(d) Rheumatism gives 46 cases per 1,000 of strength.

3. Accidents give the next greatest number; mean (1870-1880) 107; range from 65 to 114 per 1,000.

4. Diseases of the Digestive system follow, with nearly the same number, about 107; range from 96 to 122.

5. Cutaneous diseases give a mean of 104; range from 92 to 123.

6. Respiratory diseases (not including Phthisis) give a mean of 85 per 1,000; range from 76 to 103.

7. Diseases of the Eye, mean 16, with little variation.

8. Diseases of the Circulatory system, 14.

9. Phthisis, 13, with range between 11 and 14.

10. Nervous system, 12, with a range between 11 and 14.

11. The remaining diseases of numerous smaller items, such as those of the generative (venereal excluded), locomotive, urinary (gonorrhea excluded), etc.

As almost all details of these different groups are now omitted from the "Army Medical Reports," it is difficult to discuss their causation and possible diminution.

There is no room for doubt that the venereal admissions could be greatly lessened; so also could the admissions from fever, which have in fact been already reduced from 60 to 22 per 1,000 of strength; in 1879 and 1880 they were only 16 and 17 respectively. The large class of integumentary diseases would probably admit of reduction. What is the exact nature of the phlegmon and ulcers which form so large a proportion of the admissions? Trifling as the cases are, they form a large aggregate, and a careful study of their mode of production might show how they might be diminished. Probably, however, these are mere conventional terms, under which a number of trifling cases are conveniently recorded, but a complete analysis of the returns of one year under phlegmon would be desirable. So also of all the other classes, it may be concluded that an active medical officer might succeed in reducing the cases of rheumatism, bronchitis, and dyspepsia.' Many cases of acute respiratory diseases are produced by exposure on guard, especially by the passage into and from the hot close air of the guard-room to the open air on sentry duty. Good additional overcoats, means of drying the clothes, and proper ventilation of the guard-rooms, would probably lessen the cases of bronchitis and pleurisy.

2

Sickness in Military Prisons.-The admissions into hospital in the military prisons do not appear to be great; they have varied per 1,000 of admissions of prisoners from 316 (in 1851) to 725.5 in 1863. Calculated on the mean strength, the result is as follows:-In 1863, the daily average number of prisoners was 1,064; the admissions for sickness, 722; the mean daily sick, 21; the mortality, 0. These numbers give 725.5 admissions, and 19.74 mean daily sick per 1,000 of strength. Prisoners are healthier than their comrades at duty in the same garrisons where the prisoners are under sentence.

It is right, however, to say that no medical officer ought to sacrifice his men in the slightest degree for the purpose of appearing to have a small sick list and an empty hospital. There is a temptation in that direction which we have to guard against, and to remember that the only question to be asked is, What is the best for the men? not, What will make the best appearance?

9

Report on Prisons for 1863, p. 24.

VOL. II.-19

SECTION III.

Such, then, being the amount of mortality and sickness at home, it may be concluded that the soldier at present is not yet in so good a condition of physical health as he might be; and we can confidently look to future years as likely to show a continuance in the improvement now going on. In future years, however, the new system of limited service will render it difficult to trace the progress in the infantry.

Health is so inextricably blended with all actions of the body and mind, that the medical officers must consider not only all physical but all mental and moral causes acting on the men under their charge.

The amount of work, the time it occupies, its relation to the quantity of food, the degree of exhaustion it produces, the number of nights in bed, and other points of the like kind; the mental influences interesting the soldier, or depressing him from ennui; the moral effect of cheerfulness, hope, discontent, and despondency upon his health, as well as the supply of water, air, food, clothing, etc., must be taken into account. And just as the body is ministered to in all these ways, so should there be ministration of the mind. It is but a partial view which looks only to the body in seeking to improve health; the moral conditions are not less important; without contentment, satisfaction, cheerfulness, and hope, there is no health.

Hygiene, indeed, should aim at something more than bodily health, and should indicate how the mental and moral qualities, essential to the particular calling of the man can be best developed.

How is a soldier to be made not merely healthy and vigorous, but courageous, hopeful, and enduring? How, in fact, can we best cultivate those martial qualities which fit him to endure the hardships, vicissitudes, and dangers of a career so chequered and perilous?

Without attempting to analyze the complex quality called courage,- -a quality arising from a sense of duty, or love of emulation, or fear of shame, or from physical hardihood, springing from familiarity with and contempt of danger,-it may well be believed that it is capable of being lessened or increased. In modern armies, there is not only little attempt to cultivate courage and self-reliance, but the custom of acting together in masses and of dependence on others, actually lessens this. It is, then, a problem of great interest to the soldier to know what mental, moral, and physical means must be used to strengthen the martial qualities of boldness and fortitude.

The English army has never been accused of want of courage, and the idea of pusillanimity would seem impossible to the race. But drunkenness and debauchery strike at the very roots of courage; and no army ever showed the highest amount of martial qualities when it permitted these two vices to prevail. In the army of Marlborough, the best governed

There are many sober and excellent men in the army. But as a rule, the English soldier cannot be depended upon under any circumstances, if he can get drink. Well does Sir Ranald Martin, say, Before that terrible vice can be overcome, something far more powerful than medical reasoning on facts, or the warnings of experience founded on them, must be brought into active operation. Discipline must still further alter its direction:-in place of being active only to punish wrong, it ought and must be exerted further and further in the encouragement to good conduct."- Ranald Martin, Tropical Climates, p. 263.

army we ever had, ånd the most uniformly successful, we are told that the "sot and the drunkard were the objects of scorn." To make an army perfectly brave, it must be made temperate and chaste.

Good health and physical strength, by increasing self-confidence, increase courage; and self-reliance is the consequence of feeling that, under all circumstances, we can face the dangers and difficulties that present themselves.

Few wiser words were ever written than those by William Fergusson,' at the close of his long and eventful service.

"Of the soldier's life within these barracks," writes Fergusson, "there is much to be said, and much to be amended. To take his guards, to cleanse his arms, and attend parade, seems to comprehend the sum total of his existence; amusement, instruction beyond the drill, military labor, and extension of exercises, would appear, until very recently, to be unthought of; as it is impossible that the above duties can fully occupy his time, the irksomeness of idleness, that most intolerable of all miseries, must soon overtake him, and he will be driven to the canteen or the ginshop for relief.

"Labor in every shape seems to have been strictly interdicted to the soldier, as water for his drink. All, or nearly all, must have been bred to some trade or other before they became soldiers; but there is work for them no longer. Labor (the labor of field-works and fortifications) strengthens the limbs and hardens the constitution, but that is never thought of in our military life at home; so thought not the ancient Romans, whose military highways still exist, and who never permitted their soldiers to grow enervated in idleness during peace. Better, surely, would it be that every one should work at his own craft, or be employed on the public works, in regulated wholesome labor, than thus to spend his time in sloth and drunkenness. But his exercises, without even going beyond the barrack premises, may be made manifold-running, wrestling, gymnastic games of every kind, swimming, leaping, pitching the bar, the sword exercise (that of the artillery), all that hardens the muscles and strengthens the limbs, should be encouraged; and when the weather forbids out-door pastimes, the healthy exercise of single-stick, in giving balance and power to the body, quickness to the eye, and vigor to the arm, may properly be taken as a substitute for the drill which, after the soldier has been perfected in his exercise, is always felt to be a punishment. So is the unmeaning evening parade and perpetual roll-calling.

Foot-racing too, the art of running, so little practised, and so supremely useful, should be held amongst the qualities that constitute military excellence. It was so held at the Isthmian games of ancient Greece, and deserves a better place than has hitherto been assigned to it in the military pastimes of modern Britain. In our school-books we are told that the youth of ancient Persia were taught to launch the javelin, to ride the war-horse, and to speak the truth. Let the young British warrior be taught to use his limbs, to fire ball-cartridge, to cook his provisions, and to drink water. The tuition may be less classical, but it will stand him in far better stead during every service, whether at home or abroad.

"Regular bodily pleasurable exercise has been said to be worth a host of physicians for preserving military health; and occupation without distress or fatigue is happiness. The philosopher can make no more of it; and every idle hour is an hour of irksomeness, and every idle man

'Notes and Recollections of Professional Life, 1846, p. 49.

is, and must be, a vicious man, and to a certain extent an unhealthy one.'

In many of the foreign stations of the British army, excellent opportunities exist for both occupying the men and developing their spirit. All history teaches us that a hunting race is a martial one. The remarkable fighting qualities of the English, as drawn in Froissart's "Chronicles," were owing to the fact that at that time they were "a nation of hunters," and trained from infancy to face dangers alone. In India there are many places where men could not only be allowed to hunt, but where such permission would be the greatest boon to the inhabitants.

The English army has hitherto offered but few incentives to good conduct, and scanty encouragement for the cultivation of martial qualities. Men must have rewards, and feel that earnest endeavor on their part to become in all respects better soldiers is neither overlooked nor unrewarded. The new order of things introduced by Lord Cardwell seems likely to open up means of progress for men who can acquire knowledge and deserve advancement.

The cultivation of the martial qualities of the soldier is in reality a part of hygiene considered in its largest sense, but this part of hygiene must be studied and carried into effect by the combatant officers. Let us trust it may not be long before they seriously study and endeavor, by precept and example, to promote the formation of those habits of boldness and endurance, and that fertility in resources, which are as necessary as technical knowledge to render an army the formidable instrument it is capable of becoming.

COOPER MEDICAL COLLEGE,

SAN FRANCISCO, CAL

and is not to be removed from the Library Roca by ey person or under any protect wherever.

CHAPTER IV.

FOREIGN SERVICE.

THF foreign service of the British army is performed in every part of the world, and in almost every latitude, and probably more than two-thirds of each line soldier's service is passed abroad. The mere enumeration of the stations is a long task; the description of them would demand a large volume. In this short chapter, to give a few general statements as to climate and geology, and the past and present medical history of the stations, only can be attempted; such an outline as may give medical officers a sort of brief summary of what seems most important to be known.

Detailed and excellent accounts of most of the foreign stations exist, either in the independent works of army surgeons, such as those of Marshall, Hennen, Davy, and many others, or in reports drawn up for Government, and published by them. In the early "Statistical Reports of the Medical Department of the Army," short topographical notices of the stations were inserted; they are models of what such reports should be, and must have been drawn up by a master in the art of condensation. In the "Annual Reports" now published many excellent topographical descriptions will be found; and some of the Indian Governments have published complete descriptions of all their stations. In the "Bombay Transactions," the Madras Medical Journal, and the "Bengal Indian Annals" are very full accounts of almost every station that has been, or is, occupied by European troops in India. Finally, in the "Indian Sanitary Report" is much important information on the meteorology and topography of the present Indian stations. Young medical officers first entering on foreign service are strongly advised to study these accounts of the stations in the command where they are serving; it will not only give them interest in their service, but will aid them in their search how best to meet the climatic or sanitary conditions which affect the health of the men under their charge.

SECTION I.

MEDITERRANEAN STATIONS.1

GIBRALTAR.

Usual peace garrison = 4,500 to 6,000 men. Period of service, three years. Civil population = 18,381 (in 1881). Height of rock, 1,439 feet at highest point. Nature of rock, grey limestone, with many cavities filled with reddish clay; under town, an absorbent red earth forms the subsoil.

A very important Report on the Mediterranean Stations was published by the Barrack Improvement Commissioners (Dr. Sutherland and Captain Galton).-Blue Book, 1863.