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1088 THE SERVICES. visited during the year 15 headquarter hospitals, .31 civil surgeoncies, and 38 hospitals and dis- pensaries in charge of medical subordinates in various parts of the Presidency. Madras Medical College Annual Report. The most remarkable feature of the report for the eighty-seventh session of the College is the table showing the increase in the numbers of students during the last five years. The figures are : 1917-18, 473; 1918-19, 496; 1919-20, 523 ; 1920-21, 579 ; 1921-22, 634. It must be remembered, however, that these increases are not entirely due to medical students, as classes for "sanitary inspectors" and " chemists and druggists " are also held in the College buildings, and their numbers are included in these totals. Of the 634 enrolled students, only 418 were actually undergoing training for a medical -qualification. Post-gradua,te courses, junior and senior, for civil assistant surgeons were also held, while " under the scheme sanctioned in G.O. No. 533, dated 13th May, 1921, regarding the provincialisation of health officers, 15 medical graduates and one L.M.P. candidate were deputed to undergo the health officer’s training at Government expense. Fourteen of these qualified for the higher grade of health officers and the L.M.P. candidate for the lower grade." In the sanitary inspectors’ class there were 59 students, and of these 44 passed the Government technical examination. A further batch of sanitary inspectors attended what is known as the quin- quennial course of training-a course intended as a refresher course for senior inspectors. There were 63 women students in the College during the year. No less than 55 of these held some form of stipend or scholarship, 51 being Government of Madras stipen- diaries. It must be admitted that the Government is doing its best to encourage women to enter the field of medicine. The College library is popular and seems to be well equipped, constant additions being made to the number of books. The percentage of passes at all the University medical examinations was 53-1, as compared with 51.1 during the previous year. In the final examination the pass percentage was well above the average. It is worth noting, also, that the Madras Medical College regularly takes a prominent position in athletics and games, and the year under review was no exception, as many as five inter-collegiate trophies being won. Colonel F. F. Elwes, principal of the College, reports a number of changes in the teaching staff, but these were entirely due to the exigencies of the service and were unavoidable. Small-pox in Madras City. The city of Madras during recent years has been repeatedly visited with epidemics of small-pox, and in 1921-22 the fifth epidemic in seven years was experienced, causing 893 deaths out of 2284 attacks during the first six months of 1922. The Government asked for a special report from the health officer of Madras, and this, together with the remarks of the Director of Public Health and the Government review thereon, has now been published. The epidemic which ravaged the city during 1921-22 was the most severe yet experienced during the present century. In Madras City small-pox is endemic, but there must be definite reasons for the increased incidence of recent years. The health officer blames the lymph, yet in four out of the five years for which figures are given the success rate verified by his own staff was over 95 per cent., a remarkably favourable figure. In 1920 the success rate fell to 78-9 per cent., but the vaccina- tion in this year could only affect children who in 1921-22 were under 2 years of age. The tables showing incidence rates among vaccinated and unvaccinated at different age-groups suffer from the incompleteness of data common to most statistics in India. Government in their review say :- " Either a large number of unvaccinated cases have been returned as vaccinated, or, what is most likely, a large number of cases recorded as successfully vaccinated were insufficiently protected as the result of indifferent work by the vaccinators. That the work of the corporation vaceina- tors is of uneven quality is implied in the health officer’s second report. The remedy lies with the health officer himself under whose supervision they work.... The epidemic of 1921-22 is stated to have begun in November, 1921, when fij attacks were reported. But in March of that year there were 66 attacks, followed by 44 in April, and the rise to 47 in September, and 48 in October was warning enough that there was danger ahead." Statistics of attacks and prophylactic measures taken for the ten worst affected divisions of the city are tabulated in the Government review, and the remarks on this table are as follows :- " It can hardly be said that the above figures indicate very vigorous intensive work. The health officer very rightly dwells on the importance of revaccination, a problem which is engaging the attention of Government, and regard- ing which the public conscience is lamentably weak. Except in Divisions 3, 20, and 28 the out-turn of revaccination in 1921-22 was remarkably poor, and it is worthy of note that revaccination was higher in some of the more lightly affected divisions than in those which suffered most heavily. Whether special efforts were made to protect the fisherfolk, the mill- hands, and other communities most exposed to infection is not reported. It is true that dirty surroundings increase the danger of infection, but such conditions cannot in any way impair the protection afforded by vaccination. The Government hope that the officers of the corporation will take special measures to ensure the protection of those who are most exposed to infection, and that in future reports the special measures taken will not be left in doubt..... It is clear from the reports that the health staff of the corporation was caught napping. It did not wake to the dangers of an epidemic till too late. The rise in attacks in March and April, 1921, was accompanied by a spasmodic rise in primary vaccination, but no attempt seems to have been made to stimulate revaccination, and even primary vaccination declined month by month till October, when it reached its lowest ebb, with an out-turn for the month of only 864. Between March and October, 1921, revaccinations averaged 128 per month. In October the figure was only 89. Under the spur of panic the number of revaccinations in March, 1922, rose to 2439. It is regrettable that this figure was not attained a year earlier. Even after the epidemic established itself the staff failed to keep pace with its progress. Attacks escaped detection, and patients died before the disease could be diagnosed." The report concludes with the remark that no surprise need be felt that many of the statistics recorded admit of no reasonable explanation. Unless the health staff can be sure of its facts, it cannot hope to eradicate a disease which experience of other countries has proved to be preventable. Madras, Oct. 18th. The Services. ROYAL NAVAL MEDICAL SERVICE. Surg. Lt.-Cmdrs. to be Surg. Cmdrs. : H. E. Perkins, E. C. Holtom, J. G. Danson, H. H. Ormsby, E. Moxon- Browne, and A. E. P. Cheesman. Surg.-Lt. R. K. Shaw to be Surg. Lt.-Cmdr. Temp. Surg. Lt. (D.) D. C. Eglington is transferred to the permanent list. ROYAL NAVAL VOLUNTEER RESERVE. Surg. Cmdrs. A. R. Brailey, W. K. Wills, and R. J. E. Hanson to be Surg. Capts. - ROYAL ARMY MEDICAL CORPS. Maj.-Gen. S. G. Moores, late R.A.M.C., is appointed Hon. Surg. to the King, vice Col. (Hon. Maj.-Gen.) W. F. Stevenson, ret. pay, late R.A.M.C. (deed.). Col. A. H. Morris, late R.A.M.C., retires on ret. pay, Lt.-Col. (temp. Col.) C. J. O’Gorman, from R.A.M.C., to be Col., vice Col. J. B. Anderson, ret. Maj. A. S. Littlejohns relinquishes the temp. rank of Lt.-Col. on ceasing to be empld. as Assistant Director of Pathology. Temp. Capt. A. C. Murray relinquishes his commn. and retains the rank of Capt. ARMY DENTAL CORPS. Maj. J. F. Allin, from Gen. List, Reg. Army Res. of Off., to be Lt., and relinquishes the rank of Maj. MILITIA. Capt. J. A. O’Driscoll relinquishes his commn. and retains the rank of Capt.
