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who died in hospital from their wounds. The invaliding ’,,amounted to 128 per 1000. These ratios are all considerably ’above those of the troops. Enteric fever was the cause of 57-2admissions and 18’25 deaths per 1000 of strength, being verynearly the same as among the non-commissioned officersand men. The report gives an analysis of the woundsand injuries received in action and of the operationsperformed.The strength of the men of the Royal Navy, Canadian

voyageurs, kroomen and others attached to the expedition,was estimated at 2452; the admissions among them were<871, the deaths 71, and the invalided 16. Of the 71 deaths,0 were due to disease, 3 to accident, and 8 to woundsreceived in action. We have not reduced their numbers tothe annual ratios, as the information regarding this portionof the force is in some points defective.ERRATA.-In the first part of this article, published in

our last, several errors of importance unfortunately escaped- correction owing to delay in the return of the proof. Thus,on page 370, line 18 from the commencement of the article,the average death-rate of the troops should have been statedas 5’33, not " 8’42 "; in line 5 of the second paragraph onpage 371, for "Royal Engineers" read ]Tousehold Cavalry,the sickness ratio of which arm was 35 19, whilst that ofthe Foot Guards was 57-53, instead of "29’34" and "4835"

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per 1000 respectively. On page 371, first column, line 25from bottom, insert " with the exception of the admissions"after " higher"; line 10 from bottom and elsewhere, for6‘ Cottonua" read Cottonera 4th line from bottom, for"occurred" read arrived; second column, line 17,for " 752and 7-01 " read 752 and 709; page 372, first column, line 7,for 11 530 " read 539 line 29, for " some " read seven twolines further on, for "moved" read arrived; in second lineof third paragraph of same column, for " 22’3" read ,,03 ;in following paragraph, lines two and three should read"’was 985; the ratio of admissions into hospital was 1198;of deaths 11’17," &c.; in last line of the column, for 38’33read 38’23; finally, in second line of second column, for"and the admissions and mean sick" read also, with theexception of the mean sick, &e.

THE OUTBREAK OF ENTERIC FEVER ATLANCING COLLEGE AND SHOREHAM.

THE following is the gist of a report to the SteyningRural Sanitary Authority by Dr. C. Kelly, sanitary officerof health for West Sussex :-

GENTLEMEN,&mdash;I have to report to you an outbreak ofenteric fever at Lancing College, of which I received in-formation on the 23rd instant. On visiting the College onthat day with Dr. Fuller, I found that there had been four-teen cases of fever, of which two had died and three had beenremoved, so that there were then nine boys ill with the dis-ease. Three boys were admitted into the ward on July 7th, I

another on the 10th, three on the 12th, three on the 16th,and two on the 18th, but some of them felt ill two or threedays before going into the ward. The dates of admissionseemed to point either to great variation in the incubationperiod of the disease, or to a source of infection spreadingover an interval of several days. Five of those attackedwere in a dormitory in the second master’s house, and fourwere in the school house, of whom three were in one room,and one patient, being very ill, was in a separate room.Two of the patients had died, and three had been removedbefore the date of my first visit. Lancing College containsabout 200 boys, a head master, eleven masters, eight menservants, and fifteen or twenty women servants. Besidesthese, about sixty men are employed near the College inerecting a large chapel, but they had no direct communica-tion with any part of the College. The College stands upona spur of the chalk downs at an elevation of over 200 feetabove the sea; on the north, south, and east sides the groundslopes rapidly away, while it rises to the west. The situa-tion is open, airy, and dry, the grounds extending over anarea of 160 acres. To the east of the College, and at thebottom of the hill, there is a large level cricket ground,between a large clump of trees and the river Adur. Abouta mile and a half away (in a straight line) to the south-eastis the town of New Shoreham, where at this time there wasalso a large outbreak of enteric fever.

"The water-supply to the College is obtained from a finespring at the base of the chalk downs, whence it is pumpedup to a reservoir on the hill side, and thence is conveyed bya pipe across the river Adur up to the College buildings......The same Company supply various other places, as Portsladeand South wick ; but, as there was no outbreak of fever ineither of these towns, it did not seem probable that therewas any pollution of the water-supply. The drainage ofthe College is carried away to an outfall to the north-east ofthe buildings, in a large field, where it is used for irrigatingthe soil......There was nothing in the condition of the water-supply or of the drainage system which seemed to accountfor the outbreak. There is a farm on the College groundswhere a few cows are kept to supply milk to the boys; nobutter is supplied from this dairy, and all the milk is sentup for the use of the College. The cows are all in goodhealth, and yielded plenty of milk. There had been no casesof illness among those who worked on the farm. The eggsand milk came from the College farm, the bread was madeon the premises, the cheese and butter came from Dorset-shire, and the meat from London; so that very little, if any-thing, cams from local sources outside the College grounds.The boys would frequently go to Shoreham in the course oftheir walks, and they would often go to a confectioner’s tobuy pastry or sweets; but, except in this way, there wasvery little communication between Lancing College andShoreham ; and yet the fact that there was a simultaneousoutbreak of enteric fever at Shoreham pointed to, or at leastsuggested, a common cause. In the College cricket field thereare two buildings, one used by the cricketers and one used asa ‘tuck shop.’ Every afternoon Mrs. X., who lives at Shoreham,goes over to the tuck shop’ to sell her goods. She obtainedsweets and lemonade from Brighton, fruits of various kindsfrom Shoreham, and she had lately been supplying somecream which she maintained did not come from Shoreham,but from the Pad Inn, close to the entrance to the Collegegrounds [where one cow was kept]......The cow yieldedabout two and a half or three gallons daily, but no

accurate measurements were ever taken, nor were anyaccounts kept, as Mrs. X. paid each day for what shehad. But the landlady remembered that she often calledfor cream as she went by, after the strawberries came in,and she recollected serving her with three pints on one dayand two pints on another, besides smaller quantities onother days. She further remembered that these largerquantities were sold on the occasion of the Old Boys’ match,because her husband was present, and he saw Mrs. X.coming up to the grounds from his house. This was a twodays’ match, and it was played on Friday and Saturday,July 2nd and 3rd. On such an occasion a great manywere present, and Mrs. X. made provision for it by gettingmore fruit and cream......Every boy who was ill hadpartaken of strawberries and cream, but it was also truethat numbers partook of the cream who were not ill atall. A young lady, Miss H., who was present at the OldBoys’ match, fell ill at Brighton with enteric fever five

days after the match, and some boys who drank from thesame portion of cream of which she partook escaped thedisease altogether. Some boys who had been rowing on theriver the same morning, being too young to play in thematch, came back with one of the masters early in theafternoon; tired and hot, they refreshed themselves liberallywith the fruit and cream, yet not one of them was attacked.Of the boys who fell ill with the fever, six were in the firsteleven, and played in the match. No one can tell how manyof those present regaled themselves with fruit and cream ; butit was evident that far more escaped illness after partaking ofthem than the number of those attacked. It has been beforestated that the dates of incubation varied very much, so thatunless there is a great variation in the incubation period, itis hardly likely that a boy should take infected cream onJuly 2nd or 3rd, and be admitted into the ward on July 7th,or that Miss H. should fall ill about the same time. It iseemed clear that the cream at the Pad Inn was not at

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fault; and certainly if it were, it could not account for theShoreham outbreak, as no one from that town drank thismilk. Dr. Fuller, the medical officer to Lancing College, fromthe first expressed a firm belief in the cream being infected.He was attending at this time several patients in the Shore-ham Workhouse who were suffering from enteric fever, andthey obtained milk from a dairy belonging to A., and those whowere ill were chiefly women and children who drank a gooddeal of milk. Some men who worked on a railway bridgenear A.’s dairy at the end of June drank skim milk supplied

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oy A,, and three of these men fell ill, one of whom was theman who has been mentioned above as lying ill at Portslade.On visiting this dairy Mrs. A. showed by her books thatMrs. X, who supplied the tuck shop,’ had had cream fromher from June 25th to July 3rd, so that there must havebeen in the cricket field cream from two sources-one fromthe Pad Inn and the other from A.’s dairy. Mrs. X. had

nearly a quart of cream from A.’s dairy on Friday, June 25th,a quart on the 26th, a quart on the 28th, a pint on the 29tb,So pint on the 30th, ninepennyworth on July 1st, and six-pennyworth on July 3rd, after which date she had no more.If this cream were infected, those who drank of it wereliable to infection during the whole of the week previousto the Old Boys’ match on July 2nd and 3rd, as Mrs. X.supplied cream to no one else but those who frequented thecricket field. Further inquiry showed that there was a

cricket match on Saturday, June 26th, in the College grounds,between the boys and an eleven from Tunbridge, and on thisday a quart of cream was taken up by Mrs. X., who probablyhad some more on the same day from the Pad Inn. 1think it is clear that these creams were kept in separatevessels. Mrs. X. brought A.’s cream in an oval tin, holdingAbout half a gallon, while the cream from the Pad Innwas put in a jug or in a tin belonging to the inn dairy.The liability to catch the disease was probably greater onJune 26th and on the first three days of the following weekthan on July 2nd and 3rd, when only small quantities ofcream were obtained from A.’s dairy, while three pints weresupplied on July 2nd from the Pad Inn dairy, and a quartfrom the same place on July 3rd. The price of cream atA.’s dairy was 2s. a quart, so that 9d. would purchase three-fourths of a pint, and 6d. would represent half a pint. Miss H.was at the match on June 26th with her sister, and they hadon that day some cream, and it must have been on that daythat she became affected; the cream which she had at theOld Boy’s match, and which others shared without fallingill, was probably of good quality. The various dates onwhich the boys fell ill can now be accounted for, since thesource of infection was present not for one day only, but fora space of seven or eight days. Miss H.’s sister was poorlyfor a few days, and, as her temperature on one occasion roseto 103&deg; F., it is probable that she also was in some degreeinfected on June 26th. Of the boys who were attacked, onewas fourteen years of age, one fifteen, two sixteen, sevenseventeen, and three eighteen. The reason why none ofthe younger boys were attacked may be accounted for bythe fact that the older boys having more pocket-money wereable to buy the fruit and cream, while the younger ones putup with some cheaper form of refreshment. When it wasquite clear that cream from A.’s dairy had been suppliedduring the last week in June, and when others had failedabout the same time at Portslade and New Shoreham whobad been drinking milk from the same dairy, it seems almostcertain that there must have been a common origin for the,outbreaks at the College and at Shoreham, and that themilk from A.’s dairy was the common source of infection.This view is confirmed by the fact that there has been nofresh case of fever at the College since July 18th, and thecream-supply was stopped on July 3rd, while there havebeen many fresh cases in Shoreham since that date amongstthose who continued drinking this milk."

Dr. Kelly then proceeds to give a detailed description ofthe drainage and water-supply at A.’s dairy, with the resultthat he shows leakage from the drain into the well was ateast a probability. He then states, " There was no case ofillness in A.’s house, nor had there been any for a long time.There is no evidence of anyone having had enteric fever justbefore the outbreak, so that the sewers might have becomeinfected with the discharges from such a case, but entericfever has, in recent years, been very common at Shoreham,and the sewers are not very well ventilated....... There weresix cows at A.’s dairy, but one of these was not in milk;they were said to be in good health and to yield plenty ofmilk. They were not seen until July 26tb, so that theircondition during the last fortnight of June could not beascertained. Mr. Knight of Brighton, who has recentlyexamined the cows, has found nothing in their condition toaccount for the outbreak. All proper precautions have beentaken by Dr. Fuller as to the disinfection and burying of alldischarges, and the drains have been well flushed. As nofresh cases have occurred since July 18th, the outbreak ofenteric fever is now at an end, and the remaining patientsare all recovering. The outbreak has, therefore, been duenot to any defects in the sanitary arrangements of the

College itself, nor to any pollution of the water-supply, butto impure cream being taken under conditions which cannotoccur again. The well at A.’s dairy has been closed, andgood water is now supplied there from the public main."Worthing, July 29th, 1886.

BRITISH DENTAL ASSOCIATION.

ONE of the most successful meetings of the increasinglypopular British Dental Association was held last week atthe School of Mines, Jermyn-street, under the presidencyof Sir John Tomes, the president of the year, Mr. RichardWhite, being unfortunately too ill to attend.Of the papers read on the first day, that of Mr. George

Cunningham, on the Relation of Dentistry to the State, wasperhaps of the most general interest, and the moderationand practicability of the view expressed are sure to meet withgeneral approval. He recognises fully that the armysurgeon, who is already expected to be a veritable"Admirable Crichton" in surgery, medicine, midwifery,drill, ambulance, a capable administrator, able to select suit-able sites for camp, to be competent to perform complexanalyses of food and water, &c., cannot be expected to belikewise a dental specialist, but still he maintains thatsomething might and ought to be done in conservativetreatment of the teeth, something more than the radicalcure-extraction; in fact, that the army surgeon shouldhave to produce a certificate of having attended a course oflectures and gone through a course of clinical instruction indental operative surgery at a general or special hospital.It seems, several have gone further than this, and qualifiedin dental surgery at the Royal College of Surgeons.The "regulation army extracting case" seems to be of avery antiquated description, the key, of which the moderndentist has had no experience, and forceps, which it would bedifficult for a specialist to know for what purpose they wereintended, are the armamentaria. The " stopping case," on theother hand, contains gold foil, as if the most skilful dentalsurgeon was expected, but omits a mirror to see the

cavity, and tweezers to insert a dressing. We cannot nowdiscuss further this paper, but we are sure that the ArmyMedical Department, who have done so much in recentyears to promote the efficiency of the service, will improveand modify their dental equipment.

Messrs. Morton Smale and Hutchinson read an excellentpaper on Dental Education, and very strongly urged thatevery dental student should take the L.R.C.P. and M.R.C.S.under the Conjoint Scheme in which we agree; they or oneof them, should, however, be regarded not only as an advan-tage, but as a sine qud non.

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On Friday the great attraction was the Demonstrations,principally in gold fillings, at the Dental Hospital of London,and amongst the patients there was a well-known dentalpractitioner, which caused considerable amusement. Elec-tricity, both as an illuminator and a motor, was conspicuousin the exhibit of dental apparatus. The day’s proceedingsterminated with the annual dinner, under the presidencyof Sir Edwin Saunders, which took place at the Criterion.Sir Edwin, in a very apt and appropriate speech, proposingthe toast of the Queen, enlisted the sympathies of hisaudience by stating that Her Majesty had once observed tohim, "Yours is a most useful profession; for while somerequire the services of the oculist, a still smaller number theaurist, almost all, sooner or later, have need of those of thedentist." The principal toasts were that given by Mr. Sibley,"The Prosperity of the British Dental Association," to whichMr. Frederick Canton, the hon. secretary, replied, and " TheRoyal College of Surgeons," proposed by Mr. Smith Turnerand responded to by Professor John Marshall; severalothers followed. The meeting was a great success, being wellattended.The business and festivities of the week culminated in

the garden party, given by Sir Edwin Saunders, at his

charming residence, Fairlawn, Wimbledon, which was acomplete success, notwithstanding that many members ofthe profession and personal friends of Sir Edwin and LadySaunders were prevented from- attending. H.R.H. PrincessMary of Cambridge (Duchess of Teck) wrote expressing herregret that unforeseen circumstances prevented her frombeing present as she had intended and wished.