A dress to allow perfectly free respiration (freedom from pressure on chest and neck), and protection of the head and spine from the sun, will generally prevent this form. The head-dress may be wetted from time to time; a piece of wet paper in the crown of the cap is useful. When the attack has occurred, cold affusion, artificial respiration, ammonia, and hot brandy and water to act on the heart, seem the best measures. Bleeding is hurtful; perhaps fatal. Cold affusion must not be pushed to excess.

In a second form the men are exposed to continued heat,' both in the sun and out of it, day and night, and the atmosphere is still, and perhaps moist, so that evaporation is lessened, or the air is vitiated. If much exertion is taken, the freest perspiration is then necessary to keep down the heat of the body; if any thing checks this, and the skin gets dry, a certain amount of pyrexia occurs; the pulse rises; the head aches; the eyes get congested; there is a frequent desire to micturate (Longmore), and gradual or sudden coma, with perhaps convulsions and stertor, comes on, even sometimes when a man is lying quiet in his tent. The causes of the interruption to perspiration are not known; it may be that the skin is acted upon in some way by the heat, and from being over-stimulated, at last becomes inactive.

In this form cold affusion, ice to the head, and ice taken by the mouth, are the best remedies; perhaps even ice water by the rectum might be tried. Stimulants are hurtful. The exact pathology of this form of insolation is uncertain. It is the cerebro-spinal variety of Morehead.

In a third form a man is exposed to a hot land-wind; perhaps, as many have been, from lying drunk without cover. When brought in, there is generally complete coma with dilated pupils, and a very darkly flushed face. After death the most striking point is the enormous congestion of the lungs, which is also marked, though less so, in the other varieties. Dr. Parkes stated that he had never seen anything like the enormous congestion he had observed in two or three cases of this kind.

As prevention of all forms, the following points should be attended to :— Suitable clothing; plenty of cold drinking water (Crawford); ventilation; production in buildings of currents of air; bathing; avoidance of spirits; lessening of exertion demanded from the men.

Duty of Medical Officers during Marches.

General Duties on Marches in India or the Colonies.-Before commencing the march, order all men with sore feet to report themselves. See that all the men have their proper kits, neither more nor less. Every man should be provided with a water-bottle to hold not less than a pint. Inspect halting-grounds, if possible; see that they are perfectly clean, and that everything is ready for the men. In India, on some of the trunk roads there are regular halting-grounds set apart. The conservancy of these should be very carefully looked to, else they become nothing but foci for disseminating disease. If there are no such places, halting-grounds are selected. It should be a rule never to occupy an encamping ground previously used by another corps if it can be avoided; this applies to all cases. Select a position to windward of such an old camp, and keep as far as possible from it. The encampments of the transport department, elephants, camels, bullock

The heat of sandy plains is the worst, probably, from the great absorption of heat and the continued radiation. The heat of the sun, per se, is not so bad; on board ship sun-stroke is uncommon.

carts, etc., must be looked to,-they often are very dirty; keep them to leeward of the camp, not too near, and see especially that there is no chance of their contaminating streams supplying drinking water. If the encampment is on the banks of the stream, the proper place for the native camp and bazaar will always be lower down the stream. The junior medical officer, if he can be spared, should be sent forward for this purpose with a combatant officer. Advise on length of marches, halts, etc., and draw up a set of plain rules to be promulgated by the commanding officer, directing the men how to manage on the march if exposed to great heat or cold, or to long-continued exertion, how to purify water, clean their clothes, etc. If the march is to last some time, and if halts are made for two or three days at a time, write a set of instructions for ventilating and cleaning tents, regulation of latrines, etc.

Special Duties for the March itself.-Inspect the breakfast or morning refreshment; see that the men get their coffee, etc. On no account allow a morning dram, either in malarious regions or elsewhere. Inspect the water-casks, and see them properly placed, so that the men may be supplied; inspect some of the men, to see that the water-bottles are full. March in rear of the regiment so as to pick up all the men that fall out, and order men who cannot march to be carried in wagons, dhoolies, etc., or to be relieved of their packs, etc. If there are two medical officers, the senior should be in rear; if a regiment marches in divisions, the senior is ordered to be with the last. When men are ordered either to be carried or to have their packs carried, tickets should be given specifying the length of time they are to be carried. These tickets should be prepared before the march, so that nothing has to be done but to fill in the man's name, and the length he is to be carried.

Special orders should be given that, at the halt, or at the end of the day's march, the heated men should not uncover themselves. They should take off their pack and belts, but keep on the clothes, and, if very hot, should put on their great-coats. The reason of this (viz., the great danger of chill after exertion) should be explained to them. In an hour after the end of the march the men should change their underclothing, and hang the wet things up to dry; when dry they should be shaken well, and put by for the following day. Some officers, however, prefer that their men should at once change their clothes and put on dry things. This is certainly more comfortable. But, at any rate, exposure must be prevented.

At the end of the march inspect the footsore men. Footsoreness is generally a great trouble, and frequently arises from faulty boots, undue pressure, chafing, riding of the toes from narrow soles, etc. Rubbing the feet with tallow, or oil or fat of any kind, before marching, is a common remedy. In the late war the Germans found tannin very useful,—they used an ointment of one part of tannin to twenty parts of zinc ointment. A good plan is to dip the feet in very hot water, before starting, for a minute or two; wipe them quite dry, then rub them with soap (soft soap is the best), till there is a lather; then put on the stocking. At the end of the day, if the feet are sore, they should be wiped with a wet cloth, and rubbed with tallow and spirits mixed in the palm of the hand (Galton). Pedestrians frequently use hot salt and water at night, and add a little alum. Sometimes the soreness is owing simply to a bad stocking; this is easily remedied. Stockings should be frequently washed; then greased. Some of the German troops use no stockings, but rags folded smooth over the feet. French use no stockings. Very often soreness is owing to neglected corns, bunions, or in-growing nails, and the surgeon must not despise the little

The

surgery necessary to remedy these things; nothing, in fact, can be called little if it conduces to efficiency. As shoes are often to blame for sore feet, it becomes a question whether it might not be well to accustom the soldier to do without shoes.

Frequently men fall out on the march to empty the bowels; the frequency with which men thus lagging behind the column were cut off by Arabs, led the French in Algeria to introduce the slit in the Zouave trousers, which require no unbuckling at the waist, and take no time for adjustment.

At a long halt, if there is plenty of water, the shoes and stockings should be taken off, and the feet well washed; even wiping with a wet towel is very refreshing. The feet should always be washed at the end of the march.

Occasionally men are much annoyed with chafing between the nates, or inside of the thighs. Sometimes this is simply owing to the clothes, but sometimes to the actual chafing of the parts. Powders are said to be the best-flour, oxide of zinc, and above all, it is said, fuller's earth.

If blisters form on the feet, the men should be directed not to open them during the march, but at the end of the time to draw a needle and thread through; the fluid gradually oozes out.

All footsore men should be ordered to report themselves at once. Sprains are best treated with rags dipped in cold water, or cold spirit and water with nitre, and bound tolerably tight round the part. Rest is often impossible. Hot fomentations, when procurable, will relieve pain.'

Marches, especially if hurried, sometimes lead men to neglect their bowels, and some trouble occurs in this way. As a rule, it is desirable to avoid purgative medicines on the line of march, but this cannot always be done; they should, however, be as mild as possible.

Robert Jackson strongly advised the use of vinegar and water as a refreshing beverage, having probably taken this idea from the Romans, who made vinegar one of the necessaries of the soldier. It was probably used by them as an anti-scorbutic; whether it is very refreshing to a fatigued man seems uncertain.

There is only one occasion when spirits should be issued on a march: this is on forced marches, near the end of the time, when the exhaustion is great. A little spirit, in a large quantity of hot water, may then be useful, but it should only be used on great emergency. Warm beer or tea is also good; the warmth seems an important point. Ranald Martin and Parkes tell us that in the most severe work in Burmah, in the hot months of April and May, and in the hot hours of the day, warm tea was the most refreshing beverage. Travellers in India, and in bush travelling in Australia, have said there was nothing so reviving as warm tea. Chevers mentions that the juice of the country onion is useful in lessening thirst during marches in India, and that, in cases of sun-stroke, the natives use the juice of the unripe mangoe mixed with salt.

Music on the march is very invigorating to tired men. Singing should also be encouraged as much as possible.

Marching in India.-Marches take place in the cool season (November to February), and not in the hot or rainy seasons, except on emergency; yet marches have been made in hot weather without harm, when care is taken. They are conducted much in the same way as in cold countries, except that

1 The following is a very good lotion for sprains: sal-ammoniac, 20 grains, vinegar and spirit, an ounce of each.

the very early morning is usually chosen. The men are roused at half-past two or three, and parade half an hour later; the tents are struck, and carried on by the tent-bearers; coffee is served out, and the men march off by half-past three or four, and end at half-past seven. Everything is ready at the halting-ground, tents are pitched, and breakfast is prepared.

These very early marches are strongly advocated by many, and are opposed almost as strongly by some. In the West Indies, marching in the sun has always been more common than in the East. Much must depend on the locality, and the prevalence and time of hot land winds. Both in India and Algeria marches have been made at night; the evidence of the effects of this is discordant. The French have generally found it did not answer; men bear fatigue less well at night; and it is stated that the admissions into hospital have always increased among the French after night marching. Annesley's authority is also against night marching in India. On the other hand, it is stated by some that in India the march through the cool moonlight night has been found both pleasant and healthy.

Afternoon marches (commencing about two hours before sunset) have been tried in India, and often apparently with very good results.

Marching in Canada.-In 1814, during the war with America; in 1837, during the rebellion; and, in 1861-62, during the Trent excitement, winter marches were made by the troops, in all cases without loss. The following winter clothing was issued at home:-A sealskin cap with ear lappets; a woollen comforter; two woollen jerseys; two pairs of woollen drawers; a chamois leathern vest with arms; two pairs long woollen stockings to draw over the boots; sealskin mits; and a pair of jackboots. In Canada a pair of blankets and mocassins were added,' and, at the long halts, weak hot rum and water was served out. A quarter of a pound of meat was added to the ration. A hot meal was given before starting, another at mid-day, and another at night. The troops were extremely healthy. During exposure to cold, spirits must be avoided; hot coffee, tea, ginger tea, or hot weak wine and water, are the best; it is a good plan to rub the hands, feet, face, and neck with oil; it appears to lessen the radiation of heat and the cooling effect of winds.

1 See Inspector-General Muir's Report, Army Medical Reports, vol. iv., p. 378.

CHAPTER III.

THE EFFECTS OF MILITARY SERVICE.

THE influence of the various conditions of military life is shown by the records of sickness and mortality, and this must be noted in the various stations.

The recruit having entered the ranks, begins his service at home, and he is kept at his depôt for some time. He does not go on foreign service until he has completed his twentieth year. We should suppose his life would be a healthy one. It is a muscular, and, to a certain extent, an open-air life, yet without great exposure or excessive labor; the food is good (though there might be some improvement), the lodging is now becoming excellent, and the principles of sanitation of dwellings are carefully practised. Although the mode of clothing might be improved as regards pressure, still the material is very good. There is a freedom from the pecuniary anxiety which often presses so hardly on the civil artisan, and in illness the soldier receives more immediate and greater care than is usual in the class from which he comes.

There are some counterbalancing considerations. In a barrack, there is great compression of the population, and beyond a doubt the soldier has greatly suffered, and even now suffers, from the foul air of barrack rooms. But this danger is greatly lessening, owing to the exertions of the Barrack Improvement Commissioners, and, as is proved by the experience of some convict jails, can be altogether avoided.

Among the duties of the soldier is some amount of night-work; it is certain that this is a serious strain, and the Sanitary Commissioners, therefore, inserted in the "Medical Regulations" an order that the number of nights in bed should be carefully reported by medical officers. Major-General Sir Frederick Roberts, G.C.B., has lately called marked attention to the injurious effects of night duty and "sentry-go." Commanding officers should be informed how seriously the guard and sentry duties, conducted as they are in full dress, tell on the men if they are too frequent; one guard-day in five is quite often enough, and four nights in bed should be secured to the men. Exposure during guard and transition of temperature on passing from the hot air of the guard-room to the outside air are also causes of disease. The weights and accoutrements are heavy, but the valise equipment introduced by General Eyre's Committee has removed the evil of the old knapsack.

The habits of the soldier are unfavorable to health; in the infantry, especially, he has much spare time on his hands, and ennui presses on him. Ennui is, in fact, the great bane of armies; though it is less in our own than in many others. It is said to weigh heavily on the German, the Russian, and even on the French army. Hence, indeed, part of the restlessness

Nineteenth Century, November, 1882.