MOST

OST readers are familiar with the horrors of the plague epidemics that overspread Europe during the middle ages. One of these outbreaks

is of special interest, as the one so graphically described by Defoe. The death-rate in these epidemics was very high. Indeed, it has been known to reach the fearful proportions of over ninety per cent. of those seized by the disease.

At Naples, in 1556, as many as 5,000 died daily; and there were not more than 50,000 left out of a population of 290,000. In 1627, the physician Alessandro describes the Milan epidemic. Under the government of Gonsalva de Cordova there was great poverty. Wars had devasted Lombardy for about a century, and the food of the people was reduced to rice and water. The rice bread became vile through adulterations. The poor became so numerous that the authorities lodged nearly 10,000 persons in a large lazareth. The season was very hot, and symptoms of the plague soon showed itself. The latest great epidemic of malignant plague was at Marseilles, in 1720. The disease has frequently, during the present century, visited different portions of Europe, the latest being the Astrakhan, 1878.

The fearful visitation known as the black death was similar to the present Bombay plague. The black death seems to have started in China after an earthquake and an inundation of vast

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regions of country. The waters subsided only to leave the moist, muddy land covered with all kinds of dead animals and decaying vegetation. The stench and famine gave rise to an epidemic of unusual malignancy. This spread westward, and finally overran Europe, destroying more than half the population in many districts.

This disease follows closely upon famine, and the neglect of sanitary laws. Large numbers of persons are huddled together in their filthy dwellings. They are compelled to gather their grain before it is ripe. It becomes musty and unhealthy. Fear adds to the ravages of the disease, the terrors of superstition. When the plague is in its earliest stage, timely intervention, so as to avoid overcrowding, filthy conditions of the people and to supply sufficient food, readily controls the disease. But when it has become widespread, and large numbers of the populace are panic-stricken, it is by no means an easy task to stay its progress. With vigourous sanitary and quarantine regulations there is not much danger to Europe or the western countries.

The population of the famine-stricken. regions in India is given at some 90,000,000. The average annual earnings of the native labourer is about seven shillings, or $1.75. It is easy to see what must be the fate of such people when overtaken both by famine and disease. The former produces misery

and apathy, while the plague feeds upon these creatures of famine.

The researches of Kitasato, Yersin, Lowson and Aoyama have shown that there is little doubt but that the disease is of germ or bacillary nature. These germs have been isolated from those ill with the plague, and cultures made. These cultures have produced the disease in animals, especially rats, which are amenable to the plague infection. This is certainly a great step in the scientific investigation of the disease, and will throw much light on its modes of spread.

Europeans and clean, well-fed natives are but little susceptible to the infection. In such cases, prolonged contact is often required to produce the disease; nurses who are handling the sick, and carrying in their arms afflicted children, sometimes escaping, or only becoming ill after long exposure. None of the Chinese students of medicine contracted the disease, although on constant duty for six weeks in the plague hospital.

There appear to be two forms of the disease now prevailing in the East. Dr. Cantlie, who has had great opportunities of observation, divides plague cases into two classes-one a very malignant form and the other a milder type. The malignant form is characterized by sudden invasion, chills, great prostration, glandular swellings, high fever, weak pulse, vomiting and many other severe symptoms. The milder form, or pestis minor, is not so severe and comes on more slowly. It may change into the malignant form. This is one of the causes of the spread of the disease. These mild, or ambulatory, cases may journey to great distance before they become ill. Generally speaking, the plague spreads slowly. It took ten months to spread from Hong Kong to Malao, a distance of thirty miles.

Dr. Yersin claims to have obtained an antitoxine that has yielded excellent

results. He first inoculated rats, and then horses; he then tried the antitoxine in a French mission station at Amoy. Some who were already comatose when the injections were given, recovered. He is now in India, where the Government intend trying the treatment in Bombay.

The duty of the British Government is a very delicate one to discharge. It is hard to prohibit the Meccan pilgrimage. This is a religious custom of a large number of the inhabitants of India. On the other hand, the western countries ought to be protected against so fearful a scourge as far as it is possible. While it seems impossible to interfere with the religious customs of the Mohammedans, it might be possible to establish a thorough police, sanitary and commissariat camp to look after the pilgrims, both by land and sea. All suspected cases could be taken charge of and isolated. charge of and isolated. The pilgrims could also be prevented from remaining over and visiting the bazaars. pilgrim should be allowed to embark without inspection; and all the pilgrim ships should be under the control of competent sanitary experts.

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With our present knowledge of sanitation and the spread of this disease, there need be little fear of its spread in the civilized world. The death-rate also is much lower among the Europeans. In the present Bombay epidemic it is about eighteen or twenty per cent. of those attacked.

There is in this affliction in India a wide field for governmental and private philanthropy. Some 40,000,000 are in a state of total want; whereas 50,000,000 more are in a state of insufficient and dear food, short of total deprivation. It is estimated to cost the Indian exchequer about $30,000,ooo to afford a mere subsistence to the starving millions. But there must still be much left for private benevolence. It is to be hoped that this will not be found wanting.

N August last I read a paper on "The Reorganization of the Militia Medical Service" before the members of the Canadian Medical Association at Montreal, and pointed out that Canada's Militia Reserve of 250,000 men would, if brought into actual warfare, be unprovided with a proper Medical Service. The system of medical organization in Canada is the old "Regimental System," that is, every regiment takes care of its own sick. This system was abolished in England in 1873, but in all its antiquated and discredited features is still retained in Canada.

From the report which I have seen, the Militia Department does not dispute the necessity for bearer companies nor medical organization, but it points out that I have not submitted a definite scheme, and, even if I had done so, it would be open to the authorities to explain that as there is at present no organization to enable Canada to place or maintain bodies of troops in the field, it would be premature to organize medical arrangements for them.

From this it would appear that without such organization the Canadian Militia is useless as a fighting machine, and as it is impossible that under present circumstances this state of things will be allowed to continue, I would suggest that the military and medical reorganization be carried out simultaneously, as the perfection of both would be required at the same time, and the medical certainly appeals very forcibly to public sentiment, whatever

may be thought of its importance from a military point of view.

"Medical, any more than military, organization cannot be evolved in a perfect state at short notice, when suddenly required." Witness the Northwest campaign!

I will now formulate broadly the lines upon which I consider reorganization should proceed-after due consideration of the various systems I have studied, and due consultation with those capable of giving advice in these matters, foremost amongst whom I will name our late P. M. O. in Halifax, Surgeon-General Major O'Dwyer, lately transferred to England on wellearned promotion, a practical expert on military organization.

I should take the present British Army Medical Corps system with some modifications adapted to our conditions, social, political and financial, as the basis of our Canadian Militia Medical service. As the details of constitution, condition, duties and expenses connected therewith, are to be found in the Queen's regulations, or could be obtained from the Imperial authorities, there need be no delay in deciding the question, once it is granted that reorganization is desirable.

Once the government of Canada, as represented by the Minister of Militia and Defence, acknowledges the need of reorganization of the Medical Department, it will be desirable to bring together a representative of the Canadian Militia acquainted with the strength,

organization and distribution of that force, and a medical officer of experience to discuss the matter.

They would have no difficulty in providing a scheme for consideration.

A medical officer should remain as at present, attached to each military unit.

On active service in the British Army a medical officer is attached to each military unit, but only temporarily ; and this is the only provision made for regimental surgical assistance-"first aid." It is a moot question with continental military authorities whether this simple regimental arrangement will continue to prevail. In time of peace in the British service there is no provision for a regimental medical service, though trivial cases of illness in barracks are seen to by a medical officer of the military station, and these treated if they are not considered sufficiently serious to be sent to hospital. One proviso should be an integral part of any scheme propounded-to meet the views of our military aspirants-that is, that the present medical officers should (if they desire it) be allowed to remain attached to their respective corps; but it is a question for consideration whether further medical appointments should not be to the department (when organized), and not to any special corps. The officers appointed might be gazetted to a general medical staff, and then be attached to special regiments when required.

In fact, I consider it desirable, in the case particularly of juniors coming into the service, that they should have an opportunity of studying regimental life, and of mixing freely with the officers and men with whom they will have to deal.

When two medical officers belong to the same corps, as we see now in certain of our brigades of artillery and battalions of infantry, the senior, by preference, might be transferred to the general staff-or, if he so desire it, to the reserve list of medical officers.

So far the Government need incur no expense; on the contrary, there would be a distinct saving of money,

as fewer officers in the active list would be required.

I would, however, propose in addition, that a general Canadian medical staff should be formed by volunteers.

They should be an independent body, under a medical head (director-general or surgeon-general) attached to the headquarters of the Canadian army, who would advise and deal with medical affairs, under the orders of the G.O.C. of the force. He should be a paid and permanent official holding office for five or seven years.

In the new staff or department, rank, titles, terms of service for promotion, etc., should be on the lines of the army medical staff, which, however, may be shortly modified by a new warrant. As I have already suggested, the present medical officers should remain with their regiments. It might further popularize the change if medical officers entering the general service were allowed in ordinary times to be attached to particular regiments, with the understanding that they would be liable to be detached for duty elsewhere wherever most needed in factshould the occasion arise. They would be dealt with by the Government, not as an integral part of the regiment, but as part of a special body temporarily attached. In time, this scheme should insure in the service officers of different grades.

The number and rank of medical officers would depend on the number of base field hospitals and bearer companies it was intended to establish. In time of active service the reserve list list of medical officers would be largely drawn upon. In time of peace the establishment need only be small.

With regard to bearer companies, which the department thinks desirable, -except in Halifax, where we desire one most and are prepared to aid in equipping it ourselves-I would propose that a bearer company and field hospital, with their stores and equipment, should be established at the headquarters of each brigade, presuming that for fighting purposes the Canadian militia will be divided into brigades with their

headquarters in some special locality Halifax, Montreal, Toronto, London, etc., amongst others; but this is a matter for future consideration. However, we hope a half bearer company may be granted to Halifax, where Surgeon-Major Lees-Hall, of the army medical staff, and Surgeon-Lieut. Carleton Jones, of the Garrison Artillery, have kindly volunteered their services as instructors. Both have had extensive experience in this line in connection with the Army Medical Staff Corps or the St. John's Ambulance Association, in which both are zealous work

ers.

Opportunity should be given militia medical officers for special study and training, and inducements might be held out to them as regards promotion, etc., for doing so. Courses of teaching and training might be established, either in connection with the present scheme of instruction or in connection with some of the leading schools of medicine throughout the country. A course of military surgery and hygiene in each medical school might be given yearly as a voluntary part of the course, attendance upon which might be made obligatory upon a surgeon asking appointment to the militia medical service. There should also be an examination in these subjects. In England, when medical officers of volunteer regiments pass the prescribed examination, an additional capitation grant is given their corps.

I do not propose to enter into the personnel or equipment for field hospitals and bearer companies; all information required is to be found in "The Regulations for Army Medical Service (1896)," "The Standing Orders for the

Medical Staff Corps," "The Field Army Establishment," "The Equipment Regulations," and the "Store Tables" of the Imperial army.

The rank and file of the general medical service for employment in bearer companies and field hospitals might be either specially enlisted or be obtained from the various regiments. In Halifax our C. O.'s of artillery and infantry have generously offered to provide the men required to form a half bearer company between them, ten from each corps.

For many reasons it would be preferable to obtain men-easily got in such districts where medical schools existby special voluntary enlistment into the hospital corps; but the latter system is cheaper and is that employed now in England amongst volunteer regiments, where men are obtained by transfer from regiments of the brigade to which the bearer company is attached.

In England no base or field hospitals are required by the volunteer forces. These establishments would be supplied in time of emergency by the army medical staff. In this country on active service we should require them, and require them, perhaps, when we least expect to be called upon; and where, I would like to ask you, will we find them?

I will only repeat again the words of my friend Surgeon-Major General O'Dwyer: "Medical any more than military organization cannot be evolved in a perfect state at short notice, when suddenly required.” Or is the next campaign to find us as unprepared as the last?

I. Tobin, D'y Surg. Genl.