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indecorum must be abated. In the interesting history of that eminent self-denying young hero, Jack Horner, we read that
“ Jack lov'd mutton pies
But he lov'd to be wise." Our Martinet loved music, being himself musical also- but he loved regimentals. So unsuspicious of any harm, the good easy man gave an order potential that all military tweedledums and tweedledees, members of the renowned Amphion Club, should always come dressed in full military uniform. Fancy a stout gentleman besworded, besashed and becoated and bebooted playing an obligato on the violin, another blowing a clarinet with a face minacious of apoplexy, and a third wrestling desperately with the double bass ! The idea was dreadful—and so with a whir the Amphionites dissolved themselves into thin air and never met in harmony again-but consoled themselves with sundry puns, each exclaiming am-fie-on-it at the Martinet's ill-timed zeal for uniformity of costume! This constantly going in harness like a cab-horse may have a very military look, but is very uncomfortable, and certainly injurious to health. Many is the man too, sent to his long home eventually by the system of over-parading, or rather too much parading on days, or at periods of the year, when the men ought to be quietly in their barracks. The Regimental Surgeon, though his hospital may be overflowing in consequence of such over-parading, feels probably like the writhing Prince of Denmark.
““ But break my heart for I must hold my tongue.” If commanding officers were to think more about the health of their men, and of their moral happiness than their appearance, on parade or frequency of drill, it were well for the service and the State. Some there are who literally are a curse to all under their authority, keeping every one from the Major down to the Drummer-boy in a continual fret and worry, inimical to good order, discipline and real efficiency, to say nothing of health. How often have valuable lives been hazarded or lost by men being kept hours and hours in the sun, or the rain, perhaps adding to the vain pageantry of a funeral, or awaiting to salute some great man who ought to be above the vanity of exposing men unnecessarily in a trying climate on account of a mere passing reception, a ceremony often more honored in the breach than the observance. Mr. Martin* mentions a circumstance respecting a very distinguished and gallant regiment (H. M. 13th Light Infantry) to which it is probable that, if medical men could always speak out, many a parallel case might be found. “ The corps was marched cruelly, because unnecessarily, during the hot season from Nudden to Burhampore. The young soldiers had previously been drilled in the sun thrice a day, so as to greatly injure their healths before quitting Calcutta.” The effects we are further told were fatal to a remarkable degree.
In what Mr. Hunter terms cerebral fever, more peculiar to the termination of the hot season, we seem to recognise the same disease as that which came under the observation of Dr. Henderson and Dr. Monat in Bengal—and which afterwards came prominently under the attention of
* Influence on Tropical Climates, &c.
the latter very able and distinguished physician at Madras, and obtained the marked notice of the late Dr. Murray, the lamented Inspector-General of Hospitals. “In this fever”-says Mr. Hunter, “I believe the best practice to be a moderate venesection on admission, 12 or 14 oz. according to the tolerance, age, and constitution of the patient. Large bleedings I conceive to be positively injurious in all the fevers of Deesa, by creating or increasing the congestions.” How a free bleeding in this or any other fever should create congestion, is a paradox which Mr. Hunter does not explain. We shall, however, perhaps be able to understand his meaning better with Dr. Monat's assistance. Dr. Monat, in the cases of Insulation which fell under his notice, remarks that, large bleedings in some instances did no good. “ In fact, two individuals became convulsed, and shortly after they were bled, died ; and after death, it was found, that, though the heart was empty, the vessels of the head were loaded with blood.” Dr. Monat does not fall into the phraseology of Mr. Hunter, and say that this state of the cerebral vessels was caused by the bleeding; he knew better, and finding such a state exist notwithstanding the bleeding, he, like an enlightened practitioner as he is, took the hint. He did not leave off bleeding entirely, but made an alteration as to time, and directing cold and cold affusion to the head, bled when re-action took place; or when the vessels of the brain braced by that stimulation, baled back, as it were, the confined wave into the general system. In his remarks on what he calls gastro-enteric or autumnal remittent, Mr. Hunter warns us to have constant reference to the physical signs, since otherwise it is sure to be mistaken for pulmonary disease. " Whether it be from the pain caused by the depression of the diaphragm, I know not, but they refer the seat of it to their chest, which taken with the dyspnea or panting, is sure to mislead.” We are not quite clear that we entirely comprehend our Reporter's balanced remarks on bloodletting. In all except the gastroenteric, he is persuaded that it is injurious, “ yet these cerebral symptoms are so insidious during the first or second exacerbation, that we question whether it is not the safer rule to bleed in every case on admission, to the extent of the tolerance, and particularly with young soldiers of a full habit.”—Well, but now comes a damper—" nevertheless it must be admitted that the greater proportion of the deaths by hepatic abscess and dysentery as sequels, have occurred where antiphlogistics, and more pare ticularly bleeding, have been most freely employed.” We are free to confess that all this does seem somewhat extraordinary, for supposing the free bleeding and the rest of the antiphlogistic treatment to have been properly and judiciously applied, according to individual exigency and necessity, it no more appears why such sequels should be the result, than depriving a lamp of so much oil, should make it burn twice as long and brightly as it otherwise would. The cases of consumption furnished by Mr. Hunter are full of interest—and he adverts to a species of tuberculous disease among soldiers, that is masked under symptoms of dysentery, and from the frequency of that disease in India, is constantly mistaken for it.
No. V. is a series of reports made to the Medical Board on the Climate and Medical Statistics of Upper Scinde. Bowel complaints and fevers as usual, were the prevalent complaints. The season had been one of unprecedented heat. During the day a high wind generally prevailed from the westward, with clouds of dust, while at nightfall it veered to the East. They were in a most open situation, with no shelter save that of the tents. Dr. Owen with probably great justice blames the water. The following table of the range of the Thermometer during five months, is furnished by Mr. Patch, Surgeon, 21st N. I.
The temperature, it appears, goes on increasing in a regular manner monthly to July inclusive, but sudden changes are of frequent occurrence, and comparatively cold gusts of wind come down from the ranges of the mountains. There is great increase of fever cases as the temperature diminishes. Mr. Wright, Assistant Surgeon 25th N.I. reporting on the climate of Moostoong, shews fever to be the predominating disease. It was the same at Kelat. The cause, Mr. Wright refers to malaria and solar heat. At Kotra Mr. Babington, Assistant Surgeon of cavalry, reports the climate as exceedingly bad—the number per cent. under medi. cal treatment from 1st Feb. to 31st August 1841, (the best months) being 27 per cent. per mensem, and 112 during the worst. The mortality during four months was 13 out of 175. Respecting Shiakarpore, Assist. Surgeon G. F. Forbes, 8th Regt. N. I. states the worst months to be from Oct. to March—and the number of Sepoys under medical treatment during that time as 36 per cent. per mensem.
Deaths none. Assistant Surgeon Jephson reports the climate of Sukkur as very oppressive, and this has been further experienced to be the case in connexion with the operations of Sir C. Napier. The unhealthy season is during Oct. and Nov. while the Indus is falling after the annual inundation.
Malaria is, of course, rapidly generated, and to this may we principally look, as the cause of a fever variable in character from the intermittent to the remittent type, the latter often assuming a typhoid form. He considers the climate, however, as healthy for natives. Surgeon Edwards, 23rd N.I. considers the climate (being very dry) as decidedly healthy, save during October and November. The average number of his regiment under medical treatment during the best months, was 6 per cent. and 12 during the worst. The camp ground had been chosen by medical advice, and the result proved how judiciously. Medical officers are too seldom consulted on the site of encamping ground or barracks. This is an unfortunate oversight, and thousands of lives have been the sacrifice. Once let barracks be built, or any line of cantonments in an insalubrious situation, and the mischief is incalculable. On this head we would say most literally to the enquirer at any of the Presidencies and throughout India, si monumentum quæris circumspice. If we might hint a possibility of improving Medical Board returns, perhaps
it might be in the form of a note, specifying how long the subscribing medical officer had been in India. This would be an invaluable guide to us reviewers residing at a distance, in forming an estimate of the amount of dependence to be placed on individual experience.
Article VI. gives an account of the Epidemic which prevailed among the men of H. M. 17th Regt. when quartered in Colabah Barracks, after its return from the Affghan campaign, In June 1841, the whole regiment was in barracks at Colabah until September, when the head quarters embarked for Aden, leaving nearly 200 sick at Bombay. As well as we can understand (for Dr. Thomson does not preface his returns with a description of the fever) the disease may be considered to have been a cerebral remittent with great depression of the vital powers, or apparent depression. No question is of greater importance than that of bloodletting in many diseases, but especially in such as these fevers, where it is manifestly one of time, requiring the greatest nicety of decision and discriminative tact on the part of the practitioner. Bloodletting, Dr. Thomson tells us, was tried in some cases, but did not succeed, Let us look a little into this matter. We admit upon the evidence of that experience which every tyro soon acquires without Armstrong's inspirations being required to prove it, that in some cases where there is congestion (more especially in the head) depletion must have a reference to re-action. Case No. 3 is mani: festly given “ to illustrate the injurious effects of depletion." Here is the case.
“ Private Thomas Footed, aged 25 years ; in India 24 years; of a muscular frame; admitted on the 18th June, 1840, with fever of a low type, and with symptoms of congestion of all the organs, was bled to 16 ounces, and had sixty leeches applied to the head, and a blister to the neck; a dose of calomel and antimonial powder and an ounce of wine to be given every second hour.
“ On the 29th the report is, pulse 125, weak ; no remission of fever; no sleep; bowels open ; respirations frequent and labouring ; no irregular sound from lungs; great prostration of strength. A blister was applied to the chest, five grains of calomel and two of opium given, and wine continued every second hour.
“4 P.M. 29. Blister risen well; heart's action and that of lungs increased ; pulse 128, small; skin hot and moist ; no clammy perspiration.
“9 P.M. 29th. Is much worse; pulse scarcely perceptible; had slight delirium; skin covered with cold perspiration. Expired at 10 P.m. on the 29th June.
“ Sectio Cadaveris. Body in good condition and muscular; slight congestion of the lungs and liver ; considerable effusion of water on the base of the brain and along the spinal canal.”
We have to regret that, in the above case, the state of the face, the eyes, the tongue, and the pulse is not mentioned. We infer that the skin was very hot. We are not told in what position the man was when bled. We are not informed why 16 oz. and no more was abstracted. It could scarcely be from faintness, or collapse, since 60 leeches were forth with clapped to the head. While depletion is going on with one hand, however, stimulation with wine is carried on with the other. Would not cold affusion have been beneficial in such a case. Dr. Monat, when actual disease of the same nature occurred with sinking of the vital powers, would give a grain of opium to produce re-action and then bleed largely, followed by full doses of calomel and purgatives. The history or rather the abstract of two fatal cases preceding the one quoted, is not sufficiently precise to give us very clear ideas upon the subject. In regard to the first, the duration of the symptoms previous to admission is not stated, nor the state of the bowels. On the 10th of October there was severe increase of the fever. Was not the use of the lancet then indicated ? Examination of the body after death shewed serous effusion at the base of the brain, and along the spinal cord, congestion of blood in the internal organs (where ?) of the body. In the second case, the patient is admitted on the 9th of Oct. there is great prostration of the powers of life and slight headache, (p. 116). He gets a large dose of quinine. The remission lasted two hours. No blood had been taken away in the accession-some pain in the abdomen. On the 11th, 60 leeches are applied to the abdomen, but we are not told whether this was at the accession of a paroxysm. Judging from the result we should say it was not, but the contrary, since the report on the 12th is “extreme collapse”—and next day death ensues.
The post-mortem results much the same as in the case already quoted. The cause of the fever is made sufficiently clear by the following extract. Who built the barracks at Colabah ? On whose advice was the locality chosen ?
“ 1st. The barracks at Colabah are built almost on a level with the sea. 2nd. The floor is formed of a deliquescent stone, which in damp weather, is always wet, so that it is impossible for the men to keep their feet dry. 3rd. During the rains the water stagnates round the barracks, there being no proper facility for running it away, so that the ground becomes a perfect marsh. 4th. The sea recedes so far as to expose to the sun half a mile of shore covered with slimne and marine vegetation; and as the privies are situated here, the smell is often disagreeable." 90. Mr. Moffat's Report (Art XI.) is an excellent one.
He insists upon the propriety of an European regiment, for the first year of service in a Tropical climate, being kept at a healthy station. This has been a matter not sufficiently attended to; and we would refer the reader to Mr. Martin's article “ On the Selection and Improvement of Localities for the European Troops.” One great desideratum during the prevalence of rainy weather he strongly recommends, and we can testify to its judiciousness, we mean the supply of guard-rooms with stoves, to enable the men to dry their clothes and to warm themselves, after their turn of sentry is over. There is much in this valuable paper that we should like to quote if we could spare the space. Although Mr. Murray's paper on the use and abuse of Calomel contains no new facts, and no information but what may be found in other works,* still it is useful to be able to refer to a document where all the effects may be seen at a glance.
* See Influence of Tropical Climates, p. 281, the work passim, &c.