of 2 /2
1380 etiological considerations before speaking of any assigned specific cause. Among the large stations with a strength of over 1000 we find that enteric fever caused a mortality of 15-23 -at Mhow, 14’20 at Meerut, 11’96 at Peshawar, and 8.01 at Lucknow per 1000 respectively, with smaller rates at other stations. The disease is very widely distributed rin India. The following table shows that the ratios for European troops are very unlike those for native troops and ,prisoners. ’These ratios are obtained from large numbers, they are con- sistent with one another, and the facts they set forth have been repeated from year to year over such a period of time .a,s to leave no doubt of their substantial correctness. In the case of native soldiers necropsies are rarely obtainable, but among prisoners the cause of death is verified in this way in nearly every fatal case. Moreover, the total mortality from fever in the European army is not that, but considerably less than that, of the native army, and the difference cannot, there- fore, be accounted for by a mere matter of diagnosis. The .question of the immunity, or apparent immunity, of natives of India has been long recognised and differently accounted for. This immunity, it may be added, was maintained by the native contingent during our campaigns in Egypt. It is but part of a bigger question, for the Arabs of Algeria and the .natives of other countries enjoy a similar immunity. Mr. Hankin states, as the result of his observations, that the natives of India appear to be naturally insusceptible to enteric fever. The three principal views that have been put forward, according to the Sanitary Commissioner’s report, are : (1) inherent racial immunity; (2) acquired ’toleration by exposure to, and a continuous but gradual imbibition of, the poison ; or (3) the protective influence of the disease acquired in early life, but of the possible truth of this assumption there is really no reliable evidence. The results of the experimental researches of Sanarelli are quoted to show that it is possible that the natives of India may not be really immune ; but that, by the constant imbibition of bacterial toxic fluids, they may have attained intestinal tolerance, and that, therefore, fatal fevers among them may often be in reality cases of enteric fever without intestinal lesions; but in that case we do not see how the nature of the -fever can be really determined ; it must remain a reasonable conjecture insusceptible of actual proof. As regards the general contributory causes and conditions to this disease what has been pretty well established amounts to this : that enteric fever is very prevalent among Europeans in tropical and sub-tropical climates ; that it has seasonal periods of manifestation, its maxima of prevalence coin- ’ciding with the maxima of temperature, the disease, for example, occurring earlier in the plains of India than in the hills ; and that as regards the age of its subjects youth and immaturity and recent arrival in those climates are powerful predisposing causes to attack. But when we have said all this there still remains an essential factor to be added without which the disease does not appear, and this is now practi- cally assumed by all bacteriologists to be the Eberth-Gaffky bacillus. The question narrows itself down, then, into the inquiry as to the life-history of this parasite and how it gains an entrance into the human system. Mr. Hankin has by his researches thrown considerable light on the origin of some mysterious cases and outbreaks in India. Some bacteriologists hold that the bacillus is constantly present in the stools of enteric fever patients after the second week of the disease, and that it maintains its identity and can also be recognised outside the body-in water, for example, con- taminated by animal dejecta. In a very careful review of the recent literature on this subject the Sanitary Commis- sioner shows, however, that considerable difference of opinion still exists among bacteriological authorities and that there are many points which yet require to be cleared up before we can be said to have exhausted our knowledge of the sub- ject and of the causation of typhoid fever. Professor Wright of Netley and Surgeon-Major Semple, for example, have pointed out in the pages of THE LANCET2 that the typhoid fever bacillus was detectecl in the urine of enteric fever patients in six out of seven cases examined, and they accept the conclusions of Sanarelli and Wathelet that enteric fever is a blood infection and that the bacillus of Eberth is rare in the stools. Of course, if these observations be sub- sequently confirmed this source of infection will have to be recognised and guarded against. The water theory of enteric fever, a,s of cholera, has the largest amount of evidence in its favour ; but in the meantime the Sanitary Commissioner contends that it may not be the whole truth and that the lesson to be learned is that we cannot be too careful of attention to cleanliness in all things and of guarding every avenue of approach, not only from enteric fever but from any filth disease. The hygienic condition of our cantonments may be excellent, but that of the native bazaars and villages and of every place, indeed, accessible to the soldier outside cantonment limits may be, and really is, quite the reverse. The difficulty that has to be accounted for, however, is the relatively small amount of enteric fever among the children and women, who consume both water and milk, and the large amount of it among officers, who do not usually consume these or the beverages and products of the native bazaars of which they are not usually frequenters as are the men. With the number of skilled inquirers available in India, supplemented by the researches of bac- teriologists, we may fairly anticipate some fresh additions to our knowledge of the nature and causes of this fever which annually gives rise to such a great drain on the young man- hood of the European force in that country. With regard to cholera we may say that in Section 6 of the Report there is a very full and excellent analysis of the views regarding causation of cholera current at the time of Pro- fessor Koch’s memorable visit to India and subsequently to that date. We may commend this to the perusal of those of our readers who are interested in the study and desirous of obtaining a good summary of the recent advances which have been made in the etiology of cholera. THE ASSOCIATION OF FELLOWS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. A MEETING of the Committee of the Association of Fellows of the Royal College of Surgeons of England was held on May 6th, at 25, Grosvenor-street. Mr. Timothy Holmes, Vice-President, occupied the chair in the unavoid- able absence of Mr. George Pollock, President. The minutes of the last meeting were read and confirmed. Mr. H. Percy Dunn, honorary secretary, reported that, in answer to the resolution forwarded to the President of the College in reference to the admission of reporters to the meetings of the Fellows he had received a reply to the effect that the Council had already decided to admit reporters to these meetings. The subject of the direct representation of Members of the College on the Council then came up for consideration in connexion with the adverse resolution adopted at the March meeting of the Council. It was ultimately agreed that the following resolution should be forwarded to the President of the College :- The Committee of the Association of Fellows of the Royal College of Surgeons of England regrets that the Council of the College should not have seen its way to adopt the resolution passed by a large majority at the meeting of the Fellows on Jan. 2nd, and trusts that the opinion of the Fellows generally on this important subject may be ascer- tained as agreed upon at the meeting of the Council of the College held on Feb. llth." The Honorary Secretary reported that he had received a communication on the foregoing subject from Mr. Dickinson, honorary secretary of the Society of Members, and it was agreed to acknowledge the letter and to state that the Com- mittee did not see its way at the present moment to suggest any course of action. The vacancies likely to arise upon the Council in July next were then considered. Mr. Norton stated that he did not intend to come forward as a candidate this year. Several 2 THE LANCET, July 27th, 1895.

THE ASSOCIATION OF FELLOWS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

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1380

etiological considerations before speaking of any assignedspecific cause. Among the large stations with a strength ofover 1000 we find that enteric fever caused a mortality of15-23 -at Mhow, 14’20 at Meerut, 11’96 at Peshawar, and8.01 at Lucknow per 1000 respectively, with smaller ratesat other stations. The disease is very widely distributedrin India. The following table shows that the ratios for

European troops are very unlike those for native troops and,prisoners.

’These ratios are obtained from large numbers, they are con-sistent with one another, and the facts they set forth havebeen repeated from year to year over such a period of time.a,s to leave no doubt of their substantial correctness. In thecase of native soldiers necropsies are rarely obtainable, butamong prisoners the cause of death is verified in this way in

nearly every fatal case. Moreover, the total mortality fromfever in the European army is not that, but considerably lessthan that, of the native army, and the difference cannot, there-fore, be accounted for by a mere matter of diagnosis. The

.question of the immunity, or apparent immunity, of natives ofIndia has been long recognised and differently accounted for.This immunity, it may be added, was maintained by thenative contingent during our campaigns in Egypt. It is but

part of a bigger question, for the Arabs of Algeria and the.natives of other countries enjoy a similar immunity. Mr.Hankin states, as the result of his observations, that thenatives of India appear to be naturally insusceptible toenteric fever. The three principal views that have beenput forward, according to the Sanitary Commissioner’s

report, are : (1) inherent racial immunity; (2) acquired’toleration by exposure to, and a continuous but gradualimbibition of, the poison ; or (3) the protective influence ofthe disease acquired in early life, but of the possible truth ofthis assumption there is really no reliable evidence. Theresults of the experimental researches of Sanarelli are quotedto show that it is possible that the natives of India may notbe really immune ; but that, by the constant imbibition ofbacterial toxic fluids, they may have attained intestinal

tolerance, and that, therefore, fatal fevers among them mayoften be in reality cases of enteric fever without intestinallesions; but in that case we do not see how the nature of the-fever can be really determined ; it must remain a reasonableconjecture insusceptible of actual proof.As regards the general contributory causes and conditions

to this disease what has been pretty well established amountsto this : that enteric fever is very prevalent among Europeansin tropical and sub-tropical climates ; that it has seasonalperiods of manifestation, its maxima of prevalence coin-

’ciding with the maxima of temperature, the disease, for

example, occurring earlier in the plains of India than in thehills ; and that as regards the age of its subjects youth andimmaturity and recent arrival in those climates are powerfulpredisposing causes to attack. But when we have said allthis there still remains an essential factor to be added withoutwhich the disease does not appear, and this is now practi-cally assumed by all bacteriologists to be the Eberth-Gaffkybacillus. The question narrows itself down, then, into theinquiry as to the life-history of this parasite and how itgains an entrance into the human system. Mr. Hankin has

by his researches thrown considerable light on the originof some mysterious cases and outbreaks in India. Some

bacteriologists hold that the bacillus is constantly present inthe stools of enteric fever patients after the second week ofthe disease, and that it maintains its identity and can alsobe recognised outside the body-in water, for example, con-taminated by animal dejecta. In a very careful review ofthe recent literature on this subject the Sanitary Commis-sioner shows, however, that considerable difference of opinionstill exists among bacteriological authorities and that thereare many points which yet require to be cleared up beforewe can be said to have exhausted our knowledge of the sub-ject and of the causation of typhoid fever. Professor Wrightof Netley and Surgeon-Major Semple, for example, have

pointed out in the pages of THE LANCET2 that the typhoidfever bacillus was detectecl in the urine of enteric feverpatients in six out of seven cases examined, and they acceptthe conclusions of Sanarelli and Wathelet that enteric feveris a blood infection and that the bacillus of Eberth is rarein the stools. Of course, if these observations be sub-

sequently confirmed this source of infection will have tobe recognised and guarded against. The water theory ofenteric fever, a,s of cholera, has the largest amount ofevidence in its favour ; but in the meantime the SanitaryCommissioner contends that it may not be the whole truth andthat the lesson to be learned is that we cannot be too carefulof attention to cleanliness in all things and of guarding everyavenue of approach, not only from enteric fever but from anyfilth disease. The hygienic condition of our cantonmentsmay be excellent, but that of the native bazaars and villagesand of every place, indeed, accessible to the soldier outsidecantonment limits may be, and really is, quite the reverse.The difficulty that has to be accounted for, however, is therelatively small amount of enteric fever among the childrenand women, who consume both water and milk, andthe large amount of it among officers, who do not

usually consume these or the beverages and products ofthe native bazaars of which they are not usually frequentersas are the men. With the number of skilled inquirersavailable in India, supplemented by the researches of bac-teriologists, we may fairly anticipate some fresh additions toour knowledge of the nature and causes of this fever whichannually gives rise to such a great drain on the young man-hood of the European force in that country.With regard to cholera we may say that in Section 6 of the

Report there is a very full and excellent analysis of the viewsregarding causation of cholera current at the time of Pro-fessor Koch’s memorable visit to India and subsequently tothat date. We may commend this to the perusal of thoseof our readers who are interested in the study and desirousof obtaining a good summary of the recent advances whichhave been made in the etiology of cholera.

THE ASSOCIATION OF FELLOWS OF THEROYAL COLLEGE OF SURGEONS

OF ENGLAND.

A MEETING of the Committee of the Association ofFellows of the Royal College of Surgeons of England washeld on May 6th, at 25, Grosvenor-street. Mr. TimothyHolmes, Vice-President, occupied the chair in the unavoid-able absence of Mr. George Pollock, President.The minutes of the last meeting were read and confirmed.

Mr. H. Percy Dunn, honorary secretary, reported that, inanswer to the resolution forwarded to the President of the

College in reference to the admission of reporters to themeetings of the Fellows he had received a reply to the effectthat the Council had already decided to admit reporters tothese meetings.The subject of the direct representation of Members of the

College on the Council then came up for consideration inconnexion with the adverse resolution adopted at the Marchmeeting of the Council. It was ultimately agreed that thefollowing resolution should be forwarded to the President ofthe College :-The Committee of the Association of Fellows of the

Royal College of Surgeons of England regrets that theCouncil of the College should not have seen its way to adoptthe resolution passed by a large majority at the meeting ofthe Fellows on Jan. 2nd, and trusts that the opinion of theFellows generally on this important subject may be ascer-tained as agreed upon at the meeting of the Council of theCollege held on Feb. llth."The Honorary Secretary reported that he had received a

communication on the foregoing subject from Mr. Dickinson,honorary secretary of the Society of Members, and it wasagreed to acknowledge the letter and to state that the Com-mittee did not see its way at the present moment to suggestany course of action.The vacancies likely to arise upon the Council in July next

were then considered. Mr. Norton stated that he did notintend to come forward as a candidate this year. Several

2 THE LANCET, July 27th, 1895.

1381

other Fellows were mentioned as probable candidates, but itwas agreed that the further consideration of the subjectshould be deferred till the next meeting of the Committeeon May 18th.This concluded the business of the meeting and the

Committee adjourned.

THE HISTORY, METHODS, HINDRANCES,EXPENDITURE, AND POLICY OF THE

CIVIL RIGHTS DEFENCECOMMITTEE.

(Concluded from p. 1306.)

EXPENDITURE.

THE Civil Rights Defence Committee, although warmlysupported in many quarters by the- medical profession, hasnever at any time been in receipt of funds that would enablethe committee to take the first step of application for specialleave to appeal to the Judicial Committee of the PrivyCouncil and has been compelled either to remain inactive orto expend the funds already’received in renewed appeals,each of which has produced an insufficient return. Of theamounts received .E84 were paid in preliminary legal expensesincurred in Trinidad and in this country and in the expensesof preparing the petitions for special leave to appeal, whichare ready to be lodged. The expenses of the office, clericalassistance, postage, canvassing for signatures to memorials,printing, and other essential matters extending over a periodof two years have been considerable and have made largeinroads into the funds subscribed. There is an account stilldue to the printers, and the operations of the com-

mittee are hampered by the want of adequate funds. Greateconomy has been practised in all the expenditure incurredby the committee, letters and circulars wherever possiblebeing delivered by hand and as strict a supervision as possiblebeing exercised over printing and clerical expenses. Mr.Anderson’s work for the committee has been entirelygratuitous, and advantageous arrangements were made withMr. H. Anderson, solicitor of the committee, for officeaccommodation and clerical aid in his office at 5, Mitre-court, Temple, where the committee sits de die in dieva,and from which all communications and reports are datedand issued. An Ellam’s duplicator was purchased forthree guineas enabling the committee to produce manycirculars very cheaply. Still, it has been impossiblewithout arresting the progress of the movement to stintthe supply of reports, memorials, and other publica-tions, which are essential for the creation of a publicopinion favourable to the views of the committee. Itis only now that the past outlay in printing is beginningto bear fruit in publicity, it is only by such publicity as thatwhich is now being striven for and obtained that interest canbe aroused, and it is only when interest is fully aroused thatthe general and large subscriptions necessary for the success-ful prosecution of the various appeals promoted by the- committee can be received.

POLICY.It was explained in the article which appeared in THE

LANCET on Feb. 29th on the Objects and Aims of the CivilRights Defence Committee " that-

1. The primary purpose for which the Civil Rights Defence’Committee was formed was to assist Mr. R. B. Anderson toappeal to the Privy Council for the reversal of the illegal Ijudgments and orders of Colonial judges which remain inforce and control his personal liberty, preventing him fromreturning to Tobago to carry on his practice, collect hisdebts, dispose of his property, or in any way satisfactorilyto settle his affairs-judgments and orders which have been i

emphatically condemned by Royal Commissioners as

" judicial persecution " and " a public danger."2. The affirmation by the Court of Appeal of Lord

Coleridge’s decision against Mr. Anderson when a Middlesexspecial jury had found a verdict in his favour for E500damages in the action Anderson v. Gorrie and others "

has rendered it necessary for the Civil Rights Defence Com-mittee to appeal to the House of Lords to set aside this.judgment. The decision renders nugatory not only thestipulations in Magna Charta and the Bill of Rights for the

personal liberty of the subject, but the professional rightsof medical men conferred by their diplomas whereby theyhave hitherto been able to pursue their calling in peace, toenjoy the right of recovering their fees for medical attend-ance in courts of law and to determine for themselveswhether they shall attend or not attend, continue or dis-continue, attendance in any particular case. The enjoymentof these rights is now made subject to the will and pleasureof Her Majesty’s judges, and for any violation of them,however wilful and malicious, committed by a judge no

remedy at law will exist.3. In the event of the decision of the House of Lords

upholding the decision of the Court of Appeal the CivilRights Defence Committee must resort to Parliament for theamendment of the law and for compensation to Mr. Ander-son for the unprecedented wrongs he has suffered. A peti-tion to Parliament has been prepared and, if necessary,will be presented in due course by Lord Stamford at the barof the House.

4. With the view of laying the foundation of a favourableopinion in Parliament and to enlist the sympathies and aidof individual members the Civil Rights Defence Committeearranged for a conference, which was held in the House ofCommons on Aug. 29th, 1895. The result was so encourag-ing that memorials to Members of Parliament have beendrawn up for signature by constituents, and are being widelycirculated through the agency of friends and with the

cooperation of the British Medical Association and itsbranches.

5. In order to leave no avenue of justice unexploredMr. R. B. Anderson submitted to the committee a petition tothe Queen which he had drawn up, and after very full dis-cussion the committee decided not to fetter his discretionin the matter. Accordingly the petition was sent in and ananswer has been received which evades the question reallyat issue, and which will necessitate further steps.

6. Various public bodies have been approached for thepurpose of securing their cooperation and representation onthe committee. The bodies at present represented are theBritish and West Indian Alliance, the West Indian Union,the Royal College of Surgeons of England, the British MedicalAssociation, the Association of Fellows of the Royal Collegeof Surgeons of England, the West London Divisions of theLondon and Counties Medical Protection Society, and quiterecently the Medical Defence Union. The Royal College ofPhysicians of London, the Apothecaries’ Society, theUniversity of London, and the General Medical Council wereapplied to, but have not responded to the appeal. The CivilRights Defence Committee still entertains a hope that whenthese bodies come to understand how the decision of theCourt of Appeal affects the professional rights which theyguarantee every day, a different result will be obtained.

7. Efforts have been made and will continue to be madeto enlist the more active support of the public press. Tothe medical journals and to some of the weekly and dailypapers, to provincial and colonial organs of opinion, and tosome of the reviews the committee has been greatly in-debted for the insertion of articles and appeals. Quiterecently the .Echo has inserted articles and opened itscolumns to a correspondence upon Mr. Anderson’s case. TheIVestminster Review has dealt with the doctrine of judicialimmunity in an exhaustive manner, and in addition to

previous articles we have published in the columns of THELANCET the present series of articles which have, we trust,fully elucidated the whole scope and plan of operations of theCivil Rights Defence Committee. The circle of interest is

undoubtedly widening and a full awakening of the public con-science is anticipated at no very distant date. In evidence ofthis it may be mentioned that only on Friday, May 8th, theHardwicke Debating Society, which is the chief barristers’

debating society and represents the four Inns of Court,engaged in a formal debate on the following resolution,moved by Mr. Copeland and seconded by Mr. Candy, Q.C."That the modern interpretation of the law of judicial

immunity is mischievous and dangerous, is an encroachmenton the liberty of the subject, and ought to be revised." Inthe course of his speech Mr. Candy said that no more suitablecase than that of Anderson v. Gorrie could be found forappeal to the House of Lords, and that it is one whichjustified an appeal to the public for funds. The wholedebate turned on Mr. Anderson’s case, and the resolution wascarried with only two dissentients.

8. Other measures to arouse public sympathy and interesthave been undertaken both by Mr. Anderson and the Civil