JAN. 22, i9x6 GENERAL AND STATIONARY HOSPITALS. txAiNT 14! illness in the service of tlhe State, even if they had passed tel medical examination when recruited. It was possible TEIE WABt. tlhat the disease might not then have been detected; there T~~~~~~~~~~~~~~~~~~~~~~~ mighlit lhave been previous illness. Asked by Mr. Currie with regard to the case of men who had some latent GENERAL AND STATIONARY HOSPITALS. (liscase which emerged owing to the hardslhips of military (From a Correspondent in France.) service, Mr. Tennant said tlhat, speaking generally, it NVorthern would be for the military autlhorities to state whether THE differences between casualty clearing stations and tljey considered thalt the actuLal service of the State lhad other hospitals are well marked; those between general been the reason for the breakdown; if it had been, thle and stationary lhospitals may more easily be overlooked. man would receive tlle pension to which he was entitled. In certain instances in France they are almost un- On January 17th Mr. MacCallum Scott asked whether discernible. They do, however, differ as a rule very officers lholding temporary commissions invalided out by a considerably in point of size, and in any case the theo- medical board after serving during the present war would retical or official distinction between them slhould not be be liable to enrolment under tlle Military Service (No. 2) forgotten by students of army medical administration. Bill, and whether sitngle men honourably discharged on Speaking metaphorically, it may be said that general medical grounds from the army during the preselnt war and stationary hospitals are brothers, and the casualty would be liable to enrolment under the bill. In reply Mr. clearing stations tlheir distant couLsins. Of tlhe two brotlhers Tennant said that inldividuals invalided out of the service, the elder is a portly citizen who lacks nothing that wealth whdether officers or nmen, would, prima facie, be eligible for can provide, and lives as a rule in the very best part, tlhat exemption under tlle bill. is to say, at some military base. His guests, like himself, Australianl. Medical Corps.-Captain Amery asked the are supposed to be always persons of importance-in other Undler-Secretary of State for War wlhether Lieutenant- words serious cases-and he is invariably prepared to Colonel J. W. Barrett, Australian Medical Corps, occupied receive at least 520 of them; also, wlhatever their number, the Imuperial appointment of Assistant Director of Medical he is able to provide tllem with all sorts of luxury in the Services on the staff of tlle Director of Medical Services, way of up-to-date treatments. Finally, he is in a position Egypt, and consultigify oculist to His Majesty's forces in to re-equip them completely in the matter of clothing; Egypt; -whether lhe was removed from tllese offices witlh- and, on the termination of their visit-if this has been a out inquiry by the Australian Government on a recom- success-he, can hand them over to one of hiis satellites, a mendation of the Army Council, which the General convalescent camp. He is, in short, almost the military Officer Commandina in Egypt subsequently pointed out equivalent of a leading hospital in a medical centre at was due to a misunderstanding; whetlher a court of home. iniquiry lhad been lheld, and wlhat was the findina of that The younaer brother-the stationary hospital-often court; and whether, if tllat report is favourable, the Army receives the same kind of guests, but is muclh less im- Council is prepared to reinstate Lieutenant-Colonel posing in appearance. Even though he chance to be tlle Barrett, or whethier lic is prepared to make any statement immediate neiglhbour of his relative and to be really quito with regard to the value of the work done by Lieutenant- as well-to do, he maintains an establishment which is Colonel Barrett. Mr. Tcnnant: I believe the facts as much less elaborate in point of equipment and also stated in the first two parts of the question are substantially smaller (200 beds). Likewise he is supposed to be a correct. A court of inquiiry was held in Egypt in October person of more democratic tastes and hardier constitu- last year, anid in its finding the court exonerated Lieu- tion. Consequently he usually lives in a poorer part tlhau tenant-Colonel Barrett, and spoke in thLe highest terms of his brother. His natural labitat, in fact, is some spot on hlis wvork. Tile Higlh Commissioner of the Commonwealth the lines of communication, where lhe can afford tem- was informed that there was no objection to Lieutenant- porary accommodation for important persons or receive Colonel Barrett being employed in Egypt or elsewiere, guests of a humbler sort, that is, men likely to recover provided tlhe Government of the Commonwealth concurred. from their wounds or sickness with rapidity, and -whoin Rccruits' Eyesight.-Mr. Tennant has returned written it is consequently desired not to remuove further than needI answers to a series of questions by Sir John Rolleston as be from their own units. His nearest equivalent in civil to the examination of recruits for defective vision. Mr. life is perhaps a county infirmary. Tennant said that special ophthalmic surgeons were avail- The third of the group is quite a different kind of able in all conmnands, to wlhom would be referred all cases person. A dweller in the byways, he reeks little of of douibt or difficulty, and cases in which it was tllought appearances. Provided he has room for 200 guests and as that tlle defective vision could be corrected by glasses. many more as happen to arrive he is content witli the The certificates of medical eye specialists were treated in mere necessaries of life in the matter of food and furniture the same way as certificates from any other medical men. and all other items. Many of his guests are more dis- They miglht aid the medical examiner of recruits, but could tinguished than any of those received by his cousins, but not absolve him from his responsibility in passing or whatever their clharacter he always passes them on to thle the recruit. latter as soon as circumstances permit. rejecting All three are war-time institutions; in other words, they Vaccination.-In reply to Mr. P. White, the Parliamentary do not exist when the army is on a pe-ace footing, but are Secretary to the Local Government Board, on January ordered by the regulations regarding the Expeditionary 13th, stated as follows: The number of successful vaccina- Force (as revised and published in 1914) to be created on tions for whiclh vaccination officers receive certificates at mobilization in the proportion of 2 general hospitals, all ages in England and Wales was, in 1913, 430,470, and 2 stationary hospitals, and 1 casualty clearing station in 1914, 404,616, and tlle number of declarations of con- to every division in the field. As tlle same regulations scientious objection to vaccinations in 1913, 308,235, and also direct that accommodation on lhospital sllips (220 cots in 1914, 321,313. I cannot give the actual number of per division) and on ambulance trains (room for 100 lyincg clhildren vaccinated, nor tlle figures for 1915, which are down cases per division) shall be simultaneously mobilized, not yet available. It appears from the criminal statistics it will be seen that tlle total acconmmodation provided is for thle year 1913 that 146 persons were proeceded against well over 10 per cent. of army strengtlh. in that year for offences against the Vaccination Acts. This being tlle case, any one who has followed the The statistics for 1914 and 1915 have not yet been debates in Parliament, and therefore knows the approxi- published. mate strenath of the British forces in France, can calcu- late for hlimself the vast total accomnmodation which tlhe Madras Medical Council.-In reply to a question by Sir medical autlhorities in France would have been justified J. D. Rees as to the feeling alleged to be aroused amlonig in raising had they chosen to act strictly in accordance Ayurvedic plhysicians and hakims in the Madras Presi- with the regulations. Fortunately, however, for the tax- dency by the action of the Madras Medical Council under payer, for the medical profession, and for the civil popula- the Madras Medical Regulations Act, 1914, in respect of tion in GreMt Britain, this has not been their attitude. Dr. Kvrishlnaswamy Iyer's alleged covering of an Ayurvedic Whlat thley have done in reawlity i,s to comply, not withl thle phlysician, and whethler it was proposed to amend the letter of thle regulation, but withl its spirit. Thley hlave, in MIadras Act so as to bring it into linle with the Bombay short, from beginning to end kept thleir accommodation inl Medlical Act, 1912, MIr. Chamberlain said thlat hXe hlad no medical units of all kinds down as low as the position official informationl onl th n bject. immediately in view seemed to justify. The enormous 14-2 MEDICAL1O1U"A.3 TREATMENT OF ACUTE DYSENTERY. [JAN. '22, 19-16

economy thus effected in the way of personnel and all Alexdra's Imperial Nursing Service or of the other other directions will be realized only when and if the nursing bodies which are now sharing its labours. precise figures are published. For the present this, for The net result is eminently satisfactory. There are few obvious military reasons, is not likely to be done. ho*itals in Fraince which could not give points to any of The immediate outcome of this attitude towards the those which came into existence in South Africa during general problem of how to secure that there shall never the last great war, and the general level in respect of the be any shortage of beds or other accommodation in France, comfort of patients and of facilities for doing professional 'witlhout trenching too far on home resources, has been that work of the best kind falls little if at all short of that of instead of raising new general and stationary hospitals for permanent civil hospitals in Great Britain. every division that has arrived, the desired proportion of Nevertlheless, the official distinction between the tlhree beds has more often been secured by expanding the types of institution still remains, and should a general accommodation of existing units. and prolonged advance take place it may be expected to This expansion has naturally not been level throughout, become once more plainly visible. In other words, a so tllere are a good many stationary hospitals wlhose casualty clearing station is officially only a hospital so accomnmodation is not obviously less tllan that of a general long as it cannot pass its patients down the lines of com- hospital. This is one circumstance whlieh has tended to munication; it is also expected to do this as quickly as obscure the difference between the two types of institu- possible, not keeping its patients longer than their con- tion, but there are others, perliaps of more importance. dition renders imperative, or performing any operations For example-the lines of communication are, practically other than those of necessity. Beyond mattress cases, it speaking, quite short; it has been unnecessary to string has little ward or allied equipment other than what it can out the stationary hospitals aJong them; they are com- carry in its own field panniers, and it is expected to keep monly to be found at bases in the immediate locality of ready to move at almost a moment's notice. Of this fact the general hospitals where they are housed on identical some commanding officers of casualty clearing stations lines. remind themselves by keeping the motor lorries allotted Another circuLmstance is the siege-like character of the to them within direct view and making a point of using military operations during the last fourteen months. This them daily for some purpose or otlher. lhas enabled the medical authorities to avoid moving hos- Despite its namne, mobility is also expected of a pitals as frequently as would otherwise lhave been the case, stationary lhospital; for this, too, is a field unit. It pos- so that many stationary hospitals have occupied the same sesses a good deal more equipment than a casualty site for many months; some for over a year. 'Their com- clearing station, but its beds and bedding are only of manding officers have thus had time to beg, borrow,- or barrack-room type, and it is self-dependent in the matter steal all sorts of extra equipment and so bring up their of medical comforts and surgery requisites. That is to lhospitals to the level of a general hospital, both internally say, it must carry everything it requires for -any reason- and externally. The zeal in this respect of the command- able period in panniers, and it must never be surprised if ing officers, both of general and stationary hospitals-that asked to move on to some place at a distance from any is to say in regard to striving constantly towards perfection centre at a notice of twenty-four hours or so. -is beyond all praise, and the hopeful spirit they exhibit Tlle position of a general hospital, on the otlher lhand, is is often quite remarkable. Many, for instance, start considerably different. Its normal equipment is not essen- elaborate gardens, if they hiave any ground, around their tially dissimilar to that of a civil hospital, and includes huts and tents, and some have done so with much ordinary bedsteads, hair mattresses, bedside tables and the success. These things they do notwithstanding their like, as well as plenty of surgical desiderata. It also has the consciousness tllat even if their hospital is not suddenly advantage of knowing that if it is ever required to move moved on elsewhere, they themselves may be transferred it is likely to receive plenty of notice, and that in any case to another sphere of activity and leave the harvest to be it will never be sent to a place at which it cannot obtain reaped by a brother o flcer. Nor are such endings to their forthwith any stores or extra equipment that it may efforts by any means rare. It would sometimes seem, require. indeed, as if Nemesis kept a special watch for command- All three types of hospital possess tents and marquiees, ing officers who are too successful in the directions but are expected to utilize permanent buildings if suitable indicated. ones be available. A third factor is the importance that the medical autho. rities in France attach to the utilization of scientific TREATMENT OF ACUTE methods. It has led to their gradually providing almost DYSEN'TERY. AT a meeting at Alexandria on October 17th, 1915, all stationary lhospitals with annexes, such as the regula- General Surgeon- tions would seem to imply shall be attached, as a BABTIE, v.C., Principal Director of Medical Seivices rule, Mediterranean and only to general hospitals-for example, x-ray departments, Expeditionary Force, Egypt Malta, being in the chair, a discussion took place on the treatment and often pathological laboratories. of acute A further circumstance which has had the effect of dysentery. lhelpin, to eliminate the difference between the general Lieutenant-Colonel Sir RONALD Ross, who opened the discussion, after a short historical survey, drew attention and stationary lhospitals in France is that some of the to tlle latter have bean told off to do special work, and have thus relatively greater severity of tlle disease among the troops from Britain, Australia, and New Zealand com- acquired an importance which they would otherwise not to that lhave possessed. For instance, one pared among those from India. Emetine hydro- stationary hospital to have began at quite an early date to deal exclusively with cases clhloride appeared proved very successful, but a certain cases of infectious disease, and little by has percentage of remained refractory. Such little developed were into an " running dysenteries," due probably to post-amoebic institution with nearly 1,000 beds. A second, colitis. In vhllich receives none but officers, has converted itself into older cases, especially of " running dysentery" not cured by emetine, he was still partial to the equivalent of a first-class nursing home; while a third, ipecacuanha wlhich has expanded despite the great powder. Subsidiary treatment, oral and rectal, was by no success of its work, means to be devotes its energies to the rapid restoration of their despised. Bismuth seemed to have proved military distinctly usefutl. Oils appeared to be suitable on a priori efficiency to men suffering from venereal disease. and IThese are the circumstances which lhave mainly contri- grounds, olive oil had for long been used extensively buted to render the difference between in Italy. Much difference of opinion existed as to the general and value of rectal in acute stationary hospitals less discernible than it was in the injections dysentery; in clhronic first were often essential. He montlhs of the war, and some of them have had a corre- dysentery they could testify to the value of hot in cases sponding effect on the casualty clearing stations as a hip-baths witlh severe tenesmus. class. diet, his was It is not common for any of these to remain in the same Regarding personal feeling against too much place but broth, meat extracts, and eggs, and still more against very long, some of them are housed in excellent large volumes of fluid of any in buildings, and have managed to get hold of a sufficient kind, especially "running number dysentery." In conclusion, he pleaded that the complica- of bedsteads and other fittings to secure that at tions slhould not be forgotten-chronic any rate one or two of their wards shall not be distinguish- dysentery, often able from those of a with stricture and a life of misery, and hepatic abscess. stationary hospital of the more Rogers bad found that in the Brititlk army in India more elementary kind. lVbat is still more important, they all than 14 per cent. nowv include in their staffs members either of of-cases developed the latter. (Tlle report Queen of Sir Ronald Rom's lecture before the Royal Society of r T-H BmI - JAN. 22, I916] TREATMENT OF ACUTE DYSENTERY. MEDICAL Joualq" 143 I Medicine on Decemiiber 20tlh, 1915, will be found in the or the horse serum itself might have benefited the patients. BIITISH MEsDICAL JOURNAL of December 25tlh, p. 927.) Milk was excluded from the diet in acute cases, the sub- MajOr M3CCARRISON, I.M.S., said that dysentery had stitutes being albumin water, whey, arrowroot, and barley accountecl for slightly over 9 per cent. of the total Indian water. It was tlhought advisable to exclude mueat extract. casualties from the Mediterranean. The mortality lhad Perhaps the outstanding feature in serious cases was vaso- been nil, and the cases lhad usually been mild. In a con- motor collapse, the systolic blood p'ressure falling to the siderable numnber cure lhad rapidly resulted fromn rest, seventies or even to tlle sixties in fatal cases. In castor oil, or salines, and appropriate diet alone. Emetine some cases good results followed the subcutalneous in- lhad only beeni necessary for a minority. The majority of fusion of one to one and a lhalf pints of salinie. Hypertonic the cases were amoebic in origin. He was of opinion that saline infusions were m-ore painful, aind lhe was not large dloses of cimctine were not indicated; half a grain sure that they were particularly advantageous. Thie twice daily for one week, and once daily for a few days infusion was combined with 10 rainimns of adrenalin longer, was sufficient and safe. If tlle condition of the solution (1 in 100) every four lhours, inijected lhypo- patient appeared to require its more extended use, it could dermically. Solmle cases were given brandy and chain- be administered orally. He combined tllis treatment witlh pagne, some pituitary extract, some stryclhnine, but a prelim-iniary dose of castor oil and the subsequient use of adrenalin appeared tlle most reliable. Pain was relieved saliiies or caloimel, preferably the latter. Thiymol or by morphline and atropine given hypodernmically. For calomiiel, or, better, a coimibination of the two, were most tenesmus, after a dose of castor oil or enieinata to emipty effective in aSsiStincg in tlle disappearance of the cysts tlle bowel of slouglhs and debris, an eneina of 3 or 4 oz. fromn tlle stools, aind in dealing withl carriers. Quinine of warm olive oil containing a cldaclhm of iclhtlhyol was inCjections did niot destroy tlle cysts. Tlhymol slhould be beneficial in some cases. An injection containiing adrenalin given finely powdered and in doses of 30 grains daily. and astrilngenit was very successtul in otlhers. Castor oil Oils, alcolhol, vinegar, butter and glee, being solvents of (10 to 15 minimis) or paraffin in lhalf-ounce doses every few tlle d(lru g, slhould be excluded froom the dietary. WVitlh hours had been found of som-e service. For hiccougl- regard to diet, lhe emphasized the importance of resting -a sign frequently of fatal significance-atropine lhad the iniflamed gLut as m-nuch as possible; this rest was best somuetimies given temporary relief. For post-amoebic secured. by a diet consistineg solely of tepid albumnin water colitis bismutll and salicylates, astriingents, chlorine and water. Milk slhotuld only be given if the tonaue were water, and otlher antiseptics lhad been followed by un- clean. Malaria and scurvy were frequent complicatinig certain results. Weak iodiine, quiniine, and silver prepara- factoi's among tlle Indian patients, and required their tions given by tllh bowel lhad only a qualified success. appropriate treatmiients. It slhould also be borne in nmind Caroful dieting-for instance, the addition of curds or of thlat typlhoid fever miglht complicate or simiiulate dysentery, soured milk, and of beaten-up egcgs for the acute form, anid ml-iglht render tlle dianosis difficult. with the cautious trial of more solid foods, such as f -eshl Captain KERR, R.A.M.C.(T)., said that of 661 cases of fislh or custard-was of real importance. Ce-eal souip dysentery unider hiis observation 27 h1d died. Twenty-four mihlit be of service. With this careful dieting, bismiiutl, 2)ost-mortemn examiiinations indicated tlhat tlhe inD'ee on was liquid paraffin, and enemata of ichtlhyol and olive oil were arnoebic in 20 and bacillary in 4. Tlle stools of o6.5 cases used witlh favourable results. Many cases relapsed whenli of suspectcd dysentery wcr-r examined, and in 312 cases talien off the special diet. When bleeding was serious ain]oebae or amoebic cysts were found. Roughly 50 to 60 adrenalin enemata, 1 drachm of the 1 in 1,000 solution per cenlt. of tlle cases were slhown to be amoebic. The to the half-pint of water, miglht be useful. Liiue salts routine treatmnent in cases of suspected dysentery had been might be tried, and inject! n of lhcr e serum seemed to to give a course of emetine (J grain morning and evening have a good effect in excel)tional cases. The possibility for six to ten days, according to tlle severity of tlle sym- of a scorbutic elemuent should not be forgotten. For tle ptoms and tllc result obtained). In many cases an initial sequelae-asthenia, lassitude, backaclle, and tendency to dose of castor oil or salts wvas given. Afterwards, wlhen recurrent diarrhoea-he was of opinion tllat convalescenee the blood anid mucus lhad disappeared, the stools being still would be hastened by change both of climate and of loose, the emetinie was stopped and a draclhm of a bismutlh subjective outlook. salt was adnministered tlhree or four times daily until the Major T. S. Novis, I.M.S., spoke of the value of 2-graini diarrhoea ceased. At the end of two to four weeks 2 or 3 doses of ipecacuanha given every second hiour witlh an more grains of emetinie were given, or powdered ipecacu- equal quantity of tannic acid. He disagreed with the anhla was continued for a week or two. Thlroughout tlle practice of giving 30 grains after a dose of opium, and the treatment the bowel was occasionally cleared by magnesium application of a mustard plaster to the epigastriuml, sulph1ate or castor oil. In more urgent cases, with excessive because of its depressant effect and the continued purginig, collapse and exhaustion, antidysenteric serum vomiting it often produced. Intramuscular injections of (20 c.Cim., repeated two to five times) was combined with emetine (1 grain) twice daily was the most successful tl]c cnmetine and proved very satisfactory in many cases. treatment. He had seen very good results follow concen- It was frequently found necessary to employ intravenous trated solutions of magnesium sulplhate in cases pre- saline infusions in addition. He was quite convinced of sumably of bacillary dysentery, and in a few cases anti- the great value of emetine, and administered it in normal dysenteric serum had been beneficial. Tlhe indications saline solution by the deep subcutaneous method. Since were rest and cleanliness of the bowel. The former could extremue exlaustion followed severe dysentery, and heart most nearly be obtained by starving tle patient for two or weakness was common, prolonged rest in bed was essential. three days and afterwards dieting witlh a food wlhiclh left lie advised that suclh patients as hiad gone throuah a little residtue. The bowel could be kept clean by large severe attack of amoebic dysentery slhould be prescribed a enemata of normal saline run in very slowly. Appendi- mnonthly course of einetine (1 graiufor tllree or four days) costomy could scarcely be adopted for acute dysentery. for a few monthis as a preventive measure against liver Perforation was most frequent in tlhe region of the caectum, abscess. He did not favour lavage of tlle large' bowel; it and not uncommonly the extravasation became localized, hadlnot proved satisfactory in his experience. Rectal necessitating drainage. After operation tlle edges of tlle fluslling did, however, ease those cases in wlliclh tlhick wound might become gangrenous, a p-ocess which had mucus was an urgent symptom. Appendicostomy had been clhecked in a few cases by injection of emetine and been of beiefit in one case. the local application of carbolic acid. A course of emetine Lieutenant ColonIel A. H. LISTEn, R.A.M.C.(T.), said that during or after convalescence would lessen the liability to at the hlospital witlh which he was connected every case of hepatic abscess. dysentery received a fouir days' course of emetine injections Captain F. OPPENHEIMER, R.A.M.C.(S.R.), had found that (.t to grain twice daily). After four days' interval a a very light diet was unsatisfactory. All but exceptionial second similar course was given. If all straining or cases were put on such a diet as frelsh milk, tlhree eggs, bh1 eding had been relieved the emetine was then stopped. custard, one pint of beef-tea, bovril or clhicken brotlh, one He spoke of the great efficiency of the drug. Antidysen- pint of arrowroot or cornflour, clotted milk, cocoa for teric serum was employed if no improvement followed the supper, and three lemons. The eggs were beaten up in emetine, 40 c.cm. being given subcutaneously, followed the milk or, unless the patient wvere seriously ill, lightly by 20 c.cm. next day. It had proved of definite value in boiled. Meat juices or extracts did not appear to aagravate a few instances, but its results were not uniformly good. the condition. After using sodium sulph-ate (3j hourly Perhaps the cases which reacted were bacillary in origin, until a clear motion was obtained) he had abandoned it as 24MBAMM 144 SUDICAL JOURNAZ I TREATMENT OP ACUTE DYSENTERY[ r,TAN. :22, I91I6 I no improvement was observed and depression was caused. eggs were not added till he was passing three or four The practice was continued, however, in certain early motions a day with little or no mucus. bacillary cases. Enemata of quinine sulphate (1 in Professor S. KARTuLis, after referring to the great 2,000 to 1 in 500) had been used chiefly for the more prevalence of and high mortality from dysentery in Egypt severe amoebic cases. Such good results as had been before the discovery of its causation, spoke of the good obtained he attributed chiefly to their mechanical effect. results following the irrigation of the large bowel with a When there was much tenesmus he usually followed this 0.5 per cent. solution of tannic acid. He testified to the with a small starch and opium enema. He began by using very great value of emetine, but it often failed and some- emetine in half-grain doses twice daily for ten days. times did not act at all upon the living amoebae in the Since the amoebae did not always disappear from the intestine, even in repeated doses. Perhaps in one-tenth of stools he increased this period to fourteen days, using the cases treated by emetine the amoebae remained alive 1 grain daily in one dose. The results were very satis- for a long time. He had not found that quinine injections factory. Later tlle course was increased to twenty-one into the cavities of liver abscesses was satisfactory. days; three fatalities occurred. After intramuscular injec- Afterwards the amoebae were found dead, but a few days tions many cases had marked pain and stiffness two or three later they appeared again in a living condition. An injec- days later. From among about 3,000 injections about 30 tion into the abscess of 0.5 per cent. of tannic acid cases had red and swollen arms, in one case a small slough also gave negative results. The same solution injected formed, and in two suppuration occurred. Ipecacuanha hypodermically proving also unsatisfactory he tried lhad been used without favourable results as it was difficult stronger solutions, and on three occasions used one of to take effective steps to prevent vomiting. Quinine 20 per cent. The amoebae after three or four injections sulphate had been followed by some benefit in amoebic disappeared from the pus, and the abscesses soon healed. cases with a persistent high temperature, due to secondary He- had applied similar injections against amoebic intections of the colon. Dover's powders had been given dysentery itself, and found that the results were the same freely at nighlt to produce sleep and to relieve nocturnal as those of emetine; the injections of tannic acid even diarrhoea. A stock mixture of bismuth, catechu and proved effective when the emetine had failed. It was not chalk had been used freely. For the griping pains he always infallible, however. In 1913 he had ex- relied chiefly on hot fomentations and chlorodyne. The amined the stools of about 80 cases treated by both results obtained with serum in the bacillary cases had methods, and on the whole the results were good. been good but not persistently so. Usually 50 to 100 c.cm. Further progress was made when he combined lhad been injected as an initial dose and followed by emetine injections with tannic acid enemata. The 40 c.cm. on alternate days for as long as* appeared latter were constituted according to tlle formula: necessary. In the most severe cases the first dose was Tannic acid 4, iodoform 3, sodium chloride 6, arrowroot given intravenously. No ill effects had been observed. 25, aq. destillata 1,000; the mixture to be used in two Intravenous hypertonic salines were very beneficial in enemata in the twenty-four hours. Oral medication was collapsed cases. necessary to combat such symptoms as arose. His pro- Colonel TUBBY, A.M.S., thought that no surgeon could cedure was to inject at once w grain of emetine intra- consider appendicostomy advisable during an attack of muscularly, if possible, twice a day, and to order two acute dysentery. He did not advise it in clhronic enemata in twenty-four hours of this tannic iodoforim dysentery; there was danger of peritonitis following, due mixture. The enemata must be kept in the large intes- to the lack of adhesions. tine for fifteen to twenty minutes. He only used purges Lieutenant J. A. DELMEGE, R.A.M.C., gave a summary of such as castor oil or calomel in exceptional cases. The observations on the treatment of 84 cases. Sixty per injections and enemata must be continued for three or cent. were admitted during the second week of the disease, four days. Usually severe symptoms disappeared on the and 34 per cent. during the third week. Fifty per cent. fourth day, the patients becoming free from pain, tenesmus, were passing twenty motions in the twenty-four hours, and frequent motions with blood and mucus; amoebae with blood and mucus. For the remainder the average were not to be found. Afterwards he continued for a week number of motions in the twenty-four hours was between to inject the emetine and to employ the enemata once in eight and fifteen, with blood and mucus. All cases were every twenty-four hours. Two or three injections of treated with emetine intramuscularly (* grain on the emetine a week were given for anotlher two weeks. For first day, then 1 grain on each successive day). Forty per the first three days he permitted only small quantities of cent. were so treated till the total dose was 15 grains; 60 per diluted milk in weak tea, or, better, slimy soups prepared cent. until it was 4 grains. No difference in the general with fresh butter. Two to four lemon drinks were allowed condition of the two sets of cases was observed. A few in the day. On the fourth day he added, once or twice a complained of dryness in the throat, and 5 per cent. had day, macaroni, rice, or arrowroot, well boiled in water, vomiting, necessitating the discontinuance of the drug. with fresh butter. Light, solid food was allowed after a Ipecacuanha (5 grains) in powder, with 5 grains of Dover's week, but only if the stools were normal and free from powder was given to twenty-four patients after emetine amoebae. At the same time jams and marmalade miglht had been omitted. Twenty of these patients- vomited be given. In the early stages, when severe pain was after each dose, and it was discontinued. Up to 40 c.cm present, he ordered linseed poultices to the abdomen and of antidysenteric serum were given in 15 cases: 2 improved, sometimes injected morphine. For diarrhoea he had used the result was doubtful in 3, no improvement followed in 8. for the last tlhree years, with excellent results, uzara in Fifty per cent. of the cases were treated with emetine tabloid or liquid form. Two or three tabloids, or 20 mininis and bismuth salicylate (30 grains t.d.s.) and the remaining of the liquid, should be given every two houirs. He had 50 per cent. with emetine and quinine sulphate (5 grains in treated by this method about 400 cases with no fatal tablet t.d.s.). No difference was noted between the two result. The whole number of cases of amoebic dysentery sets of cases. Morphine (igrain sublingually) had proved treated by the old and new methods in the thirty-two most efficacious for abdomial pain. Tinct. chlorof. et years of his practice among private patients was about morph. co., combined with bismuth, had been used for 3,000.. Only four deaths- had occurred, and these were acute cases, and tinct. opii (nx), combined with astrin- treated by the old method. gents, for chronic cases, but in neither instance with note- Lieutenant H. CREAN.called attention to the possible worthy effect. Paraffin seemed to prsevent the reappear- value of eusol as an injection into the bowel in certain ance of streaks of bleod in the stools, when used at the cases. Eusol was a preparation which more than any stage when thle patient passed two or three hard motions other antiseptic was bactericidal without injuring the in the twenty-four hours. He had been unable to con- tissues, and it occurred to him that such a solution should vince himself that irrigations of potassium permanganate, be useful when the acutest stage was over and a secondary followed in some cases by silver nitrate (30 grains to infection remained. The solution was made of equal parts 3 pints of water), cut short the acute stage of the disease of hot saline (2 per cent.) and normal eusol. The solution or prevented its chronicity. It soon be6ame noticeable caused no pain. It had been usually given once a day for that cases kept on a low diet for a comparatively long four days, and was retained for fifteen to forty-five period improved more rapidly than those whose food was minutes. Most of the cases reacted well,as shown by the increased more quieklly. Roughly speaking, whole milk reduction in the number of stools and the subsidence of was not given till the patient passed only six motions or the irregular fever. He recorded a case in which it so a day with very little mucus, and bread-and-butter and appeared that a patient not previously exposed to infection [T BTmzm IX tAN. 22, k916] THE EAST AFYICAN CAMPAIGN. IMURDICAL J~OUAKAL I4

I mnanifested the symjptoms of dysentery forty hours after difficulty in swallowing and sensation about the throat landing at Alexandria, and in whose stools am'oebae were might prove to be due to some change in the medul- found. lary nuclei, and advised general rules for the administra- Colonel GORDoN HALL said that in the fatal cases which tion of emetine similar to those mentioned by Colonel -occurred after emetine he could see no evidenco that Healy. -emetine was the cause of death. The men died some Surgeon-General BABTIE noted with satis(faction the -days after the emetine had been withheld, and had had unanimous opinion as to the value of emetine. If given less emetine' than many others. The death was probably wvith skill and care its risks became very small. due to post-dysenteric heart failure. Since the introduc- Notes on the subject were also submitted by Dr. C. tion of enietine there had been fewer cases of liepatic EKINs, Lieutenant D. FORDB, and Lieutenant F. DUNN, abscess, and even when this had commenced emetine could R.A.M.C. -cure it. If emetine caused pain he considered that the technique was faulty. Colonel C. W. HEALY referred to 'the three cases which .had ended fatally from sudden heart failure after emetine THE EAST AFRICAN CAMPAIGN. had been employed. Two similar cases had been de- WE referred last week to some of the more important %scribed by Dr. Milton Grendiropoulo. Emetino was a diseases which prevail in East Africa, and by which powerful agent whose dosage, and the length of time unacclimatized soldiers are very likely to be attacked -during which it should be administered, had to be con- unless they fully understand the nature of the precau- sidered carefully. The' depressing effects of the drug, if tions which ought to be taken. We are now able to given in 1-grain doses dai-ly for some time, became very announce that the Army Medical Department has pre- Marked, the 'noticeabl features being general lassitude pared, for the use of soldiers, a pamphlet, entitled How to lowness of spirits, disinclination to make an effort, rapidity Keep Fit in the African Tropice, on the insect pests -of pulse, loss of appetite, nausea, and in some cases diffi- and diseases likely to be met with by an expeditionary culty in swallowing and a feeling of constriction about force operating in British East Africa. It is a very the throat and chelt. The question of idiosynicrasy excellent production, and cannot fail to be of the greatest and the fact that symptoms of collapse appeared three use in tlle campaign. -or four days after the drug had been discontinued The first part contains some brief geograplical notes, had to be considered. There could be little doubt and the second gives particulars of the climate of the that emetine, if administered continuously, depressed various regions, which, as is well known, varies ex- the lieart, for the signs of cardiac depression im- tremely, from most unhealthy tropical conditions to those proved quickly when the drug was omitted. Allan prevailing in the highlands of East Africa, where tlje found that a 4-grain dose caused nausea. Baermann and climate suits white men excellently. This part contains lleensmain found that 2 to 2f-grain doses repeated led to also a section on heatstroke and sunstroke, in wlicll the weariness and loss of appetite, and that an intermission irritating effect of even indirect sunlight on the bare skin removed these symptoms. Colonel 'Healy suggested that is noted. the dose should be from I to i grain d:aily, and that this The next part gives a short account of the nature and :should be continued until 5 grains lhad been given. The habits of insect pests and the best methods of dealing treatment should then be stopped for seven days, and with them. Particular attention is, of course, directed to might then be renewed if not contraindicated until 3 more the mosquito, to tsetse flies, and t7o ticks, but tllere are -grains had been given. When under emetine treatment useful notes also on lice, and on bed-bugs and flies. As patients should remain in bed, and an accurate record a precaution against lice the use of a powder made of ,should be kept of the pulse-rate. If this definitely naphthaline, iodoform, and creosote is recommended, increased, the drug should be omitted until the heart which, dusted on the underclothing and rubbed between resumed its normal condition. Convalescents who had the seams of the coat and troulers, is said to have a received emetine should only be allowed up gradually, marked preventive effect. One-third of an ounce is -and should return to bed if the pulse-rate increased stated to be enough to clear the clothing of one soldier, -considerably. The diet should be fluid-albumin water, but the treatment must be repeated once a week. " Crude whey, milk and barley water or soda water, arrow- oil emulsion," by which we understand an emulsion of root at first thin and gradually thickened, and Benger's crude petroleum oil with soft soap, is also recommended 'food. In severe cases the food should be given every two to be rubbed into the lhair and on the insides of stockings, hours, about 4 oz. at a time, and neither hot nor cold. boots, or puttees, on the seams of clothing, and on the IMilk diet was of the greatest benefit in chronic dysentery. neck and wrists. As the proportion of soft soap is con- Return to solid food should be made slowly. Fruit must siderable it can be used when bathing and for washing be avoided for a long time. clothes. It is also valuable against the bug and for Major HALL, R.A.M.C.(T.), gave details of the three fatal washing furniture. It is added that bed-bugs may be -cases. One case was quite convalescent and had been up prevented from climbing up by rubbing it on the legs of -and walking for four days. He complained of a sensation the bedstead. After a note on the common flea, particular in the throat; collapse appeared and death followed nine- attention is directed to the jigger flea, which lives in the -teen hours later. In neither of the others had there been sand of floors or dusty places where natives congregate; .any cause of alarm. Post mortem cardiac degeneration originally confined to America and the West Indies, it has was found in all. The dysenteric ulcers were healed in spread to Africa and has now reached India. The soldier two and healing in the third. As a routine j grain' of is recommended if he has an itchy spot on the foot to rlemetine had been given twice daily for seven days; later, show it at once to the nearest native servant. " If lie i grain once daily. Second courses were given because of nods and says ' jigger' give him a clean needle. The boys the continued presence of amoebae, and later still the drug are usually very clever at removing the jigger, which is was injected over long periods, with the idea of avoiding now like a little bag or bladder about the size of a small liver abscess. The symptoms noted were faintness, lassi- flea." Tobacco is very poisonous to these insects, and it tude, tremor of muscles, and difficulty of swallowing in is recommended to soak the boots and shoes in an infusion .3 or 4 cases and one of the fatal ones. There seemed no of native tobacco now and then. reason to suspect any particular variety of the drug. The next section deals with diseases, including bowel The amounts given in the fatal cases were 21 grains, complaints, fevers, and those due to worms. 12J grains, and 17 grains respectively. Symptoms arose Underthe head of "fever" the first place is given to respectively three, four, and four days after cessation of malaria, and the importance of remembering tlhat most the drug. In 94 other cases 21 had had over 20 grains of natives in a malarious country, and especially the clhildren, the drug and 14 over 15 grains. In oue case 28. grains carry the parasite in their blood, is mentioned. The im- had been given. Of the 21 who had had over 20 grains portance of the daily prophylactic dose of quinine is well 4 showed signs of cardiac weakness - rapidity of brought out, but though the value of the mosquito net is pulse, similarity of the cardiac sounds, and lack of the mentioned it is not much insisted on, and the soldier may .muscular element in the first sound. None showed be led to conclude that its use is impracticable. As we 4'back pressure" symptoms. Emetine was obviously a pointed out last week, the French and Belgian soldiers protoplasmic poison having a selective action on some have learnt its value, and regard it as an indispensable dforms of protoplasm, like quinine. le suggested that the part of their kit. We are inclined to believe that mosquito THE BRiTISHf I EHONOURS. 146 MEDICAL JOURIAE j HONOURS. [JAN.(JAN.. 22,22, 1916~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~1916. net drill and mosquito net inspection should be matters of Lieutenant-Colonels. campaigns. R. Pickard (T.F.). F. S. Penny. routine in all tropical A. B. Soltau (T.F.). J. W. Leake. Short notes on dengue and sandfly fever are followed by J. A. Hamilton (I.M.S.). F. J. Brackenridge. a longer note on tick fever. While it is true that it is best A. D. Sharp (T.F.) A. Chopping. to prevent the fever by taking means to avoid being-bitten H. A. Hinge (temp. Colonel). H. E. M. Douglas, V.C. by the tick, we do not altogether subscribe to the state- A. Milne-Thomson (T.F.) . L. N. Lloyd, D.S.O. in A. W. Hooper, D.S.O. T. M. Martin (A.A.M.C..) ment that no cure is known, for salvarsan is as effective G. A. Moore. G. G. Nasmith (C.A.M.C.). this disease as in syphillis, if'not more so. The next' J. R. McMunn. A. E. Ross (C.A.M.C.). section deals with sleeping sickness. Nyasaland sleeping C. K. Morgan. W. H. Parkes (N.Z.A.M.C.). sickness is distinguislhed as a separate form, due, it is F. Kiddle. TemporaryHon. Lieut.-Colorek stronglv suspected, to Glossina rmorsitans, and it would W. H. S. Nickerson, V.C. C. G. Watson, F.R.C.S. have been well to have inserted a cross reference to B . Majors. the account of tlle nagana of animals, since the same W. B. Mackay (T.F.). W. W. Jeudwine (I.M.S.)_ insect is one of the flies which most commonly' H. M. Cruddas (I.M.S.). P. Davidson, D.S.O. carries it, and- its habits differ very 'mucIh from those of W. Riach. G. palpali8, the carrier of the sleeping sickness of East D.S.O. Africa. Thle statement under the head of sleeping sick- Majors. has R. B. Ainsworth. N. Low. ness, that lumps in the neck occur after the fever E. B. Booth. A. A. Meaden. developed, is, too' absoluite enlargement of the glands' G. H. J. Brown. R. A. Needham (I.M.S.). generally develops, but not invariably. J. P. Brown (T.F.). M. B. H. Ritchie. The diseases due to worms mentioned are those pro-- B. B. Burke. F. E. Roberts. duced by ankylostoma, bilharzia, filaria, and guinea-worm. J. H. Campbell. W. F. Roe (T.F.). R. G. Easton. J. S. Y. Rogers (T.F.). Finally there is a short section on diseases of animals, P.J..Hanafih. E. Ryan. con'taining notes on "horse sickness," which. also affects DL. Harding. F. C. Sampson. mules but not donkeys, due to some parasite as yet un- J. A. Hartigan. A. B. Smailman. identified; on nagana, which affects not only horses and A. E. S. Irvine. R. J. C. Thompson. mules but also donkeys, oxen, and dogs, due to a trypano- C. L. Kerans (I.M.S.). C. H. Turner. som-e; and on the East Coast fever of cattle, due to a Captains. piroplasm carried, by ticks, but chiefly by the common J. Downie (T.F.). E. M. O'Neill. brown tick. J. W. Houston. F. Worthington. The pamphlet, as we have said, is generally most W. P. MacArthur. admirable, and if its recommendations are loyally carried Lieutenant J. F. Steven (temporary). out the effect on the health of the troops ought to be striking; but it must be recognized that while it is impor- MLITARY CROSS. tant that soldiers of all ranks should understand the Captains. dangers and the means of their prevention some of the J. W. Anderson (T.F.). J. R. Marrack (temp.). most important directions can only be taken if the need D. C. G. Ballingall. W. H. L. McCarthy (S.R.). staff H. C. Bazett (S.R.). C. McQueen. for them is fully appreciated by general officers, F. A. Beam (S.R.). G. Millar (temp.). officers, and commanding officers, including commandants B. C. Beddows. S. Miller (S.R.). of small detachments on special duty. For instance, the L. G. Bourdillon (temp.). T. M. Miller (S.R.). recommendations that in order to avoid heat-stroke in J:E. M. Boyd. J. Murdoch (T.F.). hot moist climates the men must march light, and not N. G. Chavasse (T.F.). G. E. Neligan (temp.). A. G. W. Compton (S.R.). R. B. Nicholson (I.M.S.). after a lheavy meal, are matters entirely within the H. S. Cormack (I.M.S.). J. J. O'Keeffe. control of officers. It is a little unfortunate that the R. E. Cree. W. C. Paton (I.M.S.). direction with regard to wearing coats and shirts open at C. G. Douglas (temp.). G. Petit. the neck is ambiguously expressed. It is said that the J. C. A. Dowse (S.R.). R. C. Robertson (temp.). condition of heat exhaustion is "want of P. G. M. Elvey. H. B. Sherlock (S.R.). cause of the R. Errington (T.F.). T. V. Somerville (temp.). evaporation from the skin; this is encouraged by moving E. A. C. Fazan (T.F.). S. H. Smith. about withl coat and shirt open." It is, of course, the J. H. Fletcher (temp.). C. W. Sparks (S.R.). evaporation and not the heat exhaustion that is en- W. Foot (temp.). 0. W. D. Steel (T.F.). couraged bywearing the clothes open. Another point is R. Forgan (S.R.). E. A. Sutton. that in malarious countries camps A. J. (Gilchrist (S.R.). F. T. Turner. a recommendation 0. Hairsine (S.R.). Q. V. B. Wallace (S.R.). slhould never be made at the margin of small streams and T. Hampson (S.R.). J. R. M. Whigham (temp.). lakes or pools. This, again, is a matter as to which the F. D. G. Howell. C. A. Wood (I.M.S.)., rank and file have commonly very little say. H. R. Knowles (temp.). T. W. Wylie (S.R.). S. D. Large. R. F. Young. H. Lightstone (T.F.). J. E. Dods (A.A.M.C.). E. F. W. Mackenzie (temp.). R. N. Guthrie (N.Z.A.M.C.). HONOURS. J. MacMillan (T.F.). THE London Gazette of January 14th publishes a list of Temporary Lieutenants. honours conferred on officers and men for services in the P. Cagney. A. R. Roche. war, containing over 3,400 names, and filling three whole J. D. Driberg. H. A. Rowell. pages of the Times. The names of the medical officers in H. C. Godding. A. C. S. Smith. J. T. Kirkland. W. N. Watson. the list are given below. The list also contains the names F. Wright. of many non- commissioned officers and men of the R. H. Maegilliouddy. A. R.A.M.C. and members of the military nursing services Assistant Surgeons.- upon whom distinctions have been conferred. W. J. S. Maine (I.S.M.D.). E. H. Boilard (I.S.M.D.). INDIAN ORDER OF MERIT, SECOND CLASS. C.B. Subassistant Surgeons. Surgeon-General R. W. Ford, D.S.O. Ram Singh (1/4th Gurkhas). Pargan Singh (6th Jats). Colo11els. INDIAN DISTINGUISHED SERVICE MEDAL. B. B. Grayfoot (I.M.S.). W. C. Beevor, C.M.G. I.S.M.D.-Subassistant Surgeons Pohlo Ram (1/9th Gurkhasy, J. Maher. H. M. W. Gray (T.F.). Kishan Singh (113th Indian Field Ambulance), Mathura Parshad M. J. Sexton. Sir B. E. Dawson, K.C.V.O. Wilde's Rifles). J. J. Russell. M. W. Russell. Sarswit (57th E. G. Browne. SPECIAL PROMOTIONS. C.M.G. Lieutenant-Colonels to be Brevet-Colonels. - A. J. Macnab' Colonels. (I.M.S.)5 J. M. Sloan, D.S.O. W. W. Pike, D.S.O. C. A. Young. Majors to be Brevet-Lieutenant-Colonels.-H. Boulton (I.M.S.)r C. E. Nichol, D.S.O. S. Macdonald. G. Browse (I.M.S.), F. G. FitzGerald. B. M. Skinner, M.V.O. G. T. Rawnsley. Captains to be Brevet-Majors.-M. G. Dill, C. N. Draycott. F. Smith, D.S.O. C. S. Wallace (temporary). (T.F.), C. H. S. Frankau (T.F.), R. G. H. Tate. G. D. Hunter, D.S.O. H. Alexis Thomson (T.F.). Quartermasters and Honorary Lieutenants to be Honoraryp J. Atkins (temporary). M. MacLaren (C.A.M.C). Captains.-M. Cohen (T.F.), C. H. Cooper, G. W. Harris (T.F.), W. T. Lister (temporary). - 3. Keogh (T.F.), 3. H. Maunder (T.F.), H. C. Okill (T.F.). JAN. 22, I9I6] ENGLAND AND WALES. TXzDiBKonf47

OPERATIONS IN GIiRMAN NEW GUINEA. comforts and hospital equipment the Fund may properly supply for the benefit of-Indian troops in that country. The On January 11th the Admiralty published an-order upon hospitals for Indian troops at Brighton have been closed, but Ihe operations for the reduction of German New Guinea the Lady Hardinge Hospital at Brockenhurst will be continued by a force from Australia, sixteen months ago, in the for the present. We gave some account of this hospital last -early days of the war. The D.S.O. was conferred upon March (p. 438). It is well designed and well equipped, and has Lieutenant T. A. Bond, of the Roya,l Australian Naval been admirably administered. 7Resei!ve, and fourteen other officers were commended for MEDICAL OFFICERS WANTED. services in action in the same operations. Among them 2nd Line WVelsh Border Mounted Brigade. -vas Captain Brian Colder Ampill Pockley, of the Australian Medical officers willing to serve abroad are required for this Army Medical Corps, who, as recorded at the time, was brigade. Pay and allowances as in regular army. Promotion to Iilled in action. captain after six months' service. Applications to Lieutenant- Colonel D. C. Leyland Orton, S.M.O., 2nd Welsh Border -CASUALTIES IN THE MEDICAL SERVICES. Mounted Brigade, Morpeth. Died of Wound&. 2/1st South Wales Mounted Brigade. A regimental medical officer is urgently required for a LIEUTENANT WILLIAM WILKIE DEANS, R.A.M.C., was re- Yeomanry regiment in this brigade now on the East Coast. ported in the casualtv list published on January 13th as Particulars may be obtained from the S.M.O., Head quarters, ILtving died of wounds in the Mediterranean. He took Yoxford, Suffolk. the Scottish triple qualification in 1901, and received a temporary commission as Lieutenant in tlle R.A.M.C. on September 10th, 1914. WouAnded. Lieutenant-Colonel G. A. Marshall, Australian Army MIedical Corps (Dardanelles), May 6tlh (accidentally MBDICINE IN SOUTH WALES. emitted at that time). AT a meeting of the Board of Management of the Lieutenant-Colonel W. Edward VII Hospital, Cardiff, last week Colonel Bruce Ranson, R.A.M.C.(T.F.), France. Vaughan said that within the last seven years the Captain J. A. Sinton, I.M.S., Mesopotamia. hospital had received many princely donations, which Lieutenant N. S. Joshi, I.M.S., Mesopotamia. had enabled it to provide a new wing containing 100 DEATHS AMONG SONS OF MEDICAL MEN. beds at a cost of £50,000, and a fund of £100,000 IM1urray, J. B., Lieutenant-Commander R.N., third son of the late Dr. W. B. Murray, of Tarbury, Worcestershire, lost in for their maintenance. The income of the lhospital H.M.S. Natal, blown up on December 30th. from invested funds during the period lhad been in- Scott, A. G., Second Lieutenant 2/3rd Battalion Duke of creased by £10,000 a year, but Colonel Bruce Vauglhan -Wellington's Regiment, elder son of Dr. G. H. Scott, of accepted these great results as an encouragement to ask Sheffield. for more. The immediate needs of the hospital were, lhe said, in order of urgency: (1) An extension of tlle child- NOTES. ren's hospital; (2) addition of beds for eye cases; (3) the THE COLONIAL MEDICAL SERVICES. completion of the maternity department; (4) the pro- IN tlle article on the Medical Services in 1915, published vision of an ortlhopaedic department; (5) the provision in the JOURNAL of January 15th, it was inferred that the of beds for male and female tuberculous patients for -only colonial medical service whiclh had officially served in tlle purposes of observation and treatment; (6) the tlle war was the West African medical staff. It should provision of extra surgical beds to meet the neces- have been added that the East African medical services- sity of the waiting list; (7) an additional operating those of British East Africa, Uganda, Northern Rhodesia, theatre; (8) the extension of the board-room, with and Nyasaland-have also been concerned in tlle war, separate rooms for study for the resident medical officers, ,some of their members having been on service, tllouglh and a chapel. At-present there were 55 beds for children, fortunately there have been no casualties. It miglht also and lhe suggested an addition of 25. He mentioned the be mentioned that the medical staff of General Botha's fact brought out in a recent report by Dr. Newslholme, the successful campaign in German South-West Africa consisted medical officer of the Local Government Board, that Wales of South African medical men. They also, we think, compared very unfavourably with England in regard to escaped without casualties. But they do not belong to a maternal mortality. With the full concurrence of the colonial medical service; these services are employed medical board it was desired to establish and equip in the Crown colonies only, not in the self-governing maternity and clhild welfare departments. An ortliopaedic Dominions. departmnent was also badly needed; four years ago somue- THE VALUE OF ANTITYPHOID INOCULATION. thing was done in thlis direction, but a well-organized The Research Defence Society issued a leaflet on protec- department was necessary, with at least 14 beds and an tion against typhoid fever about fifteen months ago; it lhas operating room. It was desired also, in co-operation with now added a statement, dated January, 1916, in which it the King Edward Memorial Association, to establish two is reported as follows: wards for cases of tuberculosis-one for eight women and Among our Expeditionary Force in France and Belgium the other for ten men-where the cases could be about 95 per cent. have been protected against typhoid fever, thoroughly studied from the clinical, pathological, the annual average being about 90 per cent. and bacteriological standpoints. Research must be under- The atnnual admission ratio per 1,b00 is more than nine times taken, he said, jointly by the great hospitals and the greater among the non-protected than among the protected. medical schools, and thlis all the Among the non-protected it is 9.1 per 1,000. Among the pro- rendered more tected it is 1 per 1,000. The death-ratio is thirty-one times urgent the establishment on a proper footing of the greater. Among thb non-protected it is 1.84 per 1,000. Among Welsh National School of Medicine. The hospital was the protected it is 0.06 per 1,000. ready for it and Sir William James Thomas had provided The figures for Gallipoli have not yet been thoroughly money for complete modern laboratories, but, owing to analysed and criticized; but they leave no room to doubt the the action of the Board of Education and the Treasury, value of the protective treatment. the work had been delayed. The reason given was the 'The addendum also deals with the suggestion that the necessity for reorganizing the University of Wales, but he statistics are worthless because typhoid fever and para- did not consider tllat sufficient ground for hanging up a typhoid fever are often confused. The leaflet points out definite and much-needed scheme for the building of the that this suggestion is false. medical school. Permission had been obtained to proceed If the cases of paratyphoid fever are added to the cases of with the erection of the which typhoid fever, the annual admission among the non-protected physiological block, would is 113 per 1,000. Among the protected it is 3 per 1,000. The be completed early in the next vear, but he called upon all death ratio among the non-protected is 1.90 per 1,000. Among men of influence in Wales to take their share in inducing the protected it is 0.09 per 1,000. the Treasury to remove its embargo on the establishment Copies of the leaflet can be obtained free of charge on of a complete National School of Medicine for Wales. The application to the Honorary Secretary of the Research appeal was supported by the Lord Mayor of Cardiff (Dr. Defence Society, 21, Ladbroke Square, London, W. R. J. Smith) and by Dr. Ewen Maclean, who said that the INDIAN SOLDIERS' FUND. provision of a new maternity department would not only Surgeon-General Sir R. Havelock Charles, G.C.V.O., Sir John make the institution complete, but would serve the urgent Hewett, G.C.S.I., and Mr. C. C. McLeod have gone to Egypt on need, day and night, of the whole community. it is behalf of the Indianl Soldiers' Fund to see what additional announced that in response to the appeal an anonymous