ADDENDUM.

ACCIDENTAL circumstances have caused delay in sending the MS. of this book to England. But for the interruption it would have been ready for transmission to the publishers some months ago. The delay, however, enables me to refer to a gratifying statement in The British Medical Journal of November 10, 1888, which arrived in Melbourne a few days ago. Under the head of Naval and Military Medical Services occurs the following :

"Dangerous Straw.

"The use of straw for stuffing soldiers' paillasses is open to many objections, and has been abandoned in India; it is still retained in this country, but we have reason to believe that the War Office has at present under consideration the advisability of abandoning its employment for this purpose altogether. The straw is renewed quarterly, and is sold mainly to dairy farmers, a practice which has many disadvantages. The straw is, of course, liable to become contaminated by excreta from cases of scarlet fever, typhoid fever, and of tuberculosis; in the light of recent discoveries as to the connection which exists between the infectious diseases of man and animals, the fear that disease may thus be communicated to dairy or store fed cattle, and by them to man, cannot be considered imaginary. Moreover, it is a remarkable fact that pleuro-pneumonia exists as an enzootic only in countries such as Ireland and Russia -where human beings and cattle often live under the same roof. Surgeon-Major William Hill Climo, M.D., of the Army Medical Staff, who has given much attention to this question, suggests that pleuro-pneumonia may be in some way connected with human exhalations. An epidemic of measles which occurred during the American Civil War was supposed to have been due to the use of contaminated straw for bedding.

"Surgeon-Major Climo urges the substitution of coir fibre for straw in this country, a reform which he was instrumental in

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bringing about in India. Coir fibre is cleanly, is easily disinfected, and is extremely cheap; by the substitution, a considerable annual saving to the country, estimated by the Commissariat Department at about £10,000, would be effected. The straw costs £1 12s. 4d. a bed every fourteen years; coir fibre would cost, landed in England, 3s. a bed every fourteen years; this is assuming that the coir fibre, which is so cheap, would be destroyed, as it ought to be, when discarded. We are not aware that any serious objection can be made to the substitution, and as it would probably benefit not only the public purse, but the public health, it is to be hoped that the change will shortly be effected."-The British Medical Journal, November 10, 1888.

Lengthened comment cannot be made at the last moment on the large questions and future possibilities suggested by this singularly interesting and important intimation of the views contemplated by the War Office. From old days some military surgeons have had an intuitive distrust of straw for soldiers' bedding. Thus Sir John Pringle, Professor Maclean tells us, insisted "strongly on the destruction by fire of straw that has been used in camps where this disease (dysentery) prevails." But I confess I was not aware that any one had gone so far in this salutary direction as Dr. Climo. It was unknown to me that he had effected such a sweeping and wholesome reform as the abolition of straw bedding in the army of India. Had I known this sooner I should have tried to ascertain the results of the substitution of coir for straw, if there has been time since the change of bedding for substantial results in regard to the incidence of infective disease.

In the absence of precise knowledge it would be profitless to do more than indicate the results that may have followed already, or will follow soon. Briefly, the inferences are that the returns of the sick in the regiments in India will show that in those cantonments where measles and its congeners formerly occurred, they no longer occur amongst the soldiers, or the wives and children of the married men (who will, it is assumed, have been supplied with coir in place of straw); whilst the occurrence of these diseases among the civil European residents in the same places has undergone no perceptible change. If the "straw mildew theory" is sound, there should be pronounced phenomena in this kind. However, even if well-marked differentiation were seen in the incidence of these disorders on the troops before and since the replacement of straw by coir, or in their

incidence on the soldiers and the civil European population in the same cities or districts at the present moment, it would merely be strong negative evidence that the differentiation was consequential; and, having been procured at a distance, would make no great impression on etiologists in England. For equally good data have their relative topographical values, and facts collected a few thousand miles away lose much of their significance and force. Now, however, that the scene is likely to be shifted from India to England, and that the consequences of relieving our troops from the noxious effects of the "straw fungi" is in a fair way of being brought home to European etiologists, there is some chance that before very long the bulk of the population may share in the relief.

The experiment with the bedding of the soldiers will not, of course, bring out such pronounced results as are seen in some of the results of the experiments referred to in the text that have unwittingly been made in the same direction. Under ordinary conditions in barracks the soldier is exposed to a far less degree of air-contamination with the "straw fungi " than the civilian ordinarily is, for the reason that paillasses in barracks are left uncovered daily for a much longer period than paillasses in private houses. With free air all round them the soldiers' paillasses will keep dry and crisp longer than the citizens'. On the whole, too, the amount of breathing space per man is greater, and the ventilation is better in barracks than in the bedrooms of the people. Efficient air-contamination with the "straw fungi," therefore, is less frequently reached in barracks than in ordinary sleeping rooms; and, consequently, soldiers in times of peace suffer less than other classes from the group of morbilloid disorders and their near and remote allies. But notwithstanding their relatively large exemption from these affections, some barracks are so notoriously dark and damp that a proportion of the men become consumptive: and where the existence of the tubercle bacillus is encouraged in dormitories, the straw in the paillasses will generally be, and, during certain seasons, will inevitably be moist. Hence, though the occurrence of measles among the soldiers quartered in the different parts of Great Britain and Ireland may be infrequent or rare, the occurrence among them of catarrhs, sore throats, and pneumonia is by no means uncommon. It is not to be questioned that it will be a substantial relief to the soldier to get rid of these and the other affections that are (inferred to be) dependent on straw bedding; but my extreme satisfaction with the proposed change from straw to coir does not come of the

comparatively limited good to the soldier himself. The lesson from such results would not strike deep; for they would be too vague to be easily sheeted home. It is to the wives and children of the men in a regiment that I look—or to that proportion of them entitled to quarters in the barracks and to bedding. If the War Office carry out the scheme happily suggested by Dr. Climo, each of these families in every regiment quartered in the British Isles should hereafter furnish examples of complete exemption from the whole tribe of morbilloid diseases. Hitherto these families have not been exempt at epidemical seasons from measles, rötheln, whooping cough, scarlet fever, &c. &c., both because (as I infer) the paillasses are not stripped in the married men's quarters as in the dormitories of the single men, and because the standard of efficient air-contamination is so much lower for children than for adults. It is true that, owing to the daily inspection and the enforced cleanliness of the rooms of the married men, the infective diseases taken by the children in the barracks may frequently have been of a milder type than the corresponding diseases prevalent in the neighbourhood; but as the greatest cleanliness will not, of itself, prevent the occurrence and growth of fungi in damp paillasses, the children of the soldiers have not escaped when the "natural disorders of childhood," as they are supposed to be, have been about, any more than the children of the well-to-do classes; unless in the very exceptional cases in which, notwithstanding the seasonal conditions, the straw in the paillasses of the children has been accidentally kept dry by some one of the means suggested in this book.

As, therefore, soldiers' children hitherto have been affected relatively to the same extent as other children, when epidemics of the diseases now in question have been current in the cities and towns in which regiments have been quartered, their future absolute exemption during such epidemics would be as strong negative proof as it is possible to conceive, that measles and its congeners are caused by the "straw fungi." And, in a sense, these children may be regarded as "control-children" in the forthcoming great experiment to be made by the War Office. In the whole of the kingdom they will be the only class of children kept, systematically, entirely free from whatever infectious effects may be induced by the use of straw bedding. Sections of classes of children and adults here and there have been bedded on material other than straw, and other sections have been bedded on straw which has been artificially (purposely or accidentally) kept more or less dry (and these sections, as we have