ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH
399 carrying out a more effective system of sewage disposal than has hitherto existed there. In Mauritius the general health of the troops had improved. There had been no case of plague among the troops ; malarial fevers and venereal diseasess had declined but the number of cases of enteric fever had increased. Port Louis is the main seat and source of unhealthiness, and the troops should as far as possible be located at Curepipe and in the uplands. At Ceylon there had been a marked decrease in
... marked decrease in the admissions for malarial fevers in 1900 and considerable improvement in the admission rate for venereal diseases. In the Straits Settlements the health of the troops had been exceptionally good. More'stringent measures, through the instrumentality of a local ordinance lately introduced, have been taken with much apparent success in repressing the spread of venereal diseases, and the same may be said in regard to China. In Egypt the general health of the troops is stated to have been good. With regard to the recent sudden and severe outbreak of cholera at Cairo, we may remark en passant that so far as the British troops are concerned the best thing to do is to remove them at once from Cairo to Helouan and the desert, and we are glad to notice that this is being done. In India there was an increase in the death and invaliding rates, but a decrease in the admission and constantly sick rates. The decrease of enteric fever is a notable feature and, as we have previously had occasion to point out, might have been expected from the fact that, owing to the late war in South Africa and the cessation of the usual reliefs, Lhere has been a decreased supply of susceptible material arriving in India. Of course, there are other things to be taken into account, but we reserve our remarks on this subject for the present. There is much in this report about enteric fever. The researches of various experts abroad as well as those of Dr. P. Horton-Smith and others in this country, the remarks in Munson's" Military Hygiene," and the labours more especially of the special medical commission appointed by the United States Government to report upon the causes of the great and widespread prevalence of typhoid fever among the American troops during the late war with Spain, have greatly added to our knowledge and have thrown a new and strong light on the etiology and pathology of that disease, especially in relation to its prevalence in camps and armies. The general trend of these investigations is strongly to discredit the correctness of any one and exclusive view of causation, such, for example, as that the typhoid fever of armies is solely a water-borne disease. But the subject is too large to be discussed in the present article ; we may, however, remark that the results and bearing of the American investigations are important and demand attention. ASYLUM REPORTS. County and city of Worcester Asylum (Annual Report for 1901).—The average number of patients resident during the year was 1174, comprising 527 males and 647 females. The admissions during the year amounted to 246-viz., 113 males and 133 females. Of these 210 were first admissions. Mr. G. M. P. Braine-Hartnell, the medical superintendent, states in his report that among the patients admitted 165 were in indifferent health and enfeebled bodily condition, and 50 were in bad health and exhausted condition. The number of patients discharged as recovered during the year amounted to 97-viz., 48 males and 49 females, or 8'26 per cent. of the average number resident. The deaths during the year amounted to 108, or 9' 2 per cent., as calculated on the same basis. Of the deaths four were due to renal disease, five to epilepsy, 10 each to phthisis and cardiac disease, 13 each to senile decay, colitis, and general paralysis of the insane, 20 to pneumonia, and the rest to other causes. Post-mortem examinations were made in 93 out of 108 cases. Among zymotic diseases which occurred during the year were chicken-pox, which attacked two male patients, and typhoid fever, which affected one male patient. Colitis caused a good deal of trouble by reason of its occurring in irregular outbreaks. " Various methods of treatment [for colitis] much recommended in other asylums were tried but without satisfactory results." The desire to improve the system of nursing in the asylum has led to the introduction of trained nurses in the male wards, and the new system is being watched carefully in order to determine whether a more extensive adoption of it would be justified. The method has been tried in Scctland, says Mr. Braine-Hartnell, "and its advocates are loud in their praise. I think we ought to be able to show that the increased cost would give an increased recovery rate before we make such wide and sweeping changes." The Commissioners in Lunacy state in their report that they were able to form a very favourable opinion of the condition of the asylum, that the wards were in excellent order and the day-rooms tastefully decorated, that the sanitary conditions were generally excellent, and that the medical case-books and records were very well kept. The committee of management states in its report that a cemetery for the interment of patients dying in the asylum was duly consecrated by the Lord Bishop of Worcester in July. The maintenance charge per week for patients is 7s. 7d. per head which was the same as that of the previous year.