144

HEALTH REPORT OF INDIA FOR 1888.

No. II.

THE strength of the native army of India in 1888 averaged145,252 men, of whom 124,822 were present with theirregiments and 20,430 were absent from various causes. The,admissions into hospital of the former were 995, the deaths12’84, and the proportion constantly sick 33’4 per 1000. Thedeath-rate among those absent from their corps was 28’73

per 1000. If the two classes are combined, the proportionfor the whole native army will be found to be 16’14 per 1000,or 1’33 per 1000 higher than the European army in Indiafor the same year. Of 587 men who died whEn absent fromtheir corps, 159 were on furlough and 428 on sick leave.The causes of death of these men are unfortunately notrecorded in any of the tables.Omitting the force in Upper Burmah for the first quarter

of the year and the men absent from their corps on furlough.’1nd sick leave, the sickness and mortality were distributedamong the various divisions of the Native army as follows :-

Ratio per 1000 of Average Strengtlt.Average Ad’

Deaths Mean- strength sions. Deaths. Sick."

present. SlOns. ’ Sick.

Bengal Army ........ 50,886 .. 992 13-11 328Madras ........ 25,671 .. 886 15-31 .. 36’5Bombay ........ 23,570 .. 1080 10-52 .. 34’6Punjab Frontier Force 12,426 1369 .. 15’61 36-1Central India Irregular Force 5,233 .. 658 .. 5’54 17-2Hyderabad Contingent .... 6,242 .. 734 .. fi’73 ., 27’1

Compared with the preceding year, there was a very.marked increase in the death-rates of the Madras Army andthe Punjab Frontier Force. In the former the excess

occurred almost entirely in Upper Burmah, where the- death-rate was as high as 49-58 per 1000, the chief causes.being cholera, dysentery and diarrhoea, paroxysmal fevers,and anaemia and debility. In the Punjab Frontier Forcerespiratory diseases caused a mortality of 6’44 per 1000,cholera of 3-62, and paroxysmal fevers of 1’93. There wasa marked reduction in the mortality of the Central IndiaIrregular Force and the Hyderabad contingent, chieflymanifested in cholera.Malarial fevers were assigned as the cause of 45 per cent.

,of the total admissions and 15 per cent. of the deaths of the-native troops. Respiratory diseases gave rise to 2-68 andcholera to 2’14 deaths per 1000 of strength. The mor-tality by paroxysmal fevers was 1’91 per 1000; of enteric.fever only 17 cases, with 7 deaths, were reported from thewhole force. This does not appear to be a result of defectivediagnosis, but an exemption of the native troops, comparedwith the European, from fatal forms of fever. In 1888 theratio of deaths from fever of all types was 4’48 in theEuropean force, and only 2 03 in the native ; in the former’it was the cause of 30 per cent., and in the latter of only16 per cent. of the total deaths. The ratio of deaths fromphthisis was only 0"66 per 1000 of strength ; among theEuropean troops it was only 0-64. Both classes, therefore,appear to enjoy a marked exemption from this formidabledisease. It seems probable that the ratio for the nativetroops may be slightly understated owing to the causes ofdeath of the men on sick furlough not being ascertained.While the summary of the sanitary sheets gives evidence

of considerable improvement at many of the stations, there,are still frequent complaints of overcrowding, sometimesthroughout the year, at others for varying periods, and alsoof insufficient and unsatisfactory ventilation. The drain-age of many of the stations requires to be amended, and atsome of them complaints have been made during the yearof insufficient water-supply and, at a few, of its deleteriousquality. These summaries show that considerable atten-tion has been paid by the medical officers to the health sur-roundings of the native troops, and that some, though appa-rently not very rapid, progress is being made by the mili-.’tary authorities in carrying out the recommendations madeto them on these subjects.The average number of the gaol population of India was

91,445, among whom the admissions into hospital were 1129,.the deaths 35-57, and the daily sick 37 per 1000. Thesefigures are all higher than in 1887. There is an increase of12,000 in the number of the prisoners, but this is stated tobe in consequence " of a number of subgaols in every pro-vince, as well as those of Europeans and of some newly

established gaols in Burmah" being included in the tablesfor the fust time. The sickness, mortality, and meandaily sick were all considerably higher in Bengal than inthe other two Presidencies, Bombay having the lowestratios. The high death-rate in Bengal was in a greatmeasure due to cholera in the gaols of Lower Bengal andAssam and in those of the Punjab, amounting in the formerto 9-31 and in the latter to 5 00 per 1000 of the prisoners.In the Bengal Presidency the admissions averaged 1079,and the deaths 33 93 per 1000; in the Bombay Presidency,647 and 22-24; in the Madras Presidency, 720 and 27-G4; inBurmah,1205 and 53 60; and intheAndamansand Nicobars1797 and 40 99 per 1000. In all of them fevers were themost frequent cause of admission, and next to them dysen.tery and diarrhoea. In Bengal the most frequent causes ofdeath were dysentery and diarrhoea, followed by respiratory

’

diseases, cholera, and fevers; in Bombay, respiratory diseases,dysentery and diarrhoea, and cholera; in Madras, dysenteryand diarrhoea, ansemia and debility, and respiratory diseases;and in Burmah, cholera, dysentery and diarrhoea, and re-

spiratory diseases. In some of the gaols a very high rate ofsickness and mortality was manifest. For instance, inBengal, omitting all gaols with less than an average of 100prisoners, the admissions in Amritsar were 3528, and thedeaths 36-86 per 1000; in Etah they were 2324, and 27’78 ;and in Banda, 2302 and 101’64 In Rungpore the death-rate was 174-10; in Rajshahai, 133’59; in Ranchee, 162’65;in Gya, 113-76; and in Sambalpur, 103-63 per 1000. Inonly two of the larger gaols of Bombay was there acomparatively high rate of admissions; at Kurrachee itamounted to 1232, and at Thana to 1103 per 1000; andthe highest death-rate was 42-91 at Thana; at Kurracheeit was only 22-58 per 1000. The highest ratio of ad-missions in Madras was 2112 at Rajamundry centralgaol, and Cannanore was the only other gaol which ex-

ceeded 1000. But several of them had very high death-rates. Thus, in Coimbatore Central it was 107’14; inParvatipur, 115-85; in Cannanore, 72-16; in Berhampore,52-21 ; and in Trichinopoly Central, 40-10 per 1000. Theadmissions and deaths in Burmah ran high; at Mandalaythe former were 2049; and at Pagan the latter were 269’23per 1000, or upwards of one-fourth of the average number ingaol. Minbu, Toungoo, Myingyan, and Moulmein alsofurnished very high death-rates. In the Andamans and ’

Nicobars the admissions were 1797 and the deaths 40-99 per ,

1000. In these remarks we have omitted reference to allgaols having less than 100 inmates. An examination of thesummary of the sanitary sheets from the gaols shows that inmost of those in which great sickness or mortality has beenrecorded the sanitary conditions of the gaol, its surroundings,its water-supply, and the drainage have not beensatisfactory.There is abundant evidence that much requires to be donein many of them before they can be considered as likely notto prove injurious to the health of their inmates. It wouldbe interesting to ascertain the relative health of the prisonersand of the staff in those prisons which furnish high rates ofsickness and mortality.A table is given in the report showing the relative

mortality of the prisoners and of the troops, European andnative. But there is one error in the comparison, arisingfrom the omission of the deaths of men of the native armyabsent from their corps. Thus, it is stated that, "Takingthe death-rate of native troops as unit, the death-rate ofEuropean troops will be represented by 1-2, and the death-rate of prisoners by 2-8." But if the calculation be madeon the total death-rate of the native troops, the death-rateof the European troops would be represented by 0-92 insteadof 1-2, and that of the prisoners by 2-2 instead of 2-8. Thiserror to some extent vitiates the comparison of the relativemortality by different groups of diseases, but there are nomeans of making the necessary correction. Making allow-ance, however, for this, the tables give some interestinginformation. They show the chief causes of death amongthe prisoners to be bowel complaints, among the nativetroops respiratory disease, and among the European troopsfevers. The latter enjoy an exemption from cholera,respiratory diseases, and bowel complaints compared withthe native troops, who again have a very marked exemptioncompared with the prisoners. The very low death-ratefrom phthisis, which we have already noticed in the case ofboth European and native troops, does not extend to theprisoners, among whom it amounts to 2-59 per 1000.The registration of deaths of the civil population of India

is so very imperfect, and the results obtained so irregular, .

145

that it is impossible to place much reliance on them. In a

population stated at 197,202,012, 5,075,453 deaths were re-corded, being in the ratio of 25’74 per 1000. The death-rate ranged between 30’08 in the N. W. Provinces and Oude,and 17’30 in Mysore. In all the divisions except Assam,Lower Burmah, and Bombay it was lower than in the pre-ceding year. The increase in Bombay was trifling, but inAssam it amounted to 3 56 per 1000; it is impossible, how-ever, to say how far this was due to an increase in thedeaths, or to a more efficient working of the registration.The last quarter of the years appears to be much the mostfatal; of every 100 deaths recorded 22’09 occurred in thefirst quarter, 22-96 in the second, 24’32 in the third, and30’63 in the fourth. Of the causes of death, as registered,3,371,487 were fevers, giving a ratio of 17’10 per 1000 of thepopulation, and one-third of the total mortality. Choleragave a death-rate of 1’36 per 1000 ; bowel complaints, 1’27 ;small pox, 0’47 ; injuries and accidents, 0’44 ; and all othercauses of death, 5 -10 per 1000. Under the head of injuriesand accidents are included 24,348 deaths from snake-biteor of persons killed by wild beasts, being in the proportionof 12 35 in 100,000 of the population, and 10,276 bysuicide, or 5’21 per 100,000. This is about 1-5 per 100,000lower than in England, and is probably understated.The deaths from fevers ranged between 7’3 per 1000 inthe Madras Presidency and 23’89 in the North-WesternProvinces and Oude. In all the Provinces except Bengal,Assam, and Lower Burmah the ratio was lower than in1887. Bowel complaints furnished the lowest ratio in

Bengal and the highest in Assam, in the former being 0’78and in the latter 3’25 per 1000 of the population. Thereport goes into considerable detail regarding the prevalence,as estimated by the death-rate, of cholera. It was lessfatal than in the preceding year in all the provinces exceptAssam, Lower Burmah, Madras, Bombay, and the Punjab.Much the greatest increase was in Lower Burmah. Theeffect of the removal of troops and prisoners into camp whencholera broke out in the cantonments or gaols has been verysatisfactory. In seven instances among European troopsthe disease at once ceased, and in five others it wasquickly checked. In twenty moves of native troopsfourteen were immediately freed of the disease, three hadonly one fresh case, and in the other three it very soonceased. In the case of removal from gaols the results werenot quite so satisfactory. Eleven outof seventeen movementswere successful, but at Lahore, Chinawan, Rawal Pindi,Bassein, Moulmpin, and Pagan a second or third movewas found necessary.An account is given of the military and civil sanitary

works which have been undertaken or executed during theyear. There appears to be a steady though not very rapid,progress in these works, especially as regards water-

supply and drainage.

INTERNATIONAL MEDICAL CONGRESS.

THE Congress will be opened by a general meeting in theCircus Renz, Karlstrasse, at 11 A. M. on Monday, August4th. The general meetings on Wednesday and Saturdaywill be held at the same place. The meeting rooms of allthe sections will be located in the National Exhibition

buildings in Alt Moabit Strasse.The following is the programme :—

Saturday, August 2nd.—Opening of the Medico-SeientifieExhibition in the National Exhibition buildings, Alt MoabitStrasse.

-Ilonday, August 4th.—11 A.M.: Opening of the Congressin the Circus Renz, Karlstrasse. 4 P.M.: Constitution ofthe sections in the sectional meeting rooms in the NationalExhibition Park, Alt Moabit Strasse. 9 P. M. : Social re-union of members and ladies in the Exhibition Park.Tuesday, August 5th.—8 A M. to 5 P.M.: Sectional meet-

ings. 8 P.M.: Reception of members in the Rathhaus bythe Municipality of Berlin.Wednesday, August 6th.—11 A M.: General meeting,

Circus Renz. 3 P.M. to 5 P.1%1.: Sectional meetings.7 P.M.: Sectional dinners, to some of which ladies may beinvited.Thursday, August 7th.-8 A.M. to 5 P.M.: Sectional

meetings. 9 P. M. : Ball.Friday, August 8th.—8 A.M. to 5 p, M. : Sectional meetings,

Afternoon : Court reception at the New Palace at Potsdam,by special invitation.Saturday, August 9th.—8 A M. to 11 A n-t. : Sectional’

meetings. 12 noon: Final general meeting. 8 P.M.: Fare-well dinner to members of the Congress, given by membersof the profession in Berlin, in Krolls’ Garden in the Königs-Platz.Membership tickets authorise attendance at all scientifig-

meetings, and to the Museum. For all other meetingsspecial tickets must be obtained at the Central Bureau ofthe Congress. Lady relatives of members must send theirvisiting cards in making application.After Aug. 4th the Central Bureau will be located in the

Austellung’s Park N.W., Alt Moabit. Until then lettersfor the general secretary, exhibition, and lodging’s com-mittees are to be sent to Karlstrasse 19, Berlin N. W. ; forthe treasurer, to Leipziger Strasse 75, Berlin S.W.Telegrams and letters to members during the meeting of

the Congress should be addressed -Berlin N.W., AltMoabit, No. 4-10, Bureau des Congresses.A committee, formed by the wives of Berlin medical men,

will care for the convenience of all lady visitors. Membersof the committee will wear a special badge.The general addresses will be by—(1) Sir Joseph Lister,

Bart., The Present Position of Antiseptic Surgery; (2)Dr. Robert Koch, Bacteriological Investigation ; (3) M.Bouchard, The Mechanism of Infection and Immunity s.(4) Dr. Axel Key, The Relation of the Development ofPuberty to Diseases of School Life; (5) Dr. H. Wood, OnAnaesthesia ; (6) Signor Cantani, On Antipyresis ; (7) Pro-fessor Meynert, The Cooperation of the Parts of the Brain y(8) Professor Stokvis, On Colonial Pathology.The following English members will read papers &c.:—

Sir W. Turner, Professor Cunningham, Professor Schafer,Dr. Mott, Dr. F. Semon, Professor Horsley, Dr. Sher-rington, Mr. Ballance, Sir H. Acland, Dr. Lauder Brunton,Professor Grainger Stewart, Dr. Herman Weber, SirAndrew Clark, Dr. Pavy, Dr. Ord, Dr. Dreschfeld, Dr.P. Kidd, Professor Greenfield, Dr. A. S. Eccles, Dr. H.Ashby, Mr. Jonathan Hutchinson, Mr. Muirhead Little,Professor MacEwen, Dr. Galabin, Dr. J. Williams, Dr.Macan, Dr. Thos. Keith, Dr. Lloyd Roberts, Dr. MoreMadden, Mr. Stuart Nairne, Dr. Jas. Murphy, ProfessorSimpson, Dr. W. J. Sinclair, Dr. R. Bell, Dr. T. Buzzard,Dr. C. Beevor, Mr. H. W. Page, Dr. James Ross, Dr. W.A. Brailey, Dr. Grossmann, Mr. 0. M. Berry, Dr. Jas.Stewart, Dr. D. Newman, Mr. Malcolm Morris, Dr. ColcottFox, Dr. Brooke, Dr. Mapother, Dr. P. S. Abraham, Dr.Greene, Mr. Mummery, Mr. Hayman, Mr. G. Brunton,Mr. T. G. Read, Dr. A. W. W. Baker, Mr. G. Cunningham,Dr. Beaven Rake, Dr. Geo. Buchanan, Mr. Reginald Har-rison, and others.The general programme is now ready, and may be-

obtained on application to the general secretary, BerlinN.W., Karlstrasse 19.

MUSEUM OF THE COLLEGE OF SURGEONS.

THE usual exhibition of preparations that have been addedto the museum of the Royal College of Surgeons during theyear was held on the afternoon of the 3rd inst., during thetime of the election of members of Council; want of spaceprevented us from referring to this collection last week. Fromthe annual report of the Conservator, Professor Stewart, welearn that the additions to the museum, though perhaps lessnumerous, are quite as important as in previous years. Thefollowing may be mentioned as among the additions:-Sarcoma of the prostate gland, carcinoma of the apex ofthe bladder, squamous-celled carcinoma of the uterus, con-genital hydronephrosis, cystic kidney.

Nos. 715, B to H, include specimens illustrating a peculiarand hitherto scarcely known disease of goats. The mosi)lstriking feature of the disease is enlargement of the lowerjaw, by which the mouth is kept open.,

Among the more interesting additions, mention should, inthe first place, be made of a series of Egyptian boneswhich were collected in Lower Egypt by Mr. FlindersPetrie. They were obtained from a town called Gurob, and’their date is approximately B.C. 1300. Many of them showchanges produced by osteo-arthritis, a fact of interest,as it confirms the view of the antiquity of that disease,,