chlorine, carbolic acid, sulphurous acid, &c., of the rooms, bedclothes, &c., used by the sick and their attendants, and the disinfection of their own persons" (p. 545).

These measures, if carried out faithfully and universally would, he thought, be sufficient to stamp out smallpox in Great Britain within a period of six months or a year.

Whatever we may think of the views held by our author, there can be no doubt opinions have changed even since the date of this paper (1868); and that what might then have been thought the dream of an enthusiast, is now reckoned amongst the possibilities, if not the probabilities, of the future. The progress of sanitary knowledge has been slow, but there has been progress, and the people of England are beginning at last to take some interest in the things which concern them most closely. Much, however, remains to be done not only in legislation, but in awakening a "sanitary sense" among the masses, before any such views as those we have been considering can obtain a fair hearing, or be carried to any practical issue. The problem present to the mind of Sir James Simpson is still unsolved; it is one of vast importance to the human race, and it cannot be better stated than in his own forcible words:—

"In the ten years from 1856 onwards there died in the United Kingdom, from scarlatina above 280,000; from measles above 130,000; from whooping-cough above 150,000; from smallpox upwards of 60,000; or about 600,000 of our population were killed off by these four diseases. To what extent can this terrible decennial death-roll be shortened or abolished by the process of isolation and stamping out? Is not the whole subject a grave and momentous question both for legislators and physicians ?"

II.-Military and Naval Medical Reports.1 IN ' In our last notice of the annual Army and Navy Medical Reports' we studied them mainly with a view to considering what light they threw on the phenomena of yellow fever. This year we shall pursue a somewhat different course, and endeavour chiefly to glean and present to our readers the most important facts they contain, which bear on the subject of the geography of disease. We shall also have the opportunity of gathering 11. Statistical Report of the Health of the Navy for the Year 1869. 2. Army Medical Department Report for the Year 1869. London, 1871. 3. Report on Barracks and Hospitals, with Description of Military Posts. Washington, Dec. 5, 1870.

1871.

4. A Report on Age and Length of Service, as affecting the Sickness, Mortality, and Invaliding in the European Army. By JAMES L. BRYDEN, Surgeon, Bengal Army, Statistical Officer, &c. Calcutta, 1871.

some hints on the use of quinine and other antiperiodics, especially as prophylactics. We shall conclude with a very few remarks on some of the conditions which influence the health of European troops in India.

The chief novelty in the naval reports consists in the information which they contain concerning the sanitary conditions of the great home establishments of the service, the naval hospitals, marine (divisions), and the dockyards, and which is now supplied for the first time. For the home stations the reports on those establishments are indeed more interesting than the ordinary ones, which for this year do not record much of importance besides accounts of some attacks of measles, smallpox, and scarlatina, fortunately attended by but a small mortality. In the Report on Sheerness there is an instructive account of a disease formerly common in London, now exceedingly rare; 189 fresh cases of ague occurred at Sheerness during the year. Dr. Forbes writes that although malarious poisoning thus prevails to a great extent-even infants at the breast showing its effects, it is seldom that a case of fully-developed ague running through its three stages occurs. By far the greater number of cases are of irregular ague, undeveloped or dead ague, as it is loosely called. There is all the languor and depression of the cold stage, but no well-defined hot or sweating stage. A point of much interest is, that the only visceral complication is found in the liver. Affections of the spleen, so common in the fenny and other aguish districts, are unknown in Sheerness and its immediate vicinity, though at the southeastern end of the Isle of Sheppey they occur in the old farmlabourers, who had contracted ague in boyhood. In adults the ague had a tendency to assume the quartan type, among children the quotidian. As regards treatment a brisk emetic often cuts short the first stage. Quinine of course was the main remedy, but change of air was often required.

The Return for Devonport affords a good example of the occurrence of autumnal diarrhoea, 87 cases having occurred during the quarter ending September 30th, which part of the year had been characterised by very hot weather. Many cases were attributed to unavoidable exposure to the sun, but many also to the unwholesome character of the food eaten-especially cheap fish or shell fish when not over fresh, the injurious action of which is supplemented by the use of cheap and unripe fruit. The attacks came on either early in the morning or after the midday meal. The treatment was simple, and there were no casualties.

Three cases of cholera, with one death, occurred in the home station force. There is nothing remarkable in the cases, except

their close resemblance to the Asiatic form of the disease, and their being entirely isolated.

In the Mediterranean station an outbreak of what was called influenza enterica, of which there were no fewer than 198 cases on board the Caledonia, was the most noteworthy occurrence. The crew brought out in the Revenge to join the Caledonia (which it did at Malta in the end of April) suffered on its way out from a form of febrile catarrh, accompanied by sore throat of a low type, and by great prostration. The men were transferred to the Caledonia with a low typhoid influenza hanging about them, but nothing remarkable happened till after the ship had left Malta for exercise. On the 16th of June, on their return from eleven days' practice, when near Malta, at 11 p.m., nearly fifty of the ship's company and some of the officers were suddenly attacked with diarrhoea. Besides more general symptoms of debility, in the great majority of instances the patient had a red, irritable tongue, and erysipelatous redness of the whole buccal mucous membrane. Such individuals had invariably a troublesome diarrhœa; in a few attended with nausea and sickness; and in nearly all with irregularly-occurring pyrexia. It was observed that attempts to check the diarrhoea were always followed by exacerbation of the fever. Mild laxatives, with nourishing diet, was the treatment found most efficacious. Fortunately there were no casualties. Curiously enough the termination of the epidemic was characterised by the return of the symptom which marked its commencement on leaving England, a doubtful form of cynanche, and tendency to lung complication. Staff-Surgeon Cotton in his very intelligent report looks on the whole epidemic as a manifestation of typhoid poisoning. He believed that the disease acquired infecting properties from the concentration of sick individuals as well as from a high temperature, and he thought the period of incubation short. The disease here described differed very widely from ordinary enteric or typhoid fever, and there is still much to be explained respecting the causation of that fever, especially as it occurs on board ship under a great variety of conditions.

There were a few cases of remittent fever and of ague in this command, but they do not call for any special remark. Here is Assistant-Surgeon Bolton's opinion of quinine as a prophylactic. "As such it is most necessary, especially when men are employed in or near swamps, or upon boat service; but it must be given in large doses, six grains night and morning, combined with some stimulant, such as sherry or rum. I know many old stagers on the Danube works who would sooner go to their duty without their dinner and tobacco than without their quinine. If they should even for a day forget their allowance, they are

almost certain to feel indisposed, or have an attack of ague in a few hours."

There were twenty-five cases of worms, chiefly of tænia, and attributed to the consumption of unwholesome pork got at Malta. The male fern and kousso were usually found efficacious.

The Reports on the North American and West Indian, and on the South-East Coast of America, introduce us to yellow fever. There were 106 cases, with 52 deaths. The accounts of the yellow fever are excellent, though there may not perhaps be much in the account of symptoms, or in treatment that is new. Assistant-Surgeon Thomas, who fell a victim to the disease, showed admirable self-denying thoughtfulness for his charge, in privately communicating to his commanding officer his sus picion as to the nature of the disease with which he had been attacked, and inducing him to conceal its nature, so as to prevent unnecessary alarm. One observation is singular:-"It did certainly appear that the yellow fever poison had less hold in a debilitated and worn-out constitution; and the robust and healthy constitution proved to be the aptest instrument for the development of this virus, and the best pabulum for it to feed on." We believe that in the case of most epidemic diseases we are far too apt to assume that they have a preference for the weakly. We know but little of what constitutes predisposition.

Some observations on the nature and origin of yellow fever by the Deputy-Inspector-General of the Naval Hospital at Port Royal, Dr. Donnet, of which we give the substance, are well worthy of consideration, although entering on the path of speculation.

The history of the fever which occurred in 1869 would seem to favour the theory that the germs which generate the epidemic had · their origin in the marshy and swampy grounds in the vicinity of the locality where the ships that became infected were anchored, and the choice made of these ships, to the exclusion of the others in the harbour, assisted towards confirming this belief. If therefore this theory be accepted, we must bring ourselves to admit that yellow fever may have its birth in localities such as this: that its origin may be due to some effluvium, germ, or organism generated on the surface or within the bowels of the earth; and, if so, that it finds a habitat in such places, and that therefore yellow fever is endemic in the island of Jamaica. But this noxious principle differs in toto from that which produces simple continued fevers and the types of remittent fever, for each of the various West India fevers has a distinct type, characteristic of an individual poison; for in all epidemics of yellow fever an individuality has been observed which has been constant. The epidemic of yellow fever which happened in

Lisbon in the year 1723 differed in noways from that which devastated the same city in 1857. There do, however, sometimes occur in Jamaica-modifications of fever which obscure their character, and render them less defined. These modifications may be accounted for by the admixture and absorption into the system of other poisons besides that of yellow fever, and may run a parallel course along with them.

But let us turn from these doubtful and complicated generalisations, to the practical fact laid down in the report, and unfortunately owing to various considerations of what are considered the exigencies of the service, not sufficiently often carried out, so that it cannot be too often repeated, or too strongly stated, that the only chance for a ship's company amongst whom yellow fever has made its appearance, is to have them conveyed with the utmost speed to a cold latitude.

The mortality from yellow fever was about 50 per cent., or nearly twice as great as it usually is. This is supposed to be accounted for by many of the milder cases having been returned as continued fever-a fact that militates against the opinion so strongly expressed above, of the symptoms of yellow fever being always marked so unequivocally.

There is not much to remark on the South-east Coast of America station, except that the medical men at Buenos Ayres, and two of the medical officers of the Paraguayan army, did not think there was much use in employing quinine as a prophylactic; that the men suffered extremely at Paraguay from the attacks of mosquitoes and other insects, and that a single fatal case of malignant cholera occurred in a boy. The case had all the usual symptoms of Asiatic cholera, but could be traced to no source.

There was a fatal case of tetanus in a young seaman, supervening, as most attacks usually do in the tropics, on a slight wound, in this instance of the great toe. The first symptom in this case was epigastric or diaphragmatic pain shooting to the spine. According to the experience of Buenos Ayres such a pain indicates the onset of tetanus, whereas præcordial distress indicates pyæmia. Tetanus is common in Paraguay in the cold season.

The diseases of the Pacific station suggest the inquiry, Why, in what is generally a healthy station, rheumatism should be common, for in this station and also in the China one, we find rheumatism more prevalent than in Europe? In the Home station it was 48; in the Pacific and Australian, 85; and in the China as high as 92 per 1000.

In the preceding year the ratio in the Pacific-also in Australia-had risen to 105. No cause is assigned for rheumatism being so frequent; but it is said to have been generally