and thoroughly inspected, but no insanitary condition could be detected; it Egypt. was, however, vacated. On the occurrence of every case of enteric fever very thorough investigation of the barrack room, the locality, and its surroundings was undertaken with a view to discover a possible cause, and remove any insanitary condition. With regard to seasonal prevalence, it is observed during the early months of the year there was very little incidence of the disease, but its greatest prevalence, and nearly all its mortality, was in the hot months from May to September, after which it declined somewhat. As to the age of the men attacked 6 were under 20 years of age, 62 between 20 and 25 years, 18 between 25 and 30 years, and 3 over that age; of the latter, one case occurred in a man over 40 years of age. With regard to length of service in the country it is found that no less than 73 cases occurred in men in their first year; of the remainder 6 were in their second year, 5 in their third year, and 5 had over three years' service in the country. At Alexandria the admission and mortality rates were greatly reduced as compared with those recorded in the preceding year. The garrison enjoyed perfect immunity from the disease until the end of October, when it re-appeared. The medical officer in charge notes that nearly half the admissions and fully half the deaths occurred amongst the youths composing the drafts received by the 1st Battalion, East Yorkshire Regiment. Of the 15 cases two were under 20 years of age, and 11 between 20 and 25 years, and two over that age. The cases were mostly severe, and had a tendency to recrudescence or relapse. All the fatal cases exhibited marked disease or ulceration of the glandular apparatus of the small intestines.

Simple Continued Fevers caused 521 admissions, the admission rate being 102.9 per 1,000, a decline, however, of 170 from the corresponding rate in the previous year, and of 406 from the average rate of the prceeding seven years. The constantly sick rate from these fevers was 4.19 per 1,000, lower by 1:38 than in 1892, and by 1'47 than the average rate.

Typhus Fever.-One case occurred at Cairo in a man quartered at Abbassiyeh. It proved fatal.

Dysentery was the cause of 90 admissions and 8 deaths. The ratio of admissions was 177 per 1,000, an increase of 29 on the previous year's rate, but considerably below the average rate for the preceding seven years.

Malarial Fevers.-152 cases are returned, being in the ratio of 300 per 1,000, an increase of 5.5 on the corresponding rate in 1892, and of 160 on the septennial average rate. All the admissions were due to ague, and as many as 143 occurred at Cairo, almost exclusively among men of the 7th Dragoon Guards from India, and the detachment of South Wales Borderers from Aden. At Alexandria 9 cases were returned, one fatal case occurred out of hospital.

Septic Diseases. -Under this head 6 cases of erysipelas are shown against 2 in the previous year. All occurred at Cairo.

Venereal Diseases were, as usual, very prevalent, and, including simple venereal ulcer, caused nearly a third of the total number of admissions. The admissions for primary syphilis were 287 in number, equal to 56·6 per 1,000, an increase on the previous year's rate of 141, but below the average rate by 8.8. Including simple venereal ulcers, which caused 777 admissions, and for which 50.78 men were constantly sick, the admission rate for primary venereal sores was 209.8 per 1,000, an increase of 86-7 on the previous year's rate, and above the average rate. Secondary syphilis caused 232 admissions, or 457 per 1,000, which differs only by an increase of 15 from the similar ratio in the previous year, but is above the seven years' average rate by 14.0. The admissions for gonorrhea numbered 775, equal to a ratio of 152.8 per 1,000, an increase of 42.5 on the rate in 1892, and of one-third on the average rate. The total admission rate for all forms of venereal diseases amounted to 408.3 per 1,000, which is in excess of that in the previous year by 130 7 per 1,000, and also above the septennial average rate. The amount of constant inefficiency from these diseases was equal to 31-73 per 1,000, greater than in 1892 by 8:32, and above the average.

Parasitic Diseases.-22 admissions are returned, all but one from Cairo;

they were mostly on account of tænia solium.

Alcoholism caused 15 admissions, of which 5 were cases of delirium tremens, but no death occurred.

Egypt.

Scurvy.-One case was treated in the station hospital at Cairo.

Debility was the cause of 98 admissions, mostly the result of febrile attacks; the ratio, 19.3 per 1,000, differs very little from that in the preceding year, but is a good deal below the average rate.

Rheumatism.-212 admissions are returned, 22 being cases of rheumatic fever, one of which proved fatal. The admission ratio, 41.8 per 1,000, is higher than that in the preceding year by 19-2, and also considerably above the average rate for seven years.

Tubercular Diseases caused 11 admissions and 3 deaths (one being that of an invalid after leaving the Command), as compared with 2 admissions and no deaths in the preceding year. All the cases occurred at Cairo, and were due

to tubercular disease of the lungs.

Other Diseases of this group were the cause of 43 admissions or 8.5 per 1,000. They comprised 33 cases of non-malignant new growth, 5 of scrofula, 3 of anæmia, 1 of purpura, and 1 of diabetes.

LOCAL DISEASES.-Diseases of the Nervous System caused 106 admissions, the ratio being 20-8 per 1,000, an increase of 76 on the last year's rate, and considerably above the average rate for the previous seven years. Among the cases treated there were 57 of neuralgia, 16 of vertigo, 9 of epilepsy, and 13 of mental affections. There were 3 deaths, 2 from inflammation of the cerebral membranes, and one from mania.

Diseases of the Eye.-372 admissions are returned, equal to a ratio of 73.3 per 1,000, being above the previous year's rate by 349 per 1,000, and also higher than the corresponding average rate. The chief cause of admission was conjunctivitis, very nearly two-thirds of the cases being due to this affection; they were mostly mild and readily amenable to treatment.

Diseases of other Organs of Special Senses gave an admission rate of 21.1 per 1,000, as compared with 15.5 in the preceding year, and 141 the average rate. All the admissions were for aural disease, principally cases of inflammation of the external meatus.

Diseases of the Circulatory System caused only 23 admissions, but 2 deaths. The admission ratio, 4.5 per 1,000, is less by 5-5 than in 1992, and by 100 than the average rate. The cases comprised 11 of palpitation, 8 of valve disease of the heart, one fatal, 3 of affections of the veins, and one aneurysın of the abdominal aorta, fatal.

Diseases of the Respiratory System were at the rate of 88.3 per 1,000, above the last year's rate by 396, and above the average rate of seven years by 551. The principal causes of admissions were, bronchitic affections 280 cases, pneumonia 118, and pleurisy 37. There were 13 deaths, 12 from pneumonia, and one from pneunionic phthisis. The majority of the cases of pneumonia were severe in type.

Diseases of the Digestive System caused 959 admissions and 7 deaths. The admission ratio, 1890 per 1,000, exceeds that of the previous year by 494, and is above the seven years' average by 36·6. Affections of the mouth and throat caused 311 admissions, dyspepsia 179, and diarrhoea 171. The fatal cases were, 2 from hepatic abscess, and 1 from hepatitis, internal intestinal strangulation, intestinal ulceration, gastritis, and sloughing sore throat respectively.

Diseases of the Lymphatic and Glandular System gave an admission rate of 16.2 per 1,000, very nearly double that in the preceding year, but below the average rate of seven years. The cases were of ordinary character.

Diseases of the Urinary System.-9 admissions are returned against 7 in the preceding year. The admissions included 2 for Bright's disease.

Diseases of the Generative System caused an admission rate of 178.4 per 1,000, an increase of 76.5 on the last year's rate, and still more in excess of the average rate. More than three-fourths of the admissions were due to simple venereal ulcers, and of the remainder the principal causes were balanitis, orchitis, and urethral stricture.

Diseases of the Organs of Locomotion were the cause of 54 admissions, or 10.2 per 1,000, less by 53 than in 1892, but above the average rate. Synovitis was the most frequent disease, 33 admissions being returned.

Diseases of the Connective Tissue gave an admission rate of 38.4 per 1,000, more than double that of the previous year and above the average. The cases, however, were of ordinary character."

Diseases of the Skin.-The number of admissions 320, gave a ratio of 63·1 Egypt. per 1,000, an increase of 96 on the last year's rate, and of 71 on the average rate. The chief causes of admission were boils, eczema, ulcers, and scabies.

Poisons. This order is represented by 10 admissions from poisoned wounds from stinging insects.

Injuries.-There were 557 admissions from injuries, and 3 deaths. The admission ratio, 109.8 per 1,000, is in excess of that of the previous year by 26.3, and above the average by 16.5. There were 6 cases of general injury, namely, 2 of heat stroke, fatal, and 4 of multiple injury, two of which were the result of accidents on the railway, one at Alexandria, in which the left leg was so damaged by crushing that amputation was necessary, but the man recovered and was eventually invalided: the other at Cairo necessitated ainputation of both legs, and after some time further amputation was required; the man then did well, as far as the operation was concerned, but tubercle of lung supervened, which proved fatal. One death by drowning took place at Alexandria in the Mahmoudieh Canal, though whether by accident or through foul play has not yet been arrived at. Among local injuries the chief necessitating admission were contusions, wounds, and sprains. There were also 26 cases of fracture, and 4 of dislocation.

Invaliding. The number of men invalided during the year was 72, being in the ratio of 14:19 per 1,000 of strength, which is lower by 9.67 than the corresponding rate in the previous year, and considerably below the similar average rate for the preceding ten years. In the arms of the service the highest invaliding rate was 27.52 per 1,000 in the engineers, the next 24:57 in the cavalry, followed by 17.98 in the staff and departments, 12.72 in the infantry, and 11 15 in the artillery. Compared with last year's results, the rates in the cavalry and departmental corps have increased, but the remainder decreased. Of individual corps with fair annual average strength, the Company of Engineers gave the highest invaliding rate, 27.52 per 1,000; next the 7th Dragoon Guards, 27-10; followed by the 10th Company, Eastern Division, Royal Artillery with 23:08. Taking the ages of men invalided, it is found from a table on a previous page that the highest ratio per 1,000 occurred among men between 20 and 25 years (excluding a very high rate among men over 40 years, dependent on the invaliding of two men out of a very small annual average strength). The invaliding among men between 30 and 35 years, and 35 and 40 years of age come next, 10-66 and 11:36 respectively, followed by that among men under 20 years and between 25 and 30 years of age, 9'69 and 9:42 respectively. In the previous year after the invaliding among men under 20 years of age, which was somewhat high, there was an increase during the remaining periods of age, the highest rate, except that of men over 40 years of age, whose numerical strength was very small, being among men between 30 and 35 years of age. All the ratios at the different ages compare favourably in the year under notice with the corresponding ones in the preceding year. With regard to invaliding according to length of service in the country, it will be seen that the ratios did not vary very greatly. They decreased somewhat from that among men in their first year of service in the country to that among men in their third year; the rate increased among men in their fourth year, and again fell in those among men in their fifth year and over five years' service in the country. There is no similarity in the sequence of these invaliding ratios as compared with those in the similar return for the preceding year, which shows high rates among men in their second and third years of service in the country, and low ones after that period. The principal causes of invaliding were diseases of the nervous system 14 cases, equal to 276 per 1,000, which, however, is a lower ratio than that in the previous year by 79; among the cases were 8 of mental disease. Diseases of the digestive system caused the invaliding of 8 men (including 5 for hernia), or 1:58 per 1,000, a decline of 35 from the last year's rate; debility was next in order, 7 cases, chiefly after attacks of fever, or 1.38 per 1,000, a decline of 217; followed by diseases of the generative system, urethral stricture, varicocele, and orchitis, 6 cases, or 1·18 per 1,000, an increase of 54; and enteric fever, dysentery, tubercle of lung, &c., 3 cases each.

The number of men finally discharged the service by invaliding was 49, equal to a ratio of 9:66 per 1,000, almost the same as in the previous year,

O 83200.

L

Egypt.

but below the decennial average by 15-20 per 1,000. The disabilities necessitating discharge were principally debility, 79 per 1,000, nervous disorders 1.58 (including 59 for mental disease), diseases of organs of special senses 99, diseases of the circulatory system 1:38, digestive disorders I-18, diseases of the organs of locomotion 79, and febrile diseases, generative diseases, and injuries 59 respectively.

Officers.-The average strength was 168, and there were 173 cases of illness recorded and 2 deaths. The ratio of prevalence of sickness was therefore 1029-8, and that of mortality 11.90 per 1,000, the former showing an increase of 54:6, but the latter a decrease. Among the cases treated were 3 of scarlet fever, 57 of continued fevers, including 5 of enteric fever, of which 2 proved fatal, 5 of dysentery, 8 of malarial fever, 9 of respiratory affections, 30 of affections of the digestive system, and 20 of injuries, including 2 of concussion of the brain. Six officers were invalided during the year, equal to a ratio of 35.71 per 1,000. The causes of invaliding were enteric fever 2 cases, and debility, pneumonia, diarrhoea, and dislocation, 1 case respectively.

Women. The average strength was 225, and there were 520 cases of illness, and 5 deaths. The ratio of prevalence of sickness was therefore 2311·1 per 1,000, an increase of 5157 on the corresponding rate in the previous year. The death rate, 22-22 per 1,000, also shows a considerable increase, only one death having occurred in 1892. The principal causes of sickness were continued fevers 66 cases, including 3 of enteric fever (2 of which died); debility 76 cases, ophthalmic affections 104, nearly all conjunctivitis, diseases of the respiratory system 33, including 1 fatal of pneumonia, and diseases of the digestive system 129, including two of abscess of the liver, one of which was fatal. In addition to the deaths above alluded to there was one from tubercle of lung.

Children.-The average strength was 365. The number of cases of illness was 994, equal to a ratio of 27233 per 1,000, and of deaths 33, equal to 90:41 per 1,000. Compared with the corresponding ratios for the previous year, sickness was increased by 257.5, and mortality by 22:03 per 1,000. The principal causes of sickness among children were conjunctivitis 394 admissions, diarrhoea 129, bronchial affections 99, and simple continued fever 63 cases. Among the remainder may be mentioned 13 cases of measles, 4 of scarlet fever, 3 of diphtheria, and 1 of enteric fever. The deaths were 13 from diarrhoea, 5 from debility, 2 each from measles, diphtheria, convulsions, and teething, and 1 from simple continued fever, congenital syphilis, malformation, bronchitis, enteritis, nephritis, and oedema of the glottis respectively.

SANITARY NOTES.-The Principal Medical Officer, Surgeon Colonel W. Nash, M.D., states that the general health of the troops in the Command during the past year was not very satisfactory, and compares unfavourabiy with that of the previous year. There was a slight decrease in the death rate, but the sick rates are increased, more especially at Cairo. The principal cause of this higher rate is considered to be due to the fact that the greater part of the troops had only arrived in the country during the year. Recent arrival and want of acclimatization, no doubt, increase the liability to certain febrile and other diseases, as also the fact that men new to the country are unsettled in their habits, and are exposed to many temptations, which lead to an increase of some diseases quite unconnected with climatic influence. The sanitary state of barracks and hospitals was carefully attended to. The vicinity of barracks, in some instances, is not satisfactory. In Cairo, at Kasr-el-Nil barracks, on the north side is situated the dirtiest part of the city. At the Citadel the native dwellings are in close proximity to the walls, and at Abbassiyeh barracks the village of Adli has frequently been brought to notice on account of its insanitary condition.

A considerable number of improvements have been carried out during the year, amongst others the thorough overhauling and ventilating of the drainage of the gymnasium barracks at Abbassiyeh, and alterations to the drainage at Kasrel-Nil. Some quick-growing trees have been planted in the Citadel. The hospital garden has been improved and relaid. At Alexandria the new barrack huts at Mustapha have progressed rapidly, and six are now completed and occupied. Officers' quarters have also been provided.

XV.-ON THE HEALTH OF THE TROOPS ON BOARD SHIP.

The troops embarked during the year, as shown by the returns received in the Medical Division, War Office, were :

I. Troops proceeding on service abroad
II. Troops returning from abroad -

III. Troops proceeding from one station abroad to another
IV. Invalids returning to England

I. TROOPS PROCEEDING ON FOREIGN SERVICE.

21,318

13,458

11,322

2,148

The total number of warrant officers, non-commissioned officers, and men embarked for foreign service during the year was 21,318, the equivalent annual strength being 1,371. There were 1,299 admissions and 4 deaths, being in the annual ratios of 947.5 and 2.92 per 1,000 respectively. Compared with the corresponding ratios for the previous year there is a decrease of 141-2 in the admission rate, and one of 3.92 in the death rate, and compared with the average ratios for the previous ten years the former has declined by 167·1, and the latter by 1:26 per 1,000.

The admissions and deaths in the different groups and orders of diseases are shown in Abstract XXXVII.

66

GENERAL DISEASES.-Diseases dependent on Morbid Poisons.-There were four cases of eruptive fever, three of scarlet fever on board H.M.S. "Serapis," "Crocodile," and S.S. "Java," respectively, and a case of measles on board S.S. "Malacca." Enteric fever caused one admission on board H.M.S. "Serapis," probably contracted before embarkation. Other continued fevers caused 12 admissions, similar in number to, but with a ratio of 4 per 1,000 below that of the preceding year. There were no admissions for malarial fevers, and only two for septic diseases, both being cases of erysipelas. Venereal diseases, as usual, were the chief causes of illness. Primary syphilis caused 128 admissions, or a ratio of 93-4 per 1,000, being a decrease as com pared with 1892. Including simple venereal ulcer, the ratio was 169.3 per 1,000, 33-3 below that of the previous year. Secondary syphilis caused‍36 admissions, or a ratio of 26:2, being 15.5 per 1,000 below the previous year. Gonorrhea gave 372 admissions, equal to a ratio of 271-3, or 534 per 1,000 less than in 1892. Including all forms of venereal disease, the total admission rate, 466-8 per 1,000, shows a decline, as compared with the preceding year, of 102.2.

Rheumatism caused 30 admissions, the ratio 21.9 being 3.9 per 1,000 lower than that for the previous year.

LOCAL DISEASES.-Diseases of the Nervous System caused 5 admissions, including 2 for mental diseases, and eye diseases 16. There were only 2 admissions for diseases of the circulatory system. Diseases of the respiratory system caused 96 adınissions with 2 deaths, the ratio of admission, 700 per 1,000, exceeds that of the preceding year by 207. Diseases of the digestive system gave 129 admissions, or a ratio of 941, this is likewise in excess of that for 1392, by 137 per 1,000. The ratio of admissions for diseases of the lymphatic and glandular system, 14.6 per 1,000, was lower by 66 than that for the previous year. The admissions for urinary diseases numbered 2 only. Diseases of the generative system furnished 166 of the admissions, the ratio, 121-0, being an increase of 216 as compared with that for 1892. Skin diseases caused 99 admissions, the ratio for which, 72.2 per 1,000, is 50′0 below that of the preceding year. Injuries also show a decrease of 16.9 per 1,000 in the ratio of admissions.

The deaths, 4 in number, were due to pneumonia in 2 instances, and to peritonitis and periostitis in one case respectively.

The number of officers embarked was 934, among whom 18 admissions were recorded. The number of women who embarked equalled 844; no death occurred. The number of children embarked was 1,074, among whom 7 deaths occurred from the following causes :-4 from diarrhoea, and one each from inflammation of the stomach, pneumonia, and convulsions.

Troops on
Board Ship.