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give them a bath. The latter symptom is the medulla oblongata, and upper part of the not, however, constant; some patients are spinal cord, where the slightest alteration apable to drink during the course of the disease, pears to be incompatible with life. when even a loud voice or bright light will Several microscopical sections of the morbid throw them into the most horrible convul- changes in these centres were shown at the sions. These paroxysms, which recur under Pathological Society, London, in 1872, by Dr. the influence of the slightest cause, present Clifford Allbutt. themselves with a truly fearful intensity; the “The specimens were taken from the cere whole body becomes rigid for some seconds, bral convolutions, from the central ganglia, the and then ensues a succession of violent jerks medulla oblongata, and the cord. Throughout and spasms strong enough to break almost all these centres were found the same morbid any controlling bonds, and the head and limbs conditions, but in different degrees, and these are bruised against the walls. In the intervals were as follows: 1. Evidences of great rascua continual spitting is observed, which may be lar congestion, with transudation into the sur equally due to the spasm preventing the sal- rounding tissues. In all the grey centres the iva from being swallowed, and the augmen- vessels were seen in various degrees of distentation and alteration of the salivary secretion, sion, their walls in many cases being obviously which may become a true lather (bave). The thickened, and here and there were seen pupils are dilated, the eye sunk and brilliant, patches of nuclear proliferation. There was a sleep incessantly disturbed or wanting. Some diminished consistence of some of the parts, cases are troubled with a very marked venereal particularly of the medulla. This seemed to excitement. It is extremely rare to see that be due to serous infiltration and soddening. anxiety to bite which renders the approach to 2. Hæmorrhages of various size, and in many such cases so formidable in the eyes of the places a refracting material visible outside vulgar. Some cases are gloomy and restless, the vessels, due apparently to coagulate fibrironly speaking briefly at rare intervals, and,
3. Little gaps, caused by giving themselves up to continual terrors, the disappearance of nerve-strands, which had show a true panophobia ; in others the senti- passed through the granular disintegration of ments of affection persist and are augmented. Clarke. In addition to these appearances in As the disease makes progress the attacks the nervous centres, an enlarged spleen had of spasm repeat themselves with increasing been found in both cases. The parts seemed violence, the more cruel because intelligence to be affected in the following order as regards often remains intact to the last. The con- severity: (1) medulla, (2) the cord, (3) the tinuity of the paroxysms does not fail to cerebral convolutions, and (4) central ganglia. exhaust the strength, the ideas become con
This was in accordance with the symptoms fused, the anxiety increases ; in some cases the during life-riz., (1) reflex irritability in the eyelids retract and the eyes protrude, the region of the medulla, with no tetanie spasius ; body is suffused with perspiration, and if (2) increasing irritability throughout the cord, death does not take place suddenly in the with semi-tetanus; (3) delirium.” –(Lancet, midst of a convulsion at an early stage, it 1872, vol. i. p. 82.) does so towards the third or fourth day. Hydrophobia in man is always the result Death is the constant termination of hydro- of contagion, operating only by one direct and phobia.
immediate way-the inoculation of the rabid The duration of the disease in 161 cases in virus by domestic or wild animals and the which it could be exactly ascertained was as
only vehicle is the bare or saliva which they follows:
deposit in the wound.
It has been proved that neither the fest 2 days in
nor the milk of a mad animal exercises any contagious action. Although hydrophobia
may be transmitted from carnivorous animals 2
to the herbivorous, and from the latter to others of the same species, it does not appear that the last have the power to communicate it to man,
After several successive transmisThe pathological changes must be looked sions, the faculty of contagion appears to be for primarily in the spinal cord, the other exhausted even in the dog. effects-such as inflammation of the pharyn- Hydrophobia is said to be not communicable geal mucous membrane, &c.—are only secon- from man to man. The cohabitation of a man dary. The poison, instead of, as in smallpox, affected with rabies with a woman does but going to the skin, or, as in typhoid fever, to the communicate it. There are recorded one or intestine, affects the most vital centre of life, two instances in which inoculation of animale
Deaths from Hydrophobia,
Not Cauterised. 26
sation tion indelayed sufficient.!
21 20 13 17
11 10 6
6 3 5
with the saliva of a hydrophobic patient had | less cauterisation is effected immediately, or given the disease.
very soon after the injury, it is useless. The virus only acts on denuded surfaces. It In 115 fatal cases the methods of prevention is not certain whether it can be absorbed by were noted- i.e., whether the wound was caumucous membranes, but it may be presumed | terised sufficiently or not. possible. All persons are not equally liable to be affected, " for only ninety-four persons are known to have died out of one hundred 1852-1854
18 and fifty-three bitten, making the chances of
1855 escape as three to one nearly.”—(AITKEN.)
There would appear to be a few predisposing influepces, such as all circumstances which depress the mind or body.
The season of the year has also evidently an The influence of taxation on decreasing hy. influence ; in 181 cases occurring in France, drophobia does not, according to either our
own or the French returns, appear to have 66 were in June, July, and August. March, April, and May.
any influence. It is pretty well known that December, January, and February. under the new regulations in England few September, October, and November.
dogs now escape taxation, and yet hydrophobia
is not decreased. All muzzles, the wholesale Or, dividing the year into two parts, there destruction of healthy, well-cared-for dogs, were 110 cases in the hot seasons, and only 71 | &c., are injudicious measures which should be in the cold seasons.
condemned. Prerention. - The only method of prevention known is the removal of all causes likely Hygiène- Hygiène is the art of preservto dispose dogs to receive the disease. They ing health, of prolonging life, and of showing should be frequently washed, have good food, how the human species may be perpetuated opportunities for exercising their natural ap- and developed in the grentest perfection. It petites, and a strict watch kept by the police is naturally divided into private and public on vagrant dogs. The raids made from time-private, when it relates to the individual ; to time in London are required all over the public, when it deals with masses of men. country. All unowned dogs should be de- Public Hygiène.—The comprehensive aim stroyed, and every case of canine madness and scope of public hygiène cannot be better reported to the medical officers of health in expressed than in the words of Dr. Guy: “It the district, who would then have an opportu- has to do with persons of every rank, of both nity, through the sanitary authority, of taking sexes, of every age. It takes cognisance of the the necessary measures. In cases of actual places and houses in which they live ; of their bite, the person attacked should if possible occupation and modes of life; of the food they immediately suck the wound, and if assistance eat, the water they drivk, the air they breathe. is at hand, have it cauterised. No one should It follows the child to school; the labourer wait for the arrival of a medical man, but if | artisan into the field, the mine, the factory, the wound is small, either cut it out or apply the workshop; the sick man into the hospital ; a red-hot iron at once, or use both cauterisa- the pauper into the workhouse; the lunatic tion and excision, if, as in some cases, there to the asylum ; the thief to the prison. It is is no doubt of the madness of the dog. Let with the sailor in his ship, the soldier in his no foolish feeling of ill-directed mercy influ- barrack, and it accompanies the emigrant to ence the bystanders. Many a poor wretch his new home beyond the seas. To all these who has died one of the most awful of deaths it makes application of a knowledge remarkwould have been saved by a little instant de able for its amount, and the great variety of cision. In many cases, however, the person is sources whence it is derived. To physiology bit on the highroad, or in places where assist. and medicine it is indebted for what it knows ance cannot be had. If the part bitten is one of health and disease ; it levies large contribuof the extremities, after sucking well, a tight tions on chemistry, geology, and meteorology; string placed above the injury would appear it co-operates with the architect and engineer; to be likely to prevent absorption, at all events, its work commends itself to the moralist and until the sufferer could reach some place of divine.”—(Dr. Guy, Public Health, 1874.) help; but if in the face or buttock, trust There have been treatises on hygiène from must be placed, under such untoward circum- the very earliest times, which Hippocrates is stances, in encouraging the blood to flow, and supposed to have embodied in his works ; but washing the wound in the nearest rivulet or as a science it cannot be said to have existed puddle. It is greatly to be feared that un- , until a comparatively modern epoch, for it is a science that is based on the researches and dividual who has inherited the same features, discoveries of physiologists, and actual statis- passions, and predispositions. It is, however, tics. It would be impossible for the legislator impossible here to enlarge upon the subject of to make efficient laws, or the sanitary engineer hygiène generally, since every article in this to carry out his designs effectually, without book bears upon and is included in the subject. its aid.
In England the science may be said to have Hygiène, Military- This subject is too begun with the rude measures of prevention large to be fully treated bere. The reader is in the time of the plagues and murderous epi- referred to Dr. Parkes' “Hygiène ” as the best demics of past times; to have shown its power book in our language, and to the “Handbuch when Howard purified the jails, when Jenner der Militär - Gesundheitspflege," by Dr. W. conquered smallpox, and Sir George Baker Roth and Dr. R. Lex. Berlin, 1872. discovered the cause of Devonshire colic; and Military hygiène deals with all that bears to have definitely taken its position as a branch upon the health of the soldier-his food, his of study recognised by the State, when the clothing, his dwelling, his occupations, &c. first great and comprehensive measure, the All army surgeons and writers on military groundwork of sanitary legislation, was passed hygiène unite in stating, as the result of their
- viz., the Public Health Act of 1848. Its experience, that the age of the recruit as at prestudy and practical application have done, and sent fixed is too low, and propose twenty years are doing,'great things in our armies, navies, of age as the minimum. Indeed, the events factories, and workshops. The Legislature is of the late war have strengthened the opinion at last thoroughly alive to its importance, and which a former study of physiology and the its future may be looked to as of the brightest laws of growth naturally led to- viz., that the character. It is to be confidently expected recruit of eighteen is decidedly immature. that the present Public Health Act of 1875 The Army of the Loire, composed of Fery will be greatly amended, its faults and defi- young men, melted away before the trained ciencies corrected, that the prevention of dis. German soldier. Men of twenty-seven and ease will not be a theory but an accomplished thirty can stand fatigue, insufficient food, fact, and that the twin goddesses of Health and all the changes of climate far better than and Knowledge will at last bestow their un- young lads. Military service is, and always told blessings on the land.
will be, even in peace, somewhat arduous to Private Hygiène.—There are certain general the recruit. principles which are applicable to all men- Michel Levy, in “Traité d'Hygiène Pub that they should have sufficient pure air and lique,” writing ten years ago, says: " In water; that they should live in healthy time of peace, for drilling exercise, the houses, follow occupations which are not inju- soldier is called early in the summer mornrious, be cleanly in habits, be moderate and ings, and undergoes the fatigue of monotonous abstemious in all things, wear suitable cloth- attitudes, too long exposed to the sun, wind, ing, and eat a sufficiently plentiful and nour. and dust. These exercises often become ishing diet. And, again, there are certain prin- laborious, as they are more frequent and prociples applicable to the individual only which longed at the approach of reviews and general no universal rule can embrace. One man had inspections. Then come marches, parades, better abstain entirely from alcoholic liquors ; evolutions, sham combats, gymnastic exercises, another requires a slight stimulant. À cer- keeping guard, sentry duty, picquets, and tain food is so much poison to one, while patrols, which expose the soldier to the night others eat it with impunity. Thus, “Know air (according to Marshal Soult (1812, the thyself” should be written on every door; mean of the guard-nights for the French and a knowledge of that self is to be obtained, soldier is from two to five); and all this not by a nervous and apprehensive curiosity without mentioning a number of other labours regarding all that goes on within the body of -the frequent migrations of the garrison at the individual, but by an intelligent and sen- short intervals for troops of the line, adding sible observation of the causes, whether inter- the dangers of change of climate to the fatigue nal or external, physical or emotional, which of a march. In time of war the soldier achave injuriously affected him, and a knowledge complishes great distances, passes into distant of the past medical history of his ancestors. climates, embarks for voyages more or less If every man handed down to his children a long in ships nearly always crowded, executes chronicle of his ailments, with their causes, as forced marches, fights by day, bivouacs by corrected and revised by his physician, al-night, camps beneath tents or in barracks though in many cases, it is to be feared, it which imperfectly shelter him against the would be a humiliating and painful record, rain, cold, and heat, endures hunger and yet it would be of the greatest use to the in- thirst, and undergoes in ambulances and tem.
From Disease From all alone, i.e, exCauses.
Army Loss per 1000 porary hospitals the deleterious influences of
French (1823) overcrowding. What is the result of the sum French (Paixham, 1846)
19.9 of these influences? Disregarding the excep- French, mean of 7 years (1862–68) 100
9.55 tional mortality of battle, the deaths in the
French in Algeria (1846) army in men from twenty to thirty years are, French in Algeria (1862-66) .
14.98 according to M. Benoiston de Chateauneuf, Prussian (1846-63), excluding officers 9 49
Prussian (1867) 22.5 per 1000, but according to official docu
Russian, series of years ments still higher-e.g., in 1825 it was 27-2– Russian (1857-61)
Austrian while among the civil population the deaths
Piedmontese (1859) in men of the same age are 12.5 per 1000.
United States, before the war
188 These figures are the more disproportionate, Portuguese (1851-53)
9.5 because they are furnished by men chosen in the flower of their age ; they are not explained and compares the decrease of the mortality by an increase of mortality resulting from of all arms, as shown by the following duels, suicide, nostalgia, syphilis, and celi- figures :
Mortality per 1000 per Annumbacy, which are only secondary influences. There are two principal causes of the mor
cluding violent tality of the army the sudden changes of climate, and the fatigue of the daily exercises
Mean of 10 years (1861-70) 9:45
8.534 1 Mean of 10 years (1871)
7.8 -tel, of the manoeuvres, parades, frequent watches, &c.; that is to say, an expenditure Dr. Parkes ascribes the improvement to the of force goes on which exceeds the powers of great reforms in the army with which the the constitution and that of the alimentary name of Lord Herbert is associated, and reparation. Thus we see the powerful action observes, as a curious fact, that the mortality of the degree of labour--the mortality is less of the French and English armies is now for the sub-officer than for the soldier, and almost the same-viz., about 9:5 per 1000 with less for the officer than for the sub-officer. In the colours--slightly lower, however, in the England the mortality of the whole army is English army. The causes of mortality may estimated at 17 per 1000, and at 12 per 1000 be gathered from the following table, calcufor officers. In France it is 19 for the army, lated out by Dr. Parkes, from Appendix I. in 10-8 for officers, and 22:3 for soldiers only. Dr. Balfour's Report on the Army Medical The passing into different climates and war Department Blue-Books (1859-71) : augments the mortality. Thus the French
Causes of Mortality. troops in the Antilles lost 75 per 1000, in Algeria 70, and in Egypt 69. In the
Mortality Spanish war, disease alone carried off officers
mum per Deaths in Deaths in at the rate of 37, and soldiers at the rate of
Strength (1867-71), 119 per 1000.”
Since that time there has been, however, a general improvement in the health of the Phthisis and tubercular
2 649 30 26 33.806 soldier.
1.462 16.71 9.008 port (1871) gives the following instructive vessels...... table :
6.540 Violent deaths..
0.598 6 84 6.325 Diseases nervous ?
0.576 6.58 6.596 Logs per 1000 by
system.... Continued fevers,
5.685 Death and In- chiefly enteric..... validing. Suicides
3 030 liding. Bronchitis.
5.467 Delirium tremens... All other causes..
1.756 2007 22-533 Household Cavalry..
2.49 4.93 7.47 14.07 Cavalry of line..
7.03 Royal Artillery.
2 64 5.2)
8:26 Foot Guards..
Such a result is in the highest degree satis1.77 4.34 6:11 13:21 Infantry regiments.. 230 4.47 6.77 9:14 factory, and tends to produce a confidence in Depot Brigade, Royal 2.19
5.70 7.89 9.60 sanitary measures. We will now shortly conArtillery
sider the food, clothing, and habitations of the
soldier, Dr. Parkes, also speaking of the excessive The Food of the Soldier.-One of the great mortality in all countries of the soldier in difficulties in war is to provide proper food, the years 1846-53, as compared with the and in peace as well as in war to keep men civil population, gives the following sta- from taking too much alcohol. One of the tistics :
first principles in the diet of the soldier is that
5 Years. .
3.30 191 O'SO
he should have in actual field-work very little of wet. A few of the general regulations on the alcohol. General Grant prohibited absolutely subject of clothing may, in conclusion, be given. the use of spirits in camp by his soldiers and Thus, “ It should, above all, have the preservaofficers, and the result was a most marked im- tion of health as the first object; all intended provement in the health of both classes. In the for parade, and which adds useless weight to details given under ALCOHOL it will be seen either officers or men, should be suppressed ; that there is ample proof of its inutility as a that only should be retained in which he can diet, as a heat-giver, and as a supporter of mus- at any time march against the enemy."cular exertion. That it may be required to (Lessons on Hygiène and Surgery from the give a temporary fillip in cases of emergency, Franco-Prussian War, by C. A. GORDON, is quite possible—the pedestrian who walks a M.D., C.B.) hundred miles in a hundred consecutive hours, Next in importance to clothing and diet towards the end of the course urges on his comes the habitation of the soldier--in times flagging heart by a few mouthfuls of cham- of peace lodged in barracks (see BARRACKS), pagne.
in times of war in tents, huts, or wherever he For the general diets of soldiers, see Ra- can be located. TIONS. In time of war, the great thing is to “In the densely-peopled towns or villages so vary the food of the soldier as to keep off the which soldiers are so often constrained to ravages of the scurvy. The use of fresh vege- occupy, the soil beneath the houses and around tables, fruits, &c., is essential, but not always them is often reeking with corruption, sodden to be obtained in sufficient or regular sup with the damp products of decay; and these ply. Condensed foods, meat extracts, biscuits, not only become parents of fever and nurses and the German pea-sausage are required for of all sorts of pestilential maladies by pollutquick movements; but despite the inventive ing the air, but also, as we know, by poisoning ingenuity of preservers of meat, &c., no really the waters of wells or streams with the seeds good portable and compact food has yet been of dysentery, cholera, and typhoid fever, and brought forward suitable for the soldier in probably of every form of contagious malady." such cases.
-(Dr. W. A. Guy, Public Health.) The clothing of the soldier has excited much Overcrowding in war always prevails more attention; it is evident that it ought to vary or less. It is not alone too many in one tent, according to the climate in which he is em- or too many tents on a given spot of ground, ployed. It would be, indeed, well to copy but there is a novel form of overcrowding to a certain extent the costume of the nation introduced-namely, an overcrowding on the against wbich he is engaged-- to wear the san- march. Men are occasionally pressed and dal on the hot Eastern plains, to wrap himself condensed together, breathing the breath, up in sheepskins in Siberian snows, and, gene- perspiration, and dust unavoidably raised from rally speaking, to adapt his costume to what the bodies of their comrades and the roads the experience of the natives has shown to be they traverse ; hence it is well, when circumthe best. We still load some of our soldiers stances permit, to march in as open order as with heavy, hot helmets, cramp their necks possible. See BARRACKS, CAMPS, GYMNASIUM, with stiff stocks, and injure their chests with HOSPITALS, RATIONS, TENTS. tight garments.
“The clothing of the soldier should be Hygiène, Naval—The total force sert. selected sufficiently loose to permit the neck ing in her Majesty's ships amounts to about and chest to be at ease ; the trousers should 47,640 men. The merchant navy is manded not press too tightly over the stomach.” On with about 327,000 hands, and we may reckon entering upon active service, the clothing (according to the returns of the Emigration should be new, or nearly so, the shoes well Commissioners, 1872) that about 300,000 perfitting, and the soldier should have two fan- sons annually leave the shores of the United nel binders. The cavalry should, moreover, Kingdom. Add to these figures men em. use a suspensor, a precaution the advantage of ployed on coasting vessels, barges, and other which is apparent. Up till now the use of craft, and it will be seen that sanitary science waterproof material has not been authorised, afloat cannot deal with less than half a milalthough during the late war such officers and lion men, hence its importance. men of the various contingents as were able The Navy.-The ravages that all kinds of to provide themselves with it did so, and in diseases, and especially scurvy, formerly madle the regular army officers are recommended to in our navy is a matter of history. provide themselves with two flannel shirts Sanitary progress in this department has and a waterproof cloak. The greatcoat used been slow-c.9., lemon-juice was supplied to by the men is of sufficiently good material to merchant ships as early as 1617, but was be to some extent proof against the admission / actually not introduced into the navy until