1858 T

THE NAVAL, MILITARY, AND INDIAN MEDICALSERVICES.

ROYAL NAVAL MEDICAL SERVICE.The record of the medical department of the

Royal Navy continues, we have reason to believe, c

’to be one of contentment regarding the essentialconditions of service. The retirement of Surgeon- ]

General Sir JAMES PORTER, K.C.B., from the positionof Director-General, at his own request, was a great "

loss to the Royal Navy. He had proved acapable head of the medical department during

I

a period of transition, and considerable advancesin the organisation and nursing arrangementsof naval hospitals were effected during his I

term of office. He has been succeeded bySurgeon-General A. W. MAY, C.B., who has servedwith distinction in the Egyptian and Soudan ex-peditions of 1882-85, and throughout the wholecourse of the Boer war.The recently established medical college at

Greenwich continues to fulfil the expectationsformed as to its efficiency and popularity. The

proximity to the centres of medical thought andtraining in the metropolis cannot fail to have a

good effect and lead to a general advancement of thestandard of professional efficiency, such as has beenso noticeable in the kindred institution of the

military medical service at Millbank. A portion ofthe curriculum continues to be carried on satis-factorily at Haslar, so that there has been no breachof continuity in the associations with that historiccentre of naval medical training.The Lords Commissioners have adopted certain

recommendations 1 of the Medical ConsultativeBoard made with the object of remedying to someextent the shortage in the medical branch. Somedistinct emendations of the conditions of serviceought to have the designed effect.The Honours list for the year includes a K.C.B.

conferred upon Inspector-General DUNCAN HILSTON,who has served in the New Zealand war of 1863,and in Abyssinia; and a C.B. for Deputy Surgeon-General W. M. CRAIG. Special promotion has beengranted to Surgeon G. M. LEVICE and SurgeonE. L. ATKINSON (to fleet and staff rank respectively)for service in the recent Antarctic expedition.The death roll has been a short one during the past

year. Deputy Surgeon-General J. LLOYD THOMAShad served in the China-Japan war of 1894-95, andwas present at the relief of the Peking legations(1900). Serving with the Royal Navy, though nota member of the Naval Medical Service, was

EDMUND ADRIAN WILSON, whose death in CaptainScott’s Antarctic Expedition led to a widespread ’,and spontaneous expression of affectionate regardand admiration.

THE ARMY MEDICAL SERVICE.

Scientific Research Work.Sir DAVID BRUCE and his coadjutors on the Sleep-

ing Sickness Commission have continued the studyof trypanosomes. Their earlier observations pointedto the conclusion that the organism of the humandisease in Nyassaland, T. rhodesiense, is a speciesrelated to, but distinct from, both T. brucei andT. gambiense, and that therefore the human try-panosome disease of N.E. Rhodesia and Nyassalandis not the same as that known as sleeping sicknessin Uganda and on the West Coast of Africa. Thenative name "kaodzera" was suggested for this

1 THE LANCET, Dec. 6th, 1913, p. 1649.

new disease. From the most recent researches.however, it appears probable that T. rhodesiense,and T. brucei are identical.Major W. S. HARRISON has studied streptococcus

rheumaticus, and does not consider it to be thecause of the usual form of rheumatic fever. He hasfound a bacillus resembling that of diphtheria inrheumatic joint fluids and pleural exudationswhich possibly may be causative. Valuable obser-vations have been carried out by Captain P. J.MARETT on phlebotomus flies (commonly mis-called"

sandflies," which belong to the genus Simulium)in Malta. An accurate knowledge of their life-

’

history and habits leads to the carrying out ofeffective measures of prevention, and much im-provement has already resulted from this practicalapplication of scientific research. Major S. L.CUMMINS and Major C. C. CUMMING have been

engaged in the differentiation of staphylococcipresent in vaccine lymph.An important research has been carried out by

Lieutenant-Colonel W. W. 0. BEVERIDGE, D.S.O., inconjunction with Mr. J. HARTLEY DURRANT, of theBritish Museum, on the temperature reached in thebaking of biscuits. Army biscuits are liable tobecome infested with various species of insects, .

lepidopterous and coleopterous. It was found thatbiscuits enclosed in tins hermetically sealed andstill intact were infested. Consequently either theheat in baking is insufficient to destroy the ova, ormoths and beetles gain access and deposit their ovaduring the processes of cooling or packing thebiscuits. It was determined, by experiments witha thermo-couple, that the temperature in theinterior of the biscuits reaches 100° or 105° C. duringthe baking process, and that infestation must takeplace after baking, during cooling, and before thetins are soldered up. The observers recommend thatthe biscuits should be rapidly cooled after bakingand access of moth prevented. Major S. L. CUMMINS,in his Parkes Memorial Essay on Causation andPrevention of Enteric Fever in Military Service,has recorded a long series of observations and

experiments as to the survival of B. typhosus in theexcretions, and on the clothes and persons, ofcarriers and in food. Successful prevention willconsist in the discovery and disposal of chroniccarriers, the detection of early, atypical, and abor-tive cases, and in the inoculation of all troops ofthe expeditionary force during peace time and ofall drafts proceeding to the scene of operationsduring war. Colonel W. H. HORROCKS has con-tinued his experiments on the variation of bacillustyphosus cultivated under certain conditions, espe-cially with regard to the effect of bacteria-freetoxins. He has found that B. typhosus may beconverted into B. ftealis alkaligenes: this appearsto have no pathogenic effect on the ordinarylaboratory animals, and it has not been possible tore-convert this variant into B. typhosus. Thetreatment of syphilis by intravenous injection ofsalvarsan and intramuscular injection of mercuryhas been carried out on an extended scale by-Lieutenant-Colonel T. W. GIBBARD and Major L. W.HARRISON with most excellent results. Their obser--vations and record of this therapeutic investigationwere communicated to the International Congressof Medicine and were received with great interest

, and appreciation.

Military Medical 01’f/anisation.No changes of importance have taken place during

the past year in the organisation of the medical

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services. The Secretary of State for War, both in iintroducing the Army Estimates in the House of ICommons and on the occasion of his distribution of 1

prizes at the Royal Army Medical College, alludedto the high standard of health now existing in the i-British Army and to the good work of the medicalservice. This good work now meets with recogni-tion, and the result shows itself in the existence of.an efficient administration and a contented body ofarmy medical officers.At the beginning of the year it was announced

that the appointment of Director-General, ArmyMedical Service, would in future be tenable for fouryears instead of three, as hitherto. Surgeon-GeneralSir LAUNCELOT GUBBINS will therefore remainDirector-General until March 6th, 1914. It hasbeen announced that his successor will be Surgeon-General A. T. SLOGGETT, C.B., C.M.G., at presentDirector-General of Medical Services in India. Theincrease in duration of tenure brings this office intoline with other staff appointments at headquarters,and is no doubt desirable in the interests of the publicservice; too frequent changes in high administra-tive offices are to be deprecated. It has been.announced that an increase of hospital accommoda-tion will be provided for the Territorial Force, byestablishing 14 nucleus clearing hospitals, one foreach Territorial Division, which will form centresfor the instruction and guidance of voluntary aiddetachments.

Personnel.

On the occasion of His Majesty’s birthday a C.B.was conferred on Surgeon-General L. E. ANDERSON,D.D.M.S. in Ireland ; and Major E. S. WoRTHINGTON,medical officer to the Duke of Connaught, receiveda knighthood. Lieutenant-Colonel Sir W. LEISHMANhas been appointed Honorary Physician to the

King and promoted to Brevet Colonel; and MajorR. J. BLACKHAM has received a Companionship ofthe Order of the Indian Empire. At the RoyalArmy Medical College Lieutenant-Colonel 0. L.ROBINSON has succeeded Major W. S. HARRISON asProfessor of Tropical Medicine; and Major C. E.JFowLER has been appointed Instructor at theAldershot School of Army Sanitation. We note theretirement of Lieutenant-Colonel Sir DAVID

SEMPLE, who, as the founder of the Pasteur In-stitute in India in 1900, and subsequently as thehead of the Research Institute at Kasauli, has donesuch admirable work in the treatment of rabies,the preparation of antisera, and the training ofmedical men in scientific investigation in India.The obituary list includes the names of three

Crimean veterans, Deputy-Surgeon-General G.

SANDERS, C.B., in his ninetieth year; Deputy-Surgeon-General A. S. FoGO, aged 84; and Surgeon-Major ALEXANDER REID, aged 80; also of Deputy-Surgeon-General N. NORRIS, in his eighty-thirdyear, who served in the Jowaki, Afghan, and Nile- expeditions. Surgeon-General H. S. MuiR hadserved in the Afghan campaign of 1878-80, andbefore retirement was Deputy-Director-General ofthe Army Medical Department. Major H. C. FRENCH,died at the early age of 43. He had served in the’South African war, had been awarded the AlbertMedal and the Royal Humane Society’s medal for’gallantry in attempting rescue from drowning in theStraits of Malacca, and had devoted much attentionto the prevention and treatment of syphilis in thearmy. He was Hunterian professor at the RoyalCollege of Surgeons in 1912. Colonel ANDREW CLARKhad zealously supported the medical service of

the Territorial Force, in which he was AssistantDirector of Medical Services. Dr. PHILIP FRANK,though long retired from the Army Medical Service,was known to very many of the older generation,and universally held in the highest regard.

THE INDIAN MEDICAL SERVICE.

Scientific Work.There is never any lack of subjects for original

medical research in the immense area open to theofficers of the Indian Medical Service. Of lateyears plague has held a prominent place in medicalliterature, and at the beginning of the past yeara report was issued, the seventh of the series, onplague in Madras; the inquiry is still in progress.In regard to cholera great success has attendedMajor LEONARD ROGERS’S method of transfusion ofhypertonic saline solution, combined with adminis-tration of permanganates by the mouth ; the sameofficer has also obtained extremely gratifyingresults in the treatment of intractable amoebicdysentery by hypodermic injection of salts ofemetine. The All India Sanitary Conference heldat Madras in November, 1912, under the presidencyof Sir HARCOURT BUTLER, was an important gather-ing of administrators, engineers, and medical men,at which technical questions in each of the twospheres of professional work were dealt with byexperts and criticised from all points of view.There can be no doubt that much good will comefrom such a gathering together of experienced men,accustomed to deal with the management of

epidemics, large questions of public health,and problems of administration. Meeting togetheron common ground, with opportunity for personalinterchange of experience and opinions, doctorsand engineers and administrators will certainlybenefit by the mutual intercourse, with a

resulting benefit to the public service and tLe

public health. Plague prevention, water-supply,and sewage disposal were the principal subjectsdiscussed. This conference was followed by anotheron Malaria, under the presidency of Sir PARDYLUKIS, which lasted three days ; questions of epide-miology, prevention and curative treatment weredealt with, also kala-azar and protozoal diseases.A Punjab Conference on similar lines was held atSimla later in the year, under the Lieutenant-Governor of the province, when rural sanitation,the sanitation of schools, and the prevention ofmalaria were discussed. Major R. MCCARRISONdelivered the Milroy lectures in January, embodyinghis researches on the etiology of endemic goitre,which he believes to be essentially due to a micro-organism. Major E. E. WATERS has investigatedthe value of the amorphous cinchona alkaloids inmalaria, and finds them to be from three to fivetimes as effective as quinine sulphate. It is

expected that the laboratories of the CalcuttaSchool of Tropical Medicine will be completedand ready for use next year, in connexion withthe Medical College Hospital. A similar insti-tution is being developed at Bombay inconnexion with the existing laboratories atParel. The Indian Government have sanctionedthe establishment of a bacteriological institute atMaymyo, the chief hill station of Burma, togetherwith additions to the Pasteur Institute at Rangoon.In place of the Scientific Memoirs by officers of theIndian Medical Service that have appeared duringrecent years at irregular intervals there will nowbe published quarterly an Indian Journal of

1860

Medical Research, under the editorial supervisionof the Director-General, I.M.S., and Sanitary Com-missioner with the Government of India.

Organisation.A new Royal Warrant as to promotion, &c., in the

Indian Medical Service was issued in June; im-

portant clauses are those declaring that an officerwill not be permitted to remain in the service,if during the first three years his retentionappears to be undesirable. A lieutenant is eligiblefor promotion to the rank of captain afterthree years, after passing an examination andif in all respects qualified and recommended; andsimilarly, a captain to major, and a major to

lieutenant-colonel, is "eligible for promotion if inall respects qualified and recommended," this con-dition being substituted for the words " shall bepromoted." The extension of service to complete30 years, and obtain the pension of JE700 per annum,is now definitely limited to officers who enteredbefore April, 1911. Early in the year medicalmanoeuvres on a considerable scale were carriedout at Rawal Pindi, under the Lieutenant-Generalcommanding the Northern army. Considerable

difficulty was found in staffing the field ambu-

lances, and the pe1’sonnel of the Army Bearer Corpswill probably need to be further developed. Somemodifications have been made in the arrangementsat headquarters. The Sanitary Commissioner withthe Government of India is now placed under theDirector-General, I.M.S., except in regard to givingadvice to Government on technical questions. Hewill also now go on tour instead of being per-manently located at Simla. Subjects connectedwith bacteriology and medical research are nowdirectly under the supervision of the Director-General. A new Inspector-Generalship of Hos-

pitals has been created for Bihar and Orissa,to be held by a lieutenant-colonel. The appoint-ment of sanitary commissioners is now in thehands of the local governments ; the officers are tohave not less than 15 years’ service, and theirtenure is unlimited. Deputy sanitary commissioner- i

ships are no longer restricted to officers of theIndian Medical Service. We understand that acommittee has revised the field medical organisa-tion scheme, and the scale of field equipment.In regard to the examination of medical officers,

lieutenants can now go up for promotion after oneyear instead of 18 months; also, "accelerated promo-tion " has been extended to the end of the sixteenth

year, and already several officers have regainedtheir position in the Army List owing to thisalteration.

Personnel.A brevet majority has been granted to Captain

W. T. MCCOWEN, I.M.S., in recognition of his servicesin the attack upon the Central India Horse, nearKazarun, in Persia, in December, 1911. Sir C. P.

LUKIS, Director-General, I.M.S., and Major J. C.

ROBERTSON, Sanitary Commissioner, have beennominated additional members of the Viceroy’sCouncil. At the New Year, Lieutenant-ColonelW. J. BUCHANAN and Major W. G. LISTON receivedthe C.I.E.; and on the occasion of the King’s Birth-day Surgeon-General H. HAMILTON was promotedto K.C.B.; Lieutenant-Colonel JOHN CRIMMIN, V.C.,C.LE., was granted a C.B.; and Lieutenant-ColonelG. G. GIFFARD became C.S.I. Lieutenant-ColonelJ. ROBERTS, C.LE., surgeon to the Viceroy, receiveda knighthood. Sir C. P. LUKIS has been appointedHonorary Surgeon to the King. Sir RICHARD HAVE-LOCK CHARLES, G.C.V.O., has succeeded Sir A. M.

3RANFOOT, K.C.LE., as President of the MedicalBoard at the India Office.The obituary list includes Surgeon-Major H. M.

JREENHOW, in his 84th year, the last of the medicalmincers of the Lucknow garrison in 1857; Lieu-Jenant-Colonel E. A. BIRCH, who re-wrote Goodeve’s’Management of Children in India"; Surgeon-General G. BIDIE, C.LE., a Mutiny veteran; andSurgeon-General Sir C. COLVIN SMITH, K.C.B., a

survivor of the Burmese war of 1852, and of theMutiny, who was principal medical officer of theIndian contingent in the Egyptian Expedition of1882. Sir JOHN TYLER, C.LE., was a former

Inspector-General of Prisons, who organised theIndian Section at the Indian and Colonial Exhibi-tion in 1886 ; he greatly encouraged and developedthe manufacturing industries (especially of carpets)of the jails in India.

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DENTAL SURGERY.

The subject which has attracted most attentionduring the present year has been that of peri-odontal disease (pyorrhoea alveolaris). Two valuablecontributions on this question were read before theStomatological Section of the International Con-

gress of Medicine. In the one, by Dr. ZNAMENSKY,of Moscow, the patho-histology of the disease wasfully discussed, the author reiterating his previouslyexpressed views that the first pathological changecommences at the gingival margin, and thence

spreads and involves the tissues forming the tooth-sockets. The other communication, by Mr. E. B.DOWSETT, was devoted in great measure to consider-ing the question of treatment. In a paper on theMorbid Anatomy of Periodontal Disease’ 1 theauthor, Mr. J. F. COLYER, describes the specimenscontained in the Museum of the Royal College ofSurgeons, and expresses the view (1) that thedisease is a progressive osteitis commencing at themargin of the alveolar process; (2) that the diseaseis purely local in origin and has its immediatecause in the formation of stagnation areas aroundthe teeth; and (3) that the varying density of thebone influences the rate of destruction.In a well-illustrated article Dr. MATTHEW CRYER Z

discusses the relation of the contraction of thedental arch to nasal stenosis. and expresses the

opinion that the effect of the narrow arch is tocompress the tongue and force it back into the oro-pharynx, and that spreading the dental arch givesrelief to the nasal obstruction by allowing moreroom for the tongue, which moves forwards andreleases the pressure on the soft palate and otherstructures. In connexion with this question of

mouth-breathing Mr. W. W. JAMES describes a

simple apparatus which he has found useful forestablishing nasal respiration in those cases wherethe "habit" persists after the nasal passage hasbeen freed from obstruction.

A paper on the opening of the maxillary sutureby expansion’ of the dental arch was published byDr. H. A. PULLEN. Cases before and after treatmentare illustrated, and skiagrams showing the sutureare reproduced, the author evidently believing thatit is possible to open the suture. Dr. CRYER, whosepaper was referred to above, maintains that a.

widening of the floor of the nose and the suture byexpansion of the dental arch is incompatible withthe anatomical structure of the parts involved.

1 THE LANCET, April 19th, 1913, p.1081.2 Items of Interest, January, 1913.

3 Proceedings of the Royal Society of Medicine, OdontologicalSection, April, 1913.

4 Dental Cosmos, May, 1913.