1300 LOOKING BACK.-VITAL STATISTICS.

Looking Back.FROM

THE LANCET, SATURDAY, May 1st, 1830.

ON THE MEDICAL SERVICE OF THE EASTINDIA COMPANY.

LETTER IV.lTo the Editor of THE LANCET.

SIR,-Before proceeding further in the consideration ofthe ultimate and sole recompense to medical officers of theEast India Company’s service, that is, their retiring pensions,it may be proper to mention the form of admission, at theIndia House, of recruits for this establishment, which is wellcalculated to deceive. It is this; that "assistant surgeonsare permitted to proceed to their respective presidencies,Calcutta, Madras, or Bombay, as the case may be, topractise as surgeons, and to be admitted on theestablishments as vacancies may occur." This form hasbeen observed for the last ten or twelve years. Topractise as surgeons, where ?-Upon whom ?-For what ? -The thing is quite absurd, and ridiculous ; and merely"ad captandum"-to deceive, by giving an idea that,independent of the high prospects which the Company’sservice holds out, money is to be made in India, even on

landing, by private practice ! 1 It is but fair, however, tomention, that, according to the present writer’s informa-tion, no one has hitherto been left to absolute starvation inthis way. Medical officers, shipped for India, in compliancewith requisitions to the Court of Directors from the several ipresidencies, have hitherto been wanted to fill up vacancies,occasioned by casualties, long before the period of their arrivalin India. At the presidencies, medical practice is in thehands of two or three Company’s surgeons. It is only at thePresidencies, that medical officers are paid for professionalattendance. At out-stations, a " honorarium," or fee, to themedical attendant, is seldom, if ever, dreamt of ; so that, onthe Madras establishment, at least, not above one surgeon inone hundred, after from twenty to thirty years’ service,happens to receive, in fees and presents, a sum equal to thepayment of his passage-money back to England, or 2,000rupees. Medical men are not prohibited from receivingpresents, or fees, in India, on account of professionalpractice ; but their patients (excepting at the Presidencies,or towns of Calcutta, Madras, or Bombay) must necessarilybe Compaiy’s servants ; and it is not obligatory on themto pay for medical advice and attendance ; whereas, theattendance of medical men, on all occasions, is obligatory,with or without a fee. Medical men never expect, it maybe said never accept, a remuneration from the military ;and civilians, who alone are able to pay them, very seldomthink any return for their assistance necessary. It hasbeen ruled, however, by the supreme government, and bythe subordinate governments, that it is the duty of everymedical man, to attend at the call of any personwithin his reach who may want his services, without feeor reward, and at his own expense for personal conveyance.Let it be understood that such unrequited summonses areoften frivolous, and at distances of upwards of fifty miles.Disobedience of these calls renders the surgeon liable to trialby court-martial; or to suffer by the more usual mode ofpunishing medical delinquents-marching them incessantlyabout the country to the most distant places, until they sinkunder fatigue, privation of every sort, despondency, and themalignant influence of the climate. From natives, whoseldom ask the help of an English surgeon, the complimentseldom exceeds a small present of fruit, or sweetmeats, afowl, or a lean goat, or sheep, and, on very extraordinaryoccasions, perhaps, a well-darned shawl, not worth 20 rupees, and which has been an heir-loom in the family for the best 1part of a century. So much for the practice of a surgeon inIndia....... Let us now see, by a comparative statement, in what pro-

portions the Honourable Company compensate and appreciatethe labours of their two classes of servants-soul-curers and ibody-curers.

1 Excerpts only have been transcribed.

Pay on Reti’l’ement."A chaplain, after eighteen years’ service in India,

including three years for one furlough," (that is, afterfifteen years’ actual residence in India), " is allowed to retireon the pay of lieutenant-colonel, 3651. per annum."

" A medical officer, after twenty years in India, includingthree years for one furlough," (that is, after seventeen years’service in India,) "is permitted to retire from the service onthe pay of captain, 1911. 12s. a year." After twenty andthirty years’ service in India, the same, 1911. 12s.

" A chaplain, if compelled to quit the service on accountof ill health, after ten years’ service in India, is allowed toretire on the half-pay of lieutenant-colonel, 200l. 15s. a year."A medical officer, if compelled to quit the service on

account of ill health, after ten years’ service in India, is (orrather was) permitted to retire on the half pay of lieutenant,731. ; after six years, on the half pay of ensign, 541. 15s.after thirteen, on the half pay of his rank, that of fall

surgeon, if fortunate, 1271. 15s. ; or of lieutenant, if thereverse, 73l.

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" A chaplain, after seven years’ residence in India, isallowed to come home on furlough, and receive the pay ofmajor, 292l. a year ; should he come home from sicknessprior to this period, he is to receive the pay of captain only."

" A medical officer, after ten years’ service in India, isallowed to come home on furlough, and receive the pay oflieutenant, 951. 16s. 3d. a year."

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X.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8013 births and 4780deaths were registered during the week ending April 25th.The annual rate of mortality in these towns, which hadsteadily declined in the four preceding weeks from 17’ 4 to15’ 2 per 1000, was equal to 15’ 4 irn the week undernotice. During the first four weeks of the current quarterthe death-rate in these towns has averaged only 15’7per 1000 ; the rate in London during the same period didnot exceed 15’ 4. The lowest annual death-rates in the76 towns during the week under notice were 6.7 inHornsey, 7.3 in Willesden, 8’1 in Southampton, and9’ 3 in King’s Norton; the rates in the other towns

ranged upwards to 20’ 5 in Devonport, 20’ 9 in Oldham,22.9 in Rochdale, and 23.5 in Stockton-on-Tees. The rateof mortality in London during the week did not exceed 15’ 4.The 4780 deaths in the 76 towns during the week showed anincrease of 32 upon the low number returned in the previousweek, and included 376 which were referred to the

principal epidemic diseases, against numbers declining from487 to 382 in the four preceding weeks ; of these, 138resulted from whooping-cough, 101 from measles, 49 fromdiphtheria, 35 from diarrhoea, 32 from scarlet fever, and 21from "fever" (principally enteric), but not one from

small-pox. The deaths from these epidemic diseases wereequal to an annual rate of 1.2 per 1000, correspondingwith the rate in the previous week ; the rate from thesame diseases in London was equal to 1 3. No deathfrom any of these epidemic diseases was registered lastweek in Leicester, York, Aston Manor, Coventry, or innine other smaller towns; the annual death-rates fromthese diseases, however, ranged upwards to 2’ 8 in Hudders-field, 3’ 0 in Smethwick and in Birkenhead, and 3’ 5 inRochdale. The fatal cases of whooping-cough in the 76towns, which had been 204, 150, and 134 in the three pre-ceding weeks, rose again to 138 in the week under notice;the highest death-rates from this disease in these towns lastweek were 2’ 0 in Sunderland and in Newport, 2.3 inSmethwick, and 2’ 6 in Devonport. The 101 deaths frommeasles were fewer by 26 than those in the previous week;they caused death-rates, however, equal to 1.1 in Salfordand in Swansea, 1’ 3 in Birkenhead, and 1.8 both in Prestonand in Rochdale. The deaths from diphtheria, whichhad been 53 and 39 in the two previous weeks, rose

again to 49 last week. and included 13 in London,four in West and East Ham, two in Wolverhampton andin Walsall, four in Liverpool, five in Manchester and Salford,three in Hull, and two in Middlesbrough. The 32 fatal cases

1301VITAL STATISTICS.-THE SERVICES.

of scarlet fever showed a further slight decline, but caused Edeath-rates equal to 1 - 2 in Leyton and to 1- 5 in Wallasey.The 35 deaths attributed to diarrhoea exceeded those i

in the previous week by’five, and the 21 deaths referred (

to "fever also showed a slight increase ; the deaths from 1"fever" included three in Birmingham and three in (

Huddersfield. The number of scarlet fever patients under r

treatment in the Metropolitan Asylums and London lFever Hospitals, which had steadily declined in the <

20 preceding weeks from 5581 to 2887, had further i

fallen to 2861 on April 25th; 332 new cases were, bow-ever, admitted to these hospitals during the week under 1notice, against 297 and 328 in the two preceding weeks. :The deaths in London referred to pneumonia and otherdiseases of the respiratory organs, which had been 274in each of the two preceding weeks, rose to 301 in the week Junder notice, and corresponded with the corrected averagenumber in the corresponding week of the five years 1903-07.The 31 deaths directly referred to influenza in London showeda further decline from the numbers in recent weeks. Thecauses of 62, or 1’3 3 per cent., of the deaths registered inthe 76 towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in Bristol, West Ham, Bradford, Newcastle-on-Tyne, and in 47 other smaller towns ; 12 uncertifiedcauses of death were, however, registered in Birmingham,nine in Liverpool, eight in Gateshead, and seven in Sheffieldduring the week under notice.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 19 7, 18’ 8, and16 - per 1000 in the three preceding weeks, rose again to18’ 8 in the week ending April 25th, and exceeded by 3’4the mean rate during the same week in the 76 large Englishtowns. Among the eight Scotch towns the death-rate

during the week under notice ranged from 11’ 4 and 12’ 3in Aberdeen and Leith, to 20’ 7 in Perth and 21’ 4 in

Paisley. The 663 deaths in these eight towns showed anincrease of 85 upon the number returned in the previousweek, and included 77 which were referred to the principalepidemic diseases, corresponding with the number in the

previous week ; of these, 34 resulted from measles, 14 fromdiarrhoea, 12 from whooping-cough, seven from "fever," sevenfrom diphtheria, and three from scarlet fever, but not onefrom small-pox. These 77 deaths were equal to an annual rateof 2 - 2 per 1000, while the mean rate from the same diseasesin the 76 English towns during the week did not exceed 1 - 2.The 34 fatal cases of measles showed a further decline fromthe numbers in recent weeks, and included 25 in Glasgow,seven in Edinburgh, and two in Paisley. The 14 deathsattributed to diarrhoea, exceeded the number in the previousweek by three. The 12 fatal cases of whooping-cough were,however, fewer than in any recent week; four occurred bothin Glasgow and in Edinburgh and two in Dundee. Theseven deaths referred to "fever" were all returned in

Glasgow; of these, five were certified as cerebro-spinal menin-gitis and two as enteric. Of the seven fatal cases ofdiphtheria three occurred in Glasgow and two in Dundee;and all the three deaths from scarlet fever were returned inGlasgow. The deaths referred to diseases of the respiratoryorgans in the eight towns, which had been 128 and 121 inthe two preceding weeks, further declined to 113 in the weekunder notice, but exceeded by one the number returned inthe corresponding week of last year. The causes of 24, or3’6 per cent., of the deaths in these eight towns during theweek were not certified or not stated; in the 76 Englishtowns the proportion of uncertified causes of death in theaame week did not exceed 1’ 3 per cent.

HEALTH OF DUBLIN.The annual rate of mortality in Dublin, which had

been equal to 22 - 5 and 23’ 1 per 1000 in the twopreceding weeks, declined to 21-1 1 in the week endingApril 25th. During the first four weeks of the currentquarter the death-rate in Dublin averaged 23’ 2 per 1000 ;the mean rate during the same period did not exceed 15’ 4in London and 15-6 6 in Edinburgh. The 160 deaths ofDublin residents registered in the week under notice showeda decline of 15 from the number returned in the previousweek, and included seven which were referred to the

principal epidemic diseases, corresponding with the numberin the previous week. These seven deaths were equal to

an annual rate of 0 9 per 1000, the rate during the weekfrom the .same diseases being 1’3 in London and 1, 9in Edinburgh. Of these seven deaths from epidemicdiseases in Dublin three resulted from measles, two fromwhooping-cough, and two from diarrhoea, but not one

either from scarlet fever, diphtheria, "fever," or small-pox.The fatal cases of measles corresponded with the num-ber in the previous week, while those of whooping-cough were fewer by one. The 160 deaths from all causesin the city during the week included 26 of infants under oneyear of age and 43 of persons aged upwards of 60 years;the number of deaths of elderly persons showed a consider-able decline from the numbers in recent weeks. Twoinquest cases and two deaths from violence were regis-tered, and 82, or 51 3 per cent., of the deaths occurredin public institutions. The causes of seven, or 4’ 4per cent., of the deaths registered in the city during theweek under notice were not certified ; all but one of the1420 deaths in London last week were duly certified, andin Edinburgh the proportion of uncertified deaths didnot exceed 1’6 6 per cent.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet-

Surgeons : C. Bradley to the Caesar, on recommissioning;J. L. Smith M.V.O., to the President, additional, for threemonths’ course at West London Hospital ; H. B. Beatty toRoyal Marine Division, Chatham; and R. Miller to theMagnificent. Staff-Surgeons: S. Roach to the President,additional, for three months’ course at West LondonHospital ; N. J. Roche to the Victory, additional, for Ports-mouth Dockyard ; W. K. Hopkins to the Edgar, temporary;E. G. E. O’Leary to the Sqttlpj, on recommissioning ; andE. S. Miller to the Cornmallis, on recommissioning. Sur-geons : G. E. Hamilton to the Hannibal; W. N. Blatchfordto the Sutlej, on recommissioning ; C. K. Bushe to the Corn-7vallis, on recommissioning ; P. D. Ramsay to the Vivid; andW. T. Haydon to the T’t, additional, and to the <7<ss<M’, on

recommissioning.INDIAN MEDICAL SERVICE.

The King has approved of the following retirements :&mdash;

Lieutenant-Colonel Alfred Ernest Roberts (dated April 21st,1908). Lieutenant-Colonel William Alexander Lee (datedApril 7th, 1908). Lieutenant-Colonel Kavasji HormasjeMistri (dated March 4th, 1908).

VOLUNTEER CORPS.

-Rifle: 3rd (Duke of Connaught’s Own) Volunteer Bat-talion, The Hampshire Regiment: Surgeon-Captain BonnerH. Mumby to be Surgeon-Major (dated March 17th, 1908) ;Surgeon-Lieutenant-Colonel and Honorary Surgeon-ColonelCharles Knott resigns his commission, with permission to

retain his rank and to wear the prescribed uniform (datedMarch 20th, 1908). 5th (Isle of Wight, Princess Beatrice’s)Volunteer Battalion, The Hampshire Regiment: James AlbertGibson to be Surgeon-Lieutenant (dated March lst, 1908).2nd Volunteer Battalion, The Essex Regiment : KennethSimonds Storrs to be Surgeon-Lieutenant (dated March 6th,1908).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Bedford Bearer Company : Supernumerary Captain Edmund

F. Bindloss (Brigade Surgeon-Lieutenant-Colonel, SeniorMedical Officer, Bedford Volunteer Infantry Brigade) to beMajor, remaining supernumerary (dated Feb, lst, 1908).

ROYAL ARMY MEDICAL CORPS AMBULANCE SECTION.Permission has been given for the formation of an Ambu-

lance Section of the Royal Army Medical Corps at Camborneand Redruth in connexion with the Plymouth Field Ambu-lance, R.A.M.C. The head-quarters will be at Camborne.

LITERARY INTELLIGENCE.-Messrs. Casselland Co, are issuing almost immediately a new and revisededition of 11 hygiene and Public Health," by Dr. B. ArthurWhitelegge and Dr. George Newman. The same pub-lishers are also producing a new volume by Dr. G. ErnestHerman, entitled "The Student’s Handbook of Gynasco-logy," based upon the author’s "Diseases of Women." Itcontains 172 illustrations.