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the post as a stepping-stone to other and more lucrative

positions upon the staff. He alleges that there is little

inducement for seasoned workers in the field to compete forthe appointment of ansesthetist because they receive noadequate status and their work is brushed aside as

being of scant value. Thus, we are told, anaesthetists

do not enjoy the privileges accorded to physiciansand surgeons, to assistant physicians and assistant

surgeons, and to officers such as surgeon-dentists whocontrol special departments. "A Hospital Anaesthetist" "

complains that surgeons ignore the usual amenities whichshould exist among colleagues, and in the case of the

anaesthetists dictate to them what they should do and with-hold from them alike courtesy and appreciation of their

special knowledge of their department. The natural result

of this, we are asked to believe, is that the public as a

body do not hold the anaesthetist in much repute and arenot encouraged by consulting surgeons to call him in as

an expert when dangerous or critical operations have to befaced. The surgeon is sought with care while the anaesthetistis chosen at haphazard is practically the complaint of thewriter to the Times. The view is much the same as that

expressed by Dr. HEWITT. He considers that the personneland the system of teaching at some hospitals are capable of

improvement, and circumstances can hardly have failed to

bring home to the minds of all of us that in some instancesthere is a lack of organisation in this department. This has

led to public comment and undoubtedly a vast amount ofmisapprehension exists upon the subject of anaesthetics, thebulk of the public being unaware of the importance of thework of the anaesthetist. It is usual to hear of the

wonders of modern surgery and the triumphs of the

scalpel; how often is it recognised that a skilled and experi-enced anaesthetist has fought for his patient’s life through a

weary hour or more and has enabled his eminent colleaguethe surgeon to accomplish another victory ? 2 For the sake of

the patient the potential dangers of the anaesthetic are mini-

mised, and in some cases this may lead to the ansesthetic

being given by men sound, no doubt, in the knowledgeof their profession but lacking in a scientific grasp of

the facts underlying the rules governing narcotism.

It may happen that such men undertake the duty re-

luctantly and only yield to the entreaties of a nervous

patient who dreads the advent of a stranger, while it is not

recognised by the public that a rule-of-thumb knowledgeof anaesthetics is not skilled ansesthetisation.

While all are agreed that medical students ought to be

taught more fully the recognised methods of administeringanaesthetics, the amount which they should be taught and thedue relations of the specialist anaesthetist to the generalpractitioner make up between them a most delicate ques-tion. To administer anaesthetics with complete knowledgein difficult cases and with the absolute minimum of risk

demands scientific knowledge and judgment begotten of

experience-those who can do it ought to be held in

the same regard at their schools and hospitals as anyother specialist attached to the institution. But for

this very reason every medical student cannot become an

anxsthetist of this class ; he cannot in the presentstate of the curriculum spare the necessary time for the

training, he may lack opportunities for the teaching,while he may not have the individual aptitude for an

arduous and responsible branch of his profession. All that

can be done for him, as yet at any rate, is to see that he is

thoroughly grounded in the principles of giving anaestheticsin uncomplicated cases, and the specialist anaesthetists

will no doubt approve of such a man giving an2esthe.

tics, if only because it is he whom the public will in

many cases employ. There are vastly more operations, largeand small, where anaesthetics are used than it is possiblethat any specialist class could cope with, while rural

neighbourhoods, towns of under 5000 inhabitants, and

parochial authorities cannot possibly support the services

of a member of such a class. For the present all thatcan be done is to make the teaching in anaesthetics at allour schools thorough, to insist upon all students learningthe principles of the administration of anaesthetics as a

compulsory subject, to raise the position of the anpsthetid

upon our hospital staffs to that of the other members of the

honorary staff, and to trust that such reforms will result inthe diffusion of generally adequate skill.

The Health of the Army.THE Army Medical Report for the year 1907 recently

issued has excited more than usual general comment. This is

probably due to the fact that during the present period of

reorganisation and transfiguration of our land service

military affairs have aroused greater interest than they do

normally in the public mind. The medical organisation ofour army has come in for its share of this increased atten-

tion, with the result that the public is able to realise withPLATO the importance of the influence of the physician inmatters of State. The report deserves the wide comment

that it has obtained, for it bears record to good and carefulwork on the part of this department and enables us to

perceive that a deep debt of gratitude is due to the men

of science and men of affairs-amongst whom SIDNEY

HERBERT and EDMUND A. PARKES are the most famous-

who after the Crimean war founded, in the face of

strenuous opposition, the Army Medical School. One

section alone of the present report affords a triumphantvindication of the foundation of that school-namely, thatwhich deals with the almost complete stamping-out of

"Malta fever." This fever but a few years ago was a

mysterious disease of unknown origin, levying a heavy tollon our regiments, and it may be counted one of the greatestvictories of modern science, systematically equipped and

organised, in general, and of the medical department of thearmy in particular, that this toll will no longer have to bepaid. The official statistics proving the reality of this

triumph of therapeutics have been so recently before ourreaders that we need not recapitulate them here.We publish in another column an abstract of the report on

individual diseases as they affected the troops in 1907, but it, will be convenient now to draw attention to two outstanding. causes of sickness in the army. The amount of venereal dis-

L ease appears always to vary in every part of the world from

; various reasons, some easily traceable, and others unknown.i It is a matter of great regret that the entries for 1907

1087

amounted to over 208 per 1000 of the strength of the force !employed in the London district. Such an amount of infec- t

tion reveals a state of affairs not only deplorable in itself 1

but fraught with danger to the public health, unfortunately <

not only of this but of future generations, a danger for themitigation or stamping out of which, in the present state of

public opinion, it seems hopeless to look to legislation.The death-rate and invaliding rate from diseases of the

heart and circulatory system are high and afford abundantmaterial for study and investigation. It is said, and fairlystrong evidence is brought forward to support the dictum,that a soldier of 30 is " at least five years older than a civilian

of the same age," and this sudden passing of the soldierinto middle age is due to circulatory troubles, but the

numerous exceptions to such a generalisation and the factthat the officer class are not affected in the same waywould seem to indicate that the admittedly unsatis-

factory state of things arises from causes which are

capable of being brought under control. We are inclined

to believe that a series of causes acting together are

often responsible : syphilis, alcohol, tobacco, malarial

infection, with climatic changes and altered conditions

of blood pressure. "As regards the relative importanceof the different causes of invaliding, diseases of the

circulatory system still hold the first place," as they havedone, with one exception, for the past 27 years. While

disordered action of the heart in immature recruits may be

sometimes entirely functional in its nature " as from a

dilated stomach," in which case they ought not to be

invalided but detected and cured, we must reiterate the

conclusion which we have recently on several occasions ex-

pressed in these columns, that, as a rule, it is due to differentforms and degrees of cardiac dilatation, which, apart from

any valvular defects, leads to regurgitation at the auriculo-ventricular orifice. It would be interesting if we could

obtain from the medical records of civil life some data

as to the prevalence of diseases of the heart and

circulatory system amongst those constantly engaged in

arduous labour, as in lifting and removing articles of heavyfurniture. We are inclined to surmise that in the case of

the soldier it is the intermittent nature of the heavy work,at any rate in the case of persons with fairly sound arteries,that does the mischief.

During the past year important changes were intro-

duced in the scale of rations for foreign stations,which were brought into more uniformity as regardsgrocery and vegetable rations, the scale adopted beingper diem : tea, j- ounce, or coffee, 1* ounces; sugar,2 ounces; salts ounce ; pepper, 1-36th ounce; fresh

vegetables, pound, or dried vegetables, 2 ounces, and thismust be considered together with the purchase value of themessing allowance granted to each soldier. The meals

are now served to the mess collectively in rooms

and dining halls specially set apart for the purpose,which allows of a greater variety in foods and obviates thedirty and unhealthy practice of using the men’s dormitoriesfor meals. Steady, if slow, improvement is reportedin the comfort of barrack buildings from year to year.Reconstruction and remodelling of the drainage systemshave been widely proposed and in some instances in-

augurated, soldiers’ married quarters have been improved

md extended, the water-supply has been dealt with, lava-

;ory accommodation increased, and plunge- and shower-

aaths erected, and the gravity of the question of sewagedisposal has been recognised. Should the hygiene andsanitation of our army ever attain the standard now

indicated the result will more than reward and justifythe care and expense. The present state of affairs is a

matter of gratification, at least when compared with thatrevealed half a century ago after the Crimean war. We

must briefly notice, however, a section of the report which

appears to us both gloomy and unsatisfactory : this deals withthe all-important subject of recruiting, touching essentiallyand, as we have on several recent occasions emphasised inthese columns, indicating the grave problem of the healthand physique of the young adult male population. Last

year, roughly speaking, nearly 300 per 1000 recruits wereeither rejected on inspection or found unfit within three

months of enlistment. Notwithstanding that a fixed

standard of weight has been abolished, that the medical

examiners have passed all who came up to the

physical requirements of infantry of the line, althoughthey were afterwards rejected by the recruiting officer

because they were too small for the corps of their choice,that a more lenient standard of dentition" has been

adopted, &deg; that varicocele is viewed with greater leniencynow than in past times," and that men are now accepted’’ with only one-sixth of the normal acuteness of vision inone eye, provided that the other is normal," "the majorityof recruits were growing lads ...... 95 per cent. of the totalout of work at the time of enlistment ...... in many instances

suffering from want of food ...... most of the men will notbe capable of doing the work of a mature soldier for at leasttwo years....... Immaturity has always been the outstand-ing defect of our recruits, and in this respect little or noimprovement was shown during the year." Both under the

head of recruiting and invaliding the unsatisfactory resultof employment of inexperienced medical men is alluded to.

It is impossible to exaggerate the importance of these points,being, as they are indeed, the finger on the pulse of thenational health. Recent investigations have given anuncertain answer to the question whether the national healthwas improving or deteriorating. We should like to see a

small practical committee appointed which would make upits mind and give us a definite opinion on this point.Practical experienced medical men and employers of labourcould tell us more real truth on this subject than philan-thropists, statesmen, and men of science, with their own

axes to grind and their own theories to establish at the

expense of facts.

Annotations.

RECENT CHANGES IN THE NAVY.

" No quid nimis."

I WE are glad to notice that the new medical director-general of the navy has lost no time in strengthening theHaslar course. During the last session the examination ofrecruits, the administration of anaesthetics, and other

subjects coming within the sphere of a naval surgeon’sduties have been systematically taught. We observe

with pleasure that on the whole the recent changesin the victualling of the navy have been attended