM MAC CORMAC, Bart., K.C.B.,K.C.V.O., to a crowded meeting, entitled,

Some Remarks by Way of Contrast on War SurgeryOld and New

He dealt with the position attained and yet to be attainedin general estimation of the sterling merit of the medicalofficer of the army and quoted from McWhinnie’s intro-

ductory address at St. Bartholomew’s Hospital in 1856Colonel Ambert’s touching eulogy of the military surgeonduring and after battle. He agreed with McWhinnie thatthe blame attached to the medical department of thearmy at the beginning of the Crimean campaignwas due to non-adoption by the authorities of theirrecommendations and when these injunctions were tardilyattended to matters improved markedly. The results ofsurgery in the Crimea far surpassed (according to Dr.Balfour, then of the Royal Military Asylum, Chelsea) theanticipations of even the best friends of the department. He

compared the Peninsular, Crimean, American, and Franco-German wars with the South African war as to length ofstruggle, number of wounded, and strain upon the Army

Medical Department. He said that in considering mattersthere must be taken into account the organisation of themedical corps, the improvement in means of transport of .

sick and wounded, the formation of hospitals and commis-sariat supply. He mentioned the introduction of chloroforminto field work and stated that Baudens mentioned it as beingadministered 25,000 times without a single fatal result. Itwas more precious in the field than in civil practice. Anti-septics were not employed in the Austro-German war and onlyto a slight extent in the Franco-German war. He nexttouched upon the mortality after operations and gave a listof the serious septic surgical accidents then prevalent afteroperation, and mentioned the heavy mortality in fractures ofbones and the great number of deaths from hsemorrhage.He explained the bearing that the large bullet had onthe increased mortality, and he mentioned Bergman’s andReyher’s success in treating bullet-wounds of the knee-jointin the Russo-Turkish war. In Egypt in 1882 antisepticsurgery prevented the occurrence of one single case ofpost-operation sepsis, as gangrene, erysipelas, pyasmia. InSouth Africa chloroform and morphia were universally usedand gave blessed relief from much pain and suffering. Themodern bullet caused less shock and less injury to tissues.Bone was damaged in a limited degree and recovery wasgenerally rapid and without complication. The bullet was

aseptic, did not as a rule carry clothing into the wounds, andacted mainly as the producer of subcutaneous wounds, there-fore frequency of recovery was great. Bullet-woundsof the abdomen, thorax, head, joints, spleen, liver, and

kidneys were commonly less fatal than ever before known.Large arteries were cut without any appreciable haemorrhage.In the Crimean and the Franco-German wars deaths from

haemorrhage in the field were about 20 per cent. ; in theSouth African and the Cuban wars deaths from this causewere comparatively rare. He did not advise interferencewith resulting arterio-venous aneurysms unless complicated.Non-interference was what was found in South Africa tosuit the majority of every class of injury, especially inabdominal cases. He then compared the mortality frominjuries occurring to various parts of the body in thevarious campaigns, as the thigh, the chest, the head, theabdomen, &c. Amputations would be found to have beenamazingly rare. He next compared the relative numbersof killed and wounded in the South African war and thosecasualties occurring in previous wars. In the American warone man was killed for every four and a half men whowere wounded ; in South Africa only one man was killed

’

to every seven men who were wounded. From 6 to 8per cent. now died from wounds ; in America 14&frac12; per cent.

. died. Sir W. Mac Cormac next touched upon the causes ofthe small mortalitv in South Africa and he cited the lists of’ killed and wounded at Gravelotte, St. Privat, Koniggratz,

Waterloo, and Mars-la-Tour, when the killed often exceeded10,000 in a single fight, and the wounded ran into tens ofthousands. On the other hand, in South Africa, whereas at

’ Colenso the Boers had five only killed and 25 onlywounded we suffered a loss of 1100 casualties owing

’ to the Boers not being seen and our men fighting in theopen. The casualties were surprisingly small in number.He next dealt with the field dressings and commended thesame in a qualified manner. The Roentgen rays came in for

well-deserved praise as against the harmful and oft-disastrousr probe, a cause of much pain and suffering. He then gave an

’ account of the magnificent work done by the organisationsfor removing and attending to the wounded and the enormousdistance in aggregate travelled by the hospital trains, thegreat value of the hospital ships, and he laid the greatest

1 possible stress on the remarkable rapidity with which the1 wounded had been transported from the field of battle- two places where every care and luxury had been provided.3 He concluded a paper of world-wide interest by a reference1 to the bad old days when the wounded were allowed to lie outt on the field of battle to be robbed and murdered by thieves and cut-throats among camp followers.1 The PRESIDENT characterised Sir William Mac Cormac’sr paper as being above comment or criticism, and he said thatthe paper was a most remarkable vindication of the Royalf Army Medical Corps in South Africa.. Dr. ROBERT FARQUHARSON, M.P., also characterised the3 paper as being far beyond criticism. The country ought to be2 grateful to Sir William Mac Cormac for his noble work, his- experiences, and the recounting of them. He agreed withf the President that the paper thoroughly vindicated the RoyalyArmy Medical Corps. It was most ungenerous of the

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general public to have so treated men working hard on behalf iof the suffering. He had asked on the floor of the House of 3Commons that the Government would speak some cordial 1words of thanks to the Royal Army Medical Corps as they fully deserved it. They had sent out a commission to

inquire about the Royal Army Medical Corps but no icommission had been sent out to inquire about the failures tof generals and military departments ; it seemed that s

the Jonah of the services was the medical department.That commission reported favourably, for it could not havedone otherwise, and it was no packed or whitewashing com- mission, and to speak of it as such was an outrage and a scandal. The surgical skill displayed in South Africa was highly creditable to those employed. The favourable results 1

of this campaign as regards medical skill in the treatment Iof wounds would impart confidence to the soldier and as a consequence, he knowing himself to be surgically safe if awounded, would, if it were possible, fight with greater <

pluck. He cordially hoped that Sir William MacCormac’spaper would be widely circulated throughout the world. s

Fleet-Surgeon G. KIRKER, R.N., said that in theRusso-Turkish war, in which he happened to have been ’’

employed through the kind influence of Sir William Mac Cormac, he came to the conclusion then that conical bullets would inflict less severe wounds than sphericalbullets. He had put this on record and his prediction had anow come true. In Turkey compound bullet-fractures of the

thigh healed rapidly. Lung wounds were singularly rapidin recovery. He had seen knee-joints heal after injurywithout suppuration. Mr. Clinton Dent had brought forwardthe fact that the nature of the projectile was the real cause 1of the trivial character of the resulting course of the cure andnot so much the use of antiseptic surgery as was commonlysupposed, though the latter in great part contributed to afavourable result.

Surgeon-General T. F. O’DWYER, A.M.S., Principal MedicalOfficer, Aldershot, said that deductions by a master mind werewhat were wanted and Sir William MacCormac had given them, and that made his work so much the more valuable. AtWaterloo 50, 000 infantry had a front of three miles but inthe advance from Bloemfontein rather less than that numberhad a front of 20 miles. This contrast involved a markedincrease of medical transport. The antiseptic field dressingwas a most important part of the equipment and every manwas well instructed in its use. The medical department hadfound so much equipment that very little was left to supple-ment their efforts, as available material was exhausted. sothat showed that they had done much good work.

Surgeon-General J. B. HAMILTON, A.M.S. (retired), gave ashort account of the progress of the development and adoptionof the conical ball. The Snider-bullet had not been used in

fighting with the army. This was fortunate as the Snider-bullet would have been a most deadly bullet. Most fortu-

nately for humanity it went out. He thought that the Dum-Dum bullet was a deplorable mistake of the Government forwhich we had been suffering a just retribution in SouthAfrica. He gave the results of experiments on soft-nosedbullets recorded last year at the meeting of the section byhimself. The Dum-Dum bullet caused injuries out of all

proportion to what was necessary. The form of projectilewas vital to humanity. The medical profession should pressthe Government to abandon the soft-nosed bullet. TheGeneva Convention had condemned it and all found using itshould be court-martialled and promptly shot.

Surgeon-Major G. K. POOLE, M.D., referred to the menwho had come home from South Africa and noted that somehad suffered terribly, whilst others made quite light of theirinjuries.

Surgeon-General R. HARVEY, C.B., D.S.O., Director-General, Indian Medical Service, said that during the lastfive years the first field dressing had been issued to thewhole of the Indian army and had proved exceedingly valu-able. The loss from wounds was very small indeed. He agreedthat the Dum-Dum bullet should not be used against civilisedtroops, but when one came to deal with those of lowernervous organisation, such as savages, Soudanese, Ghazis inIndia, the Dum-Dum bullet was the only possible meansof stopping a rush. It caused serious panic among civilisedtroops to see a man hit five or six times mortally through thebody and after all come on and kill his man before he fell.In his opinion in war the main object was to "stop yourman" ; if one could not do so by injuring him then thenext best means, even to killing him, must be adopted.,Humanity, he thought, "began at home," and from his

point of view it was far more humane to kill the ’’ other

fellow" before he succeeded in doing the like service foryou, and that there was a limit to certain things no less inkilling than in others, especially where certainty of means ofdoing so were involved.

Dr. J. W. SMITH (Manchester) said that from his experiencein South Africa he agreed with Sir William Mac Cormac thatthe first field dressing was not as antiseptic or as efficaciousas was supposed. It was the nature of the small bullet-wounds, the hot sun, and the clear dry air that caused thegood results. Adhesive plaster should be used in the field

dressing. He would like to bear testimony that the RoyalArmy Medical Corps, to whom he was temporarily attached,did their work splendidly in South Africa. He gave evidencebefore the Commission and he could truthfully state uponhis honour that there was nothing upon which the Commis-sion was not most fully informed from all quarters and underall circumstances. Especially at Bloemfontein was this thecase, the fullest investigation being made.

Dr. F. C. H. PrGGOTl (Teignmouth) pointed out that theso-called explosive bullet was in reality an expanding bullet.

Surgeon-General R. HARVEY said that an explosive bulletwas not used by us at any time, and they were only used bysome sportive Boer who, having used them for gameshooting, decided to use them on our men.

Lieutenant-Colonel G. M. J. GILES, I.M.S., said thatSurgeon-General Hamilton’s humanity might suit thenative’s point of view, but was not humanity for poor TommyAtkins.

Surgeon-General C. SIBTHORPE, C.B., disagreed withSurgeon-General Hamilton on the matter of the Dum-Dumbullets against savages.

Sir WILLIAM MAC CORMAC, in reply, spoke eulogisticallyof the work of the Royal Army Medical Corps. He said thatbullets not pills, according to Lord Kitchener, with whom heagreed, were what were wanted at Bloemfontein shortlyafter its primary occupation. This was not surprising, as themain consideration was war, and they must bear in mind thatonce upon a time the wounded were killed by their ownpeople ; nowadays they strained their resources to theutmost on their behalf.

Dr. LEIGH CANNEY (London) read a paper onAir-borne Typhoid Fever in Armies.

He dealt with the water-supplies of various Indian citiesand various outbreaks of enteric fever, and contended in a.

long paper containing much original work that water, andnot air, was the main channel for conveyance of typhoidinfection, and that air, dust, and flies were a comparativelyweak medium. He reviewed sanitary matters in India andthen dealt with the same in the campaign in SouthAfrica. This was followed by an exposition on sanita-tion in Egypt, especially at the barrage works on the

Nile, and on tourists’ risks. He strongly advocated a specialwater corps attached to the Royal Army Medical Corps tocare for the water-supplies of the army when in the field.

In the discussion which followed the PRESIDENT com-

mented in favourable terms on Dr. Canney’s paper andstated that for the most part he believed that typhoid feverwas water-borne.

Surgeon-General C. M. CUFFE, C.B., said that he had hadsome returned enteric fever invalids from South Africa, andamong them were men of the Northamptonshire Regimentwho contracted enteric fever due, he thought, to sewer gasentering the barrack room from sewer pipes found to be defee.tive. The urine of other patients who had recovered fromenteric fever had been examined and the result was negativeas far as the typhoid bacillus was concerned. The outbreakwas, in his opinion, due to direct infection from the sourcementioned, and he advised the authorities accordingly. Hethought that flies were a great source of infection. The un-satisfactory army kitchen arrangements and defective cleanli-ness of the cooks were in great part responsible. Soldiers,on the other hand, would persist in drinking water labelednot for drinking.

"

Dr. J. W. WASHBOURN (London) believed that there wassome foundation for the air-borne theory. The Maidstone out-break showed water-borne typhoid fever. There would alsobe in every epidemic direct infection of certain cases. such asoccurred in Maidstone. He thought that dust did occasionallyconvey typhoid fever in South Africa, though it was not themain cause, for in summer in South Africa there was littledust and much typhoid fever. He therefore thought thattyphoid fever was chiefly water-boine. He agreed withDr. Canney as to proper protection of water by such acorps, as it would prevent epidemics.

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’- Lieutenant-Colonel GILES, 1. M. S.,- thought that flies anddust were some of the ways of carrying typhoid fever as well as water which everyone was agreed on was the main sourceof infection. He thought trench latrines a deadly and horriblesource of typhoid fever infection, chiefly due to the inter-mediary agency of flies between the latrines and the food.Removal of filth by the Government for two years kept down typhoid fever for that period. He thought that the Agra water-supply was as good as was that even of London. ;

Dr. G. E. G. SIMONS (Merthyr Tydvil) said that his

experience as a medical officer of health entitled him tospeak on the matter and that in his opinion, judging from results, typhoid fever was more due to flies than to waterand to direct contamination. In a large epidemic he foundthat houses in cne terrace the water supplied to which wasgood and free from infection were always being attacked andhad been so for years past. There were accumulations ofmanure and filth close by and the flies lived and bred there.He cleared away the filth and the typhoid fever ceased. Hefound here also that in summer and early autumn adults andchildren were affected, but that in winter children alonewere infected. When summer returned the typhoid fever inadults did so also. He found the soil near a surface

drainage channel infected with typhoid bacilli which werecultivated from the channel and were afterwards used inWidal’s reaction. The children infected were those of a

school age who played about the drain. He thought thatthe infection reached the children direct and was transportedto food by flies and thus affected the adults in summer. In acase of two regiments near, and civilians, taking the samewater-supply the soldiers of one regiment which was withoutfly-proof cages for the food were the only persons attackedby typhoid fever, and the soldiers of the other regimentwhich had them, and the civilians, were not troubled with asingle case.

Dr. LEIGH CANNEY, in reply, said that the Royal ArmyMedical Corps ought to have a water corps. He agreed withDr. Washbourn that the majority of cases were due to water.A discussion then followed on

The Organisation of the Xilitary Services.The PRESIDENT deprecated the discussion at the present

time as the matter was sub judice elsewhere.Surgeon-General R. HARVEY agreed with the President but

wished to state that the report of the Parliamentary BillsCommittee had aroused unanimous disapproval and opposi-tion in the Indian Medical Service throughout all India.

Though he sympathised with the Royal Army Medical Corpshe did not approve of its rehabilitation being effected atthe expense of the Indian Medical Service if the proposalsof the committee’s report were carried out. He thought thatthe reform could be carried out in the Royal Army MedicalCorps without interfering with the Indian Medical Service.The Indian Medical Service were quite contented with theirlot and any grievances they had were minor and localand not of main service interest. The service shouldoffer good prizes to good men-at present good andbad ranked together-attach a good allowance to stationhospitals, and give them to good men. The men shouldhave plenty of practical experience in times of peace andleave for study and instruction. He tried a scheme

in India to put all men in Punjaub through a four-months’course of practical surgical training in the hospitals. He

thought the military discipline should be removed from pro-fessional duties and that professional etiquette should takeits place ; men should not be ordered to change their dia-gnoses and thus stultify themselves, nor ought they to becompelled to ask leave to do a circumcision, or to give chloro-form, or to avulse a toe-nail. Each man should be solelyresponsible for his case as in civil life. He was emphaticallyof the opinion that the Indian Medical Service would beruined by the interference suggested in the committee’sreport.

Surgeon-Major G. K. PooLE, M.D., also spoke. ‘

Inspector-General A. TURNBULL moved that the furtherdiscussion of this matter be now forthwith closed. Thiswas seconded by the PRESIDENT and approved by the

meeting. -

DERMATOLOGY.

WEDNESDAY, JULY 31ST.The proceedings of the section commenced with an

exhibition of cases, after whichThe PRESIDENT (Dr. J. J. PRINGLE London) made a few

introductory remarks.

Dr. RAYMOND J. SABOURAUD (Paris), who spoke in French,read a paper

On the R&ocirc;le of Cocei in the Pathology of the Skin,and said that there were three microbes of the genus4 4 coccus " which played an important role in the pathologyof the skin. The first was the streptococcus of Fehleisen,the special cutaneous lesions produced by which was theimpetigo contagiosa of Tilbury Fox. The second was thestaphylococcus aureus of Rosenbach, the special cutaneouslesions produced by which was the follicular orificial pustuleof the impetigo of Bockhart. The third was a grey culturedstaphylococcus (morococcus of Unna), the special lesion pro-duced by which was pityriasis simplex wherever situated.Apart from their specific lesions each of these microbesmight be accidentally found in other lesions as a" secondary infection," by the evolution of which each mightbe modified in its own special pathogenic manner. He wasof opinion that the varieties of cocci invading the skin weremuch less numerous than was generally believed by Unnaand others, and he thought it possible that the three kindsof cocci he was about to describe were quite likely to bepolymorphic varieties of one and the same microbe.

1. ?%6 streptococcus.-The streptococcus which mightcause a great number of general lesions might produce verydiverse cutaneous lesions. In the course of streptococcicsepticaemia the bullse of infectious pemphigus might arise.In them cultures proved the existence of the streptococcus asin the different metastatic lesions of the visceral organswhich it also caused. In the course of these infective states

lumps might develop in the skin similar to those of erythemanodosum. which were the result of streptococcic thrombi inthe blood-vessels of the derma. Direct inoculation of

streptococci into the derma might produce erysipelas,characterised by the multiplication of the microbe in all theepidermic and dermic layers of the affected region. But the

specific lesion which the inoculation of the streptococcusprovoked in the epidermis was the impetigo contagiosa ofTilbury Fox. It began by a flaccid bulla of very ephemeralexistence, which yielded an enormous quantity of serous liquid.This exudation dried up to form a yellow, scabby, adherentcrust. Under the crust was found a little fibrinous exuda-tion characteristic of the multiplication of streptococci onthe ulcerated epidermis. The lesion disappeared withoutleaving any cicatrix. Streptococci very often occurred as

complications of a great many diffused lesions of the

epidermic surface (eczema). Their secondary multiplicationreproduced the two capital symptoms-that is, the diffuseexudation of limpid serum and the slight fibrinous, greyish-blue exudation on the surface of the epidermis deprived ofits horny layer. The streptococcus might cause dermiculcerations deeper than mere epidermic erosions-the rupiaof Bateman. These were conical ulcers with thin scabs

containing a sanious liquid. This lesion was now errone-

ously known in France under the name of "ulceratedecthyma." The proper treatment of the streptococcic lesionsof the epidermis was the local application of solutions of thesulphates-for example, sulphate of zinc one gramme, aquadestillata from 100 to 200 grammes.

2. The staphylococcus aureus.-The specific lesions ofthe staphylococcus aureus was the pustule. This intra-

epidemic pustule was generally perifollicular. Oftenit was deeper than the epidermis and produced a smallcicatrix in the derma. The perifollicular pustule con-

tained groups of staphylococci under its corneal covering.The cavity of the pustule was full of leucocytes and at itsbase was a point of dermic necrosis. This pustule mightextend in depth and thus cause a boil, a furunculous abscess,or a sycosis as the result of a deep multiplication of themicrobes consecutive upon a superficial orificial peri-follicular invasion. These pustules might appear spon-taneously (impetigo of Bockhart), or as the result of tradetraumatisms (dermatitis of hands of washerwomen), or aftersome medicinal applications (acne picis, pustular mercurialeruptions, &c.). In hairy regions pustular eruptions becamevery chronic, for example, sycosis. These pustules might besecondary to a pre-existing local necrobiosis. Thus, boils, acnecheloid, and acne varioliformis necrotica were pustules causedby the staphylococcus aureus, originating round comedones.The staphylococcus aureus might secondarily infect alllesions where the derma was exposed, either spontaneously(for example, eczema) or accidentally (for example, vesicantapplications). It might grow and multiply on lesions whichit had not caused and might spread to evoke near them, oreven on them, its own special lesion, the follicular orificial