the troops quartered in the notoriously unhealthy barracks of Lower St. Elmo and Fort Ricasoli. The admissions rose to 228, and the deaths actually amounted to no less than 7.93 per 1,000 of strength. Out of 100 deaths no less than 32.2 or nearly one-third, were from "continued fever," i.e., enteric fever in great measure. In 1872 there was also a great deal of fever, the admissions being 233, and the deaths 3.91, per 1,000 of strength. In 1878, also, there were 209 admissions and 5.16 deaths per 1,000 of strength, the deaths being in almost all cases enteric.

In former years phthisis was the cause of 39 per cent. of the deaths, or nearly the same as at Gibraltar. Latterly there have been fewer deaths at Malta, but a considerable number of tubercular cases are sent home. The disease is probably detected earlier, and the men do not die as formerly at the station. Still this does not account for the whole diminution, and there has been clearly a lessening of phthisis. There was formerly a large amount of stomach and bowel disease, and dysentery was forty times as frequent as in England.' It is certainly a very remarkable circumstance, that both at Gibralta and Malta there should have been this extraordinary liability to affections of the alimentary canal. At Malta, as at Gibraltar, it may have been chiefly owing to impure water and to food. 2 Of late years stomach and bowel affections have been less frequent, but are still more common than at home; in 1861 the 89,000 men on home service gave only 67 cases of acute dysentery, and no deaths, while the 6,000 men at Malta had 34 cases and 2 deaths. In 1864 there were three deaths from acute dysentery among 5,654 men, while in the home stations there was only 1 death among 73,252 men. If it had been equally fatal at home, there would have been nearly 39 deaths. In the three years (1878-80) the admissions at Malta were only 4.4, and in 1880 only 2.2 per 1,000 and no deaths.

In the "Statistical Report" for 1853 it is observed that the number of cases of liver disease at Malta is remarkably high; and the writers, while believing there must be "something in the climate of Malta peculiarly favorable to the production of hepatic affections," were unable to find, on bringing the cases into relation with the temperature, any connection. The cause of this may be something very different, and it is very desirable that the food should be looked to. There is a suspicion at Netley (which requires a few years more experience to test it), that the cases of echinococcus of the liver are more frequent in men from the Mediterranean stations than others (Dr. Maclean). The case of Iceland should lead us to look into this point.

The history of admission for venereal disease is important; in 18371846, inclusive, the admissions were only 99 per 1,000, or two-thirds less than at home; in 1859, when the next report appeared, they were 149 per 1,000; and in 1860 they were 147.9 per 1,000. In the early period there were police regulations, which were suspended in the two latter years. In June, 1861, the police regulations were re-enforced, and the admissions for the year sank to 102. The 4th battalion of the Rifle Brigade showed the following remarkable result: - In the first half of 1861 there were 57 admissions; in the last half only 17. In 1862 the total number of cases of "enthetic disease" in the whole garrison were only 49.5; in 1863, 441; and in 1864, 53.2 per 1,000. They were increased in that year by the women who came from Ionia with the troops. In 1865 they were 44; in

'In England, in 1837-46, every 1,130 men gave one case of dysentery; in Malta, in the same years, every twenty-eight men gave one case of dysentery. The mortality of the disease was, however, nearly the same (see pages 21 and 118 of the Report of 1853). * Report of 1853, p. 118.

2

1866, 59.6 per 1,000. In 1870 and 1871 the admissions were very few; in the latter year, which was the worst, the admissions of primary syphilis were only 8.3 per 1,000 of strength. If the home return is looked at, it will be seen what an effect has been produced at Malta by good regulations, although the number of cases fluctuates from causes traceable to special influences; the reduction is almost entirely of syphilis, not of gonorrhoea. In the later years there has been an increase and considerable fluctuations. Such, then, in brief, seem to be the chief medical points of importance at Malta, viz., a liability to phthisis, less marked of late years; a great amount of fever, from bad sanitary conditions in great part; a liability to stomach and intestinal affections, which, though less obvious, is still great, and a singular tendency to a liver affection, which may be parasitic. The chief improvements advised by the Barrack Commissioners refer to a larger water supply, a better distribution, improved drainage, and efficient ventilation. In the time of war, the dangers at Malta would be the same as at Gibraltar; the aqueducts might be cut by a besieging force, and the water supply restricted to the tanks. Although these are supposed to hold a large quantity, they are not kept full, and could not, perhaps, be rapidly filled. The garrison might be driven to distil the sea water. A still more serious danger would be the overcrowding of a war garrison. Doubtless, in case of a war, the garrison would only be concentrated in the lines when the siege commenced, but the crowding during a siege of three or six months might be very disastrous. The danger should be provided for beforehand by a clear recognition of what accommodation would be granted for war, and how it is to be obtained without violating either the conditions of health or of defence.

1

On the Influence of Age on Mortality in Gibraltar and Malta.

This station was first occupied in 1878. It is an island in the Levant, about 50 miles from the nearest mainland, and 240 from Port Said at the entrance of the Suez Canal. Size, 90 miles by 40; area, about 4,000 square miles; civil population, about 185,000 (in 1881). Our information about the climate is as yet imperfect, but it appears to resemble that of Malta, with greater rainfall.

The stations at present occupied are Nicosia (592 feet above the sea), as headquarters; Polymedia camp (400 feet), by the bulk of the troops, from October to May; and Mount Troados (5,720 feet), from May to October. The average strength (1880) was 443 officers and men. The mean

Dr. Notter analyzed, in 1872, fourteen of the tank waters of the different forts, and found the condition of the water to be satisfactory.

temperature at Polymedia during the cooler season (November to May inclusive) is about 59° to 60°; of Mount Troados (May to September inclusive), about 64° Fahr. The rainfall appears to be considerable, for in seven months (November to May) in 1880, 31.81 inches fell, of which no less than 12.26 were recorded in December alone. The number of rainy days in the seven months was 58. The prevailing wind would appear to be N. W.

On the first occupation in 1878 there was a great amount of sickness, chiefly from paroxysmal fever. This appeared to arise from the unsuitable sites selected for the temporary camps and the turning up of soil infiltrated with organic matter. During the five months (24th July to 31st December, 1878) there were, out of a strength of 894 non-commissioned officers and men, 3,931 admissions for disease and 36 deaths, or at the rates of 4,397 and 40.3 per 1,000 respectively. Expanding these to an annual rate, they amount to 10,094 admissions and 92 deaths per 1,000 of strength, an enormous amount. Eighty-four per cent. of the admissions and 61 per cent. of the deaths were due to fever, almost all paroxysmal (socalled remittent), only 14 admissions (actual number) and 2 deaths being due to enteric. In 1879 (strength 660) there was a great improvement-the ratios being 1,470 admissions and 21 deaths per 1,000, 35 per cent. of the admissions and 50 per cent. of the deaths being still due to paroxysmal fever. There were 3 deaths from dysentery, against 4 in 1878. In 1880 (strength 443) the total admissions were 1002.2 and the deaths only 2.26 per 1,000 strength. Paroxysmal fevers gave only 196.4 of admissions and no deaths. The only death in the command was from pulmonary extravasation, and occurred out of hospital. On the whole, we may consider the station healthy if proper precautions are taken: for, if we omit the admissions for injuries, the ratio for disease in 1880 was only 884.8 per 1,000 of strength, and of these 383.7 were venereal or the sequelæ of venereal disease. The invaliding in 1880 amounted to 18.07 per 1,000, one-fourth of which was due to syphilis; the number constantly sick was 53.27 per 1,000, of whom 4.45 were cases of injury and 28.69 venereal or its sequelæ ; and the average duration of each case of sickness was 19.45 days.

The possibility of placing the troops in the hills at a considerable elevation (Mount Troados, 5,720 feet) during the hottest months, will always be a great advantage to this station.

SECTION II.

WEST INDIES.

The history of sanitary science affords many striking instances of the removal of disease to an extent almost incredible, but no instance is more wonderful than that of the West Indies. Formerly service in the West Indies was looked on as almost certain death. It is little over sixty years since the usual time for the disappearance of a regiment 1,000 strong was five years. Occasionally in a single year a regiment would lose 300 men, and there occurred from time to time epochs of such fatality that it was a common opinion that some wonderful morbid power, returning in cycles of years-some wave of poison-swept over the devoted islands, as sudden, as unlooked-for, and as destructive, as the hurricanes which so sorely plague the

"Golden isles set in the silver sea."

What gave countenance to this hypothesis was, that sometimes for months, or even for a year together, there would be a period of health so great that a regiment would hardly lose a man. But another fact less noticed was not so consistent with the favorite view. In the very worst years there were some stations where the sickness was trifling; while, more wonderful still, in the worst stations, and in the worst years, there were instances of regiments remaining comparatively healthy, while their neighbors were literally decimated. And there occurred also instances of the soldiers dying by scores, while the health of the civil inhabitants in the immediate vicinity remained as usual.

If anything more were wanted to show the notion of an epidemic cycle to be a mere hypothesis, the recent medical history of the West Indies would prove it. At present this dreaded service has almost lost its terrors. There still occur local attacks of yellow fever, which may cause a great mortality; but for these local causes can be found; and otherwise the stations in the West Indies can now show a degree of salubrity almost equalling, in some cases surpassing, that of the home service.

us.

The causes of the production, and the reasons of the cessation, of this great mortality are found to be most simple. It is precisely the same lesson which we should grow weary of learning if it were not so vital to The simplest conditions were the destructive agents in the West Indies. The years of the cycles of disease were the years of overcrowding, when military exigencies demanded that large garrisons should hold the islands. The sanitary conditions at all times were, without exception, infamous.

There was a great mortality from scorbutic dysentery, which was almost entirely owing to diet.' Up to within a comparatively late date, the troops were fed on salt meat three, and sometimes five, days a week, and the supply of fresh vegetables was scanty. It required all the influence of Lord Howick, the then Secretary at War, to cause fresh meat to be issued, though it had been pointed out by successive races of medical officers that fresh meat was not only more wholesome, but was actually cheaper. The result of an improvement in the diet was marvellous; the scorbutic dysentery at once lessened, and the same amount of mortality from this cause is now never seen. Another cause of dysentery was to be found in the water, which was impure from being drawn from calcareous strata, or was turbid and loaded with sediment. The substitution of rain-water has sufficed in some stations to remove the last traces of dysentery.

If the food and water were bad, the air was not less so. Sir Alexander Tulloch has given a picture of a single barrack at Tobago, said to be the best in the whole Windward and Leeward Command," the figures of which tell their own tale.

Barrack at Tobago in 1826.-Superficial space per man, 224 feet; breadth, 23 inches; cubic space, 250 feet.

The men slept in hammocks, touching each other. In these barracks, crowded as no barracks were even in the coldest climates, there was not a single ventilating opening except the doors and windows; the air was fetid in the highest degree. With this condition of atmosphere it is impossible not to bring into connection the extraordinary amount of phthisis which prevailed in the soft and equable climate of the West Indies. There

This is pointed out in the Statistical Report (1838) on the West Indies, by Tulloch and Balfour; and it is believed that the improvement in the diet was in a great measure owing to these gentlemen. 2 Report, 1838.

was more phthisis than in England, and far more than in Canada. The first great improvement was made in 1827, when, iron bedsteads being introduced, each 3 feet 3 inches wide, greater space was obliged to be given to each man.

Every arrangement for removal of sewage was barbarous, and in every barrack sewage accumulated round the buildings and was exposed to heat and air. When yellow fever attacked a regiment, every stool and evacuation was thrown into the cesspools common to all the regiment; and in this way the disease was propagated with great rapidity, and was localized in a most singular manner, so that a few hundred yards from a barrack, where men were dying by scores, there would be no case of fever. In spite of this, it was many years before the plan of at once evacuating a barrack where yellow fever prevailed was adopted.

The barracks themselves were usually very badly constructed, and when in some cases the architects had raised the barracks on arches from the ground, in order to insure perflation of air below the buildings, the arches were blocked up or converted into store-rooms; and the barracks, with spaces thus filled with stagnant air beneath them, were more unhealthy than if they had been planted on the ground.

The localities for barracks were often chosen without consideration, or for military reasons,' into which no consideration of health entered. Almost all were on the plains, near the mercantile towns, where the soil was most malarious, and the climate hottest and most enervating. Malarious fevers were, therefore, common.

To all these causes of disease were added the errors of the men themselves. For the officers there existed, in the old slave times, the greatest temptation. A reckless and dangerous hospitality reigned everywhere; the houses of the rich planters were open to all. A man was deemed churlish who did not welcome every comer with a full wine, or more often a brandy, cup.

In a climate where healthy physical exertion was deemed impossible, or was at any rate distasteful, it was held to be indispensable to eat largely to maintain the strength. To take two breakfasts, each a substantial meal, was the usual custom; a heavy late dinner, frequently followed by a supper, succeeded; and to spur the reluctant appetite, glasses of bitters and spirits were taken before meals.

The private soldiers obtained without difficulty abundance of cheap rum, which was often poisoned with lead. Drunkenness was almost universal, and the deaths from delirium tremens were frequent and awfully sudden. The salt meat they were obliged to eat caused a raging thirst, which the rum-bottle in reality only aggravated.

To us these numerous causes seem sufficient to account for everything,

The history of the old St. James's Barracks in Trinidad is too remarkable to be passed over. It was determined to build a strong fort-a second Gibraltar-on the lower spurs of the hills overlooking the plain where the barracks now stand. When the works had been carried on for some time, it was discovered that they could not hold the troops. The barracks were then ordered to be placed on the plain, under cover of the guns of the fort. Before the fort was quite finished, it was found to be so unhealthy that neither white nor black men could live there, and it was abandoned. The barrack, it is said, was not then commenced; yet though the reason for placing it in that spot had gone, it was still built there, on a piece of ground near two marshes (Cocorite and the Great Western Marsh), below the general level of the plain, and exposed to the winds from the gullies of the neighboring hills. Yet this bad position, so fruitful of disease, was in reality less injurious than the bad local sanitary arrangements of the old St. James's Barrack itself.

VOL. II.-20