1300 LOOKING BACK.-VITAL STATISTICS.

Looking Back.FROM

THE LANCET, SATURDAY, May 1st, 1830.

ON THE MEDICAL SERVICE OF THE EASTINDIA COMPANY.

LETTER IV.lTo the Editor of THE LANCET.

SIR,-Before proceeding further in the consideration ofthe ultimate and sole recompense to medical officers of theEast India Company’s service, that is, their retiring pensions,it may be proper to mention the form of admission, at theIndia House, of recruits for this establishment, which is wellcalculated to deceive. It is this; that "assistant surgeonsare permitted to proceed to their respective presidencies,Calcutta, Madras, or Bombay, as the case may be, topractise as surgeons, and to be admitted on theestablishments as vacancies may occur." This form hasbeen observed for the last ten or twelve years. Topractise as surgeons, where ?-Upon whom ?-For what ? -The thing is quite absurd, and ridiculous ; and merely"ad captandum"-to deceive, by giving an idea that,independent of the high prospects which the Company’sservice holds out, money is to be made in India, even on

landing, by private practice ! 1 It is but fair, however, tomention, that, according to the present writer’s informa-tion, no one has hitherto been left to absolute starvation inthis way. Medical officers, shipped for India, in compliancewith requisitions to the Court of Directors from the several ipresidencies, have hitherto been wanted to fill up vacancies,occasioned by casualties, long before the period of their arrivalin India. At the presidencies, medical practice is in thehands of two or three Company’s surgeons. It is only at thePresidencies, that medical officers are paid for professionalattendance. At out-stations, a " honorarium," or fee, to themedical attendant, is seldom, if ever, dreamt of ; so that, onthe Madras establishment, at least, not above one surgeon inone hundred, after from twenty to thirty years’ service,happens to receive, in fees and presents, a sum equal to thepayment of his passage-money back to England, or 2,000rupees. Medical men are not prohibited from receivingpresents, or fees, in India, on account of professionalpractice ; but their patients (excepting at the Presidencies,or towns of Calcutta, Madras, or Bombay) must necessarilybe Compaiy’s servants ; and it is not obligatory on themto pay for medical advice and attendance ; whereas, theattendance of medical men, on all occasions, is obligatory,with or without a fee. Medical men never expect, it maybe said never accept, a remuneration from the military ;and civilians, who alone are able to pay them, very seldomthink any return for their assistance necessary. It hasbeen ruled, however, by the supreme government, and bythe subordinate governments, that it is the duty of everymedical man, to attend at the call of any personwithin his reach who may want his services, without feeor reward, and at his own expense for personal conveyance.Let it be understood that such unrequited summonses areoften frivolous, and at distances of upwards of fifty miles.Disobedience of these calls renders the surgeon liable to trialby court-martial; or to suffer by the more usual mode ofpunishing medical delinquents-marching them incessantlyabout the country to the most distant places, until they sinkunder fatigue, privation of every sort, despondency, and themalignant influence of the climate. From natives, whoseldom ask the help of an English surgeon, the complimentseldom exceeds a small present of fruit, or sweetmeats, afowl, or a lean goat, or sheep, and, on very extraordinaryoccasions, perhaps, a well-darned shawl, not worth 20 rupees, and which has been an heir-loom in the family for the best 1part of a century. So much for the practice of a surgeon inIndia....... Let us now see, by a comparative statement, in what pro-

portions the Honourable Company compensate and appreciatethe labours of their two classes of servants-soul-curers and ibody-curers.

1 Excerpts only have been transcribed.

Pay on Reti’l’ement."A chaplain, after eighteen years’ service in India,

including three years for one furlough," (that is, afterfifteen years’ actual residence in India), " is allowed to retireon the pay of lieutenant-colonel, 3651. per annum."

" A medical officer, after twenty years in India, includingthree years for one furlough," (that is, after seventeen years’service in India,) "is permitted to retire from the service onthe pay of captain, 1911. 12s. a year." After twenty andthirty years’ service in India, the same, 1911. 12s.

" A chaplain, if compelled to quit the service on accountof ill health, after ten years’ service in India, is allowed toretire on the half-pay of lieutenant-colonel, 200l. 15s. a year."A medical officer, if compelled to quit the service on

account of ill health, after ten years’ service in India, is (orrather was) permitted to retire on the half pay of lieutenant,731. ; after six years, on the half pay of ensign, 541. 15s.after thirteen, on the half pay of his rank, that of fall

surgeon, if fortunate, 1271. 15s. ; or of lieutenant, if thereverse, 73l.

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" A chaplain, after seven years’ residence in India, isallowed to come home on furlough, and receive the pay ofmajor, 292l. a year ; should he come home from sicknessprior to this period, he is to receive the pay of captain only."

" A medical officer, after ten years’ service in India, isallowed to come home on furlough, and receive the pay oflieutenant, 951. 16s. 3d. a year."

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X.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8013 births and 4780deaths were registered during the week ending April 25th.The annual rate of mortality in these towns, which hadsteadily declined in the four preceding weeks from 17’ 4 to15’ 2 per 1000, was equal to 15’ 4 irn the week undernotice. During the first four weeks of the current quarterthe death-rate in these towns has averaged only 15’7per 1000 ; the rate in London during the same period didnot exceed 15’ 4. The lowest annual death-rates in the76 towns during the week under notice were 6.7 inHornsey, 7.3 in Willesden, 8’1 in Southampton, and9’ 3 in King’s Norton; the rates in the other towns

ranged upwards to 20’ 5 in Devonport, 20’ 9 in Oldham,22.9 in Rochdale, and 23.5 in Stockton-on-Tees. The rateof mortality in London during the week did not exceed 15’ 4.The 4780 deaths in the 76 towns during the week showed anincrease of 32 upon the low number returned in the previousweek, and included 376 which were referred to the

principal epidemic diseases, against numbers declining from487 to 382 in the four preceding weeks ; of these, 138resulted from whooping-cough, 101 from measles, 49 fromdiphtheria, 35 from diarrhoea, 32 from scarlet fever, and 21from "fever" (principally enteric), but not one from

small-pox. The deaths from these epidemic diseases wereequal to an annual rate of 1.2 per 1000, correspondingwith the rate in the previous week ; the rate from thesame diseases in London was equal to 1 3. No deathfrom any of these epidemic diseases was registered lastweek in Leicester, York, Aston Manor, Coventry, or innine other smaller towns; the annual death-rates fromthese diseases, however, ranged upwards to 2’ 8 in Hudders-field, 3’ 0 in Smethwick and in Birkenhead, and 3’ 5 inRochdale. The fatal cases of whooping-cough in the 76towns, which had been 204, 150, and 134 in the three pre-ceding weeks, rose again to 138 in the week under notice;the highest death-rates from this disease in these towns lastweek were 2’ 0 in Sunderland and in Newport, 2.3 inSmethwick, and 2’ 6 in Devonport. The 101 deaths frommeasles were fewer by 26 than those in the previous week;they caused death-rates, however, equal to 1.1 in Salfordand in Swansea, 1’ 3 in Birkenhead, and 1.8 both in Prestonand in Rochdale. The deaths from diphtheria, whichhad been 53 and 39 in the two previous weeks, rose

again to 49 last week. and included 13 in London,four in West and East Ham, two in Wolverhampton andin Walsall, four in Liverpool, five in Manchester and Salford,three in Hull, and two in Middlesbrough. The 32 fatal cases