NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
118
REPORTS AND RETURNS.
[SECT. XX.
(c.) The proportion which admissions and deaths from epidemic diseases
have borne to the total admissions and deaths from all causes during the year.*
(d.) Any specialities in the types of disease should be accurately noted.
52. Diseases belonging to the zymotic class,* being the chief causes of
loss of efficiency in armies, Medical Officers should carefully note those local or
personal conditions with which these diseases may have been connected under
the following heads :—
(a.) General defects in position of station, on low ground near marshes
requiring drainage.
(b.) Overcrowding in camps, barracks, huts, tents, or hospitals.
(c.) Defective drainage and ventilation in camps, barracks, huts, tents,
or hospitals.
(d.) Marshes or wet ground, water-courses, or works of irrigation to
wind ward.
(e.) River banks.
(f.) Nuisances, defective cleansing.
(g. ) Want of cleanliness in barracks, huts, or hospitals, and want of
lime-washing.
(h. ) Defective drainage of ground near barracks, hospitals, &c.
(i. ) Defective sanitary condition of privies, latrines, water-closets,
stables, &c.
(j. ) Monotonous diet, defective diet, salt provisions.
(k. ) Defective clothing.
* The following is a list of the more important mitigable or preventible diseases.
They are most of them included under General diseases A. and B., and are to be specially
referred to, and their statistics carefully given :—
Fevers—Intermittent.
" Re mi t t e n t .
" Yellow.
" Continued.
" Relapsing.
" Typhoid.
" Typhus.
" Plague.
Influenza.
P
yæmia.
Hospital Gangrene.
Cholera.
Diarrhœa.
Dysentery, Acute.
" C h r o n i c .
" Scorbutic.
Small-Pox.
Varioloid.
Chicken-Pox.
Miliary Fever.
Scarlatina, including Scarlet Fever.
Measles.
Diphtheria.
Erysipelas.
Erythema.
Scurvy.
Ophthalmia.
Furunculus.
Carbuncle.
Syphilis.
Gonorrhœa.
Itch.
Rheumatism.
Intemperance.
Sunstroke.
Foot Lameness.
SECT. XX.]
REPORTS AND RETURNS.
119
(l. ) Bad water, especially if polluted by putrescent organic matter.
(m.) Drunkenness, or use of unwholesome liquors.
(n.) Nature and description of duties.
(o.) Heavy rains, or unusual heats, calms.
(p.) Climatic peculiarities.
(q.) Prevalence of epidemics, and at what season.
53. The Medical Officer should endeavour to form an estimate of the
relative value of each class of causes which have predisposed the troops to these
diseases. He should give a minute account of them, together with a state
-ment of what precautionary measures he recommended, either verbally or in
writing, to his Commanding Officer, and the result of his recommendations.
54. If any diseases have become epidemic in the district, he should
examine carefully into their history, and predisposing causes, and report on
these as well as the steps he recommended to protect the troops from an
invasion of the disease, with the results.
55. He should state to what extent new arrivals at the station have
suffered from climatic disease: also the proportion of acclimatised troops who
have been affected; and whether the proportion of attacks and deaths have
been greater in young soldiers or in those of more mature age.
56. If cholera has prevailed, he should state the measures adopted by
him for discovering and treating the disease in its premonitory stages, and
the results.
57. If any disease, such as fever, erysipelas, hospital gangrene, &c.,
has appeared among the sick after they have been admitted into hospital, he
should report the history of the occurrence, its causes, the measures adopted
to arrest these diseases, and the results.
58. If diseases, not of the zymotic class, have occurred among the troops
to any unusual extent, the circumstances should be specially recorded; also
the causes, with the steps taken for their removal, and the prophylactic
measures adopted.
59. The Medical Officer should state to what extent, and with what
results, he has used mercury in the treatment of syphilis.
60. All important or unusual cases of disease should be carefully
reported as to their—
History,
Etiology,
Symptoms,
Diagnosis,
Prognosis,
Treatment,
Results,
Post mortem appearances, if fatal.
120
REPORTS AND RETURNS.
[SECT. XX.
61. Phthisis pulmonalis and other chest affections should be carefully
investigated, their stethoscopic signs minutely noted, and their history and
causes registered under the following particulars :—Constitution, predisposi-
tion, overcrowded barrack-rooms, defective ventilation, exposure, defective
exercise, personal habits, or any other conditions from which the disease may
appear to have arisen. Any prophylactic or sanitary precautions recommended.
should be carefully reported, and their results.
62. Tubercular deposits, in other viscera, should be reported in a
similar manner.
63. All defects in the hygiene or medical care and treatment of the
troops, and all sanitary defects existing at the time the report is made up,
should be carefully noted, and recommendations which were made for their
removal, and for improvement of the service generally, should be appended.
64. Medical Officers should bestow great pains on their reports as
selections from them will be made, if found of sufficient interest, and published.
annually with their names, for the information of the service.
V.—INSTRUCTIONS REGARDING THE CARE AND TREATMENT OF OFFICERS AND
MEN SUFFERING FROM MENTAL DISEASES.
65. Especial attention should be given to all indications of insanity
arising among soldiers, the earliest symptoms of mental disorder should be
accurately observed, and suitable means of alleviation should be promptly
adopted. and carefully carried out.
66. Any obvious or marked. change in temper, disposition, habits, or con-
duct, or any peculiar expression of countenance, state of sleeplessness, excite-
ment, or depression, which cannot be traced to an assignable or special cause,
should be noticed and duly watched, with a view of ascertaining whether such
states are or are not the first manifestations of mental aberration, and should this
prove to be the case, some precautionary steps or means of alleviation should
be at once taken.
67. Whenever the incipient symptoms of the disorder have become more
fully developed, the patient should be placed under judicious care, in cheerful
airy apartments, lighted, and ventilated, and supplied with all articles need-
ful for comfort, and also for the proper treatment of the case.
68. The Medical Officers being left unfettered as to the precise mode of
treatment to be pursued in each individual case, it appears only necessary to
urge on them the importance of generally adopting a liberal and soothing
system, including good diet, warm clothing, and bedding, free exercise, kind
and cheerful demeanour of attendants, and all the various medical and moral
influences found so beneficial in the treatment of insanity.
SECT. XX.]
REPORTS AND RETURNS.
121
69. If a propensity to suicide be manifested by the patient, all means of
effecting this object should be removed; he should be carefully watched, and,
during the night time, an attendant should be placed to sleep in the same room
with him.
70. In every case of insanity it is essential to bear in mind, that the patient
is not accountable for his actions, and, consequently, that a more than
ordinary degree of responsibility attaches to the Medical Officer and others
entrusted with his care and treatment.
71. The symptoms, progress, and the remedies employed should be care
- f u l l y r e c o r d e d ; a n d , i n t h e e v e n t o f a t r a n s f e r t o a n o t h e r e s t a b l i s h m e n t , a f u l l
statement of the past history, and of the existing condition, mental and
bodily, of the patient, should be drawn out and sent with him. In order to
preserve a full record of all cases of insanity occurring in the Army, the
particulars in regard to such cases required by the instructions for invaliding
(see page 45) must be carefully recorded.
72. The previous diseases to which the patient has been subjected for at
least the two preceding years, (if the man has been with his regiment for that
period), must also be noted.
73. In the event of a fatal termination of the case, a careful record should
be made of the morbid appearances of the brain, spinal marrow, thoracic and
abdominal viscera.
VI.—INSTRUCTIONS TO MEDICAL OFFICERS FOR FILLING UP THE STATISTICAL
RETURNS.
DISCHARGING AND INVALIDING.
FORM D. (No. 31.)
74. Is to be filled up according to the classification of diseases, wounds,
and infirmities of invalids at each quinquennial period of life. It is to be
made up by the Regimental Surgeon or the medical officer in charge, and is
to be sent annually to the Inspector General.
FORM E. (No. 32.)
75. Is to be kept by the Principal Medical Officer at the Invalid Depôt.
An Abstract of this Register on Form D, is to be made by the Principal
Medical Officer, and sent, at the end of each year, to the Inspector General.
REGIMENTAL RECORDS OF HEALTH AND SICKNESS.
FORM F. (No. 33.)
Medical Histories Book.
76. This book will remain with the regiment. It will therefore be a con-
venient repository for its brief Medical Annals.
VOL. II. Q
122
REPORTS AND RETURNS.
[SECT. XX.
77. Under each year, A.D., will be recorded in a few words the following
particulars :
—
(a) The names of the Commanding Officers and the dates of their
appointments.
(b)The names of the Surgeons and Assistant Surgeons; the dates of
their appointments.
(c ) The station of the regiment (of head quarters and detachments),
distinguishing dates of arrival and departure, the barracks and hospitals
occupied.,
(d) The mean strength of non-commissioned officers and privates
during the year; the number of recruits; the number of discharges on various
grounds; the number of deaths; the number of attacks of sickness; the
average number constantly sick; the transfers to and from the regiment will
also be noticed.
(e) Brief notices, expressed in few words, and referring to the annual
reports, if any epidemics, or of any unusual exemption from sickness.
(f)Records of any new facts; or of any discoveries which the expe
- r i e n c e o f t h e r e g i m e n t m i g h t s u g g e s t t o t h e S u r g e o n s .
(g.). Dates of any important event connected with the medical history
of the regiment.
78. This book is intended to contain the continuous medical history of
each man in the regiment.
79. Every entry in the sheet is to refer exclusively to the man whose
name is written at the top of it.
80. The particulars in the first part of the description must be obtained
from the Adjutant. The height may be obtained either by direct measurement
or from the Regimental Records. The circumference of the chest by a common
tape measure. In using the spirometer, if the regiment be provided with
one, the man must be directed to fill the lungs as much as possible, and then
to blow gently into the instrument through the tube, to empty the lungs of
air as far as he can do so. The number of cubic inches indicated by the
spirometer must then be recorded. The amount or capacity so obtained
affords a valuable means of comparison in the event of the man afterwards
suffering from phthisis or other pulmonary disease.
81. The dynamometer is of use, not only in ascertaining the muscular
force of the man at the time of enlistment, but also to show its increase or
diminution at subsequent periods. It is of great importance to fill up the
whole of the particulars at this part of the history with care and accuracy. It
should be done as soon as the man joins his regiment. The sheet is hence-
forward to be devoted exclusively to the man's medical history, which begins.
SECT. XX.]
REPORTS AND RETURNS. 1 2 3
from the first day of his admission into hospital, and is to be carefully filled
up with the particulars of every attack of illness till the man is dead or
discharged the service.
82. If a man is invalided, or is transferred to another regiment, his
Medical Histories Sheet is to go with him, and, in the latter case, is to be
inserted forthwith in the Medical Histories Book of the regiment he has joined,
by the medical officer of the regiment.
83. When any man dies, or is discharged, his Medical Histories Sheet is
to be transmitted by the Regimental Surgeon, through the Administrative
Medical Officer, to the Inspector General. When any man is sent to an Invalid
Depôt, his Medical Histories Sheet, which had been sent with him, is to be
transmitted to the Inspector General by the medical officer of the Invalid
Depôt whenever the man is discharged.
84. By these means the Inspector General will become possessed of a vast
amount of important information respecting the health of the army, derived
from papers which have ceased to be of use to the regiment.
FORM G. (No. 27.)
Regimental Hospital Admission and Discharge Book (for Non-Commissioned
Officers and Men).
85. This book is intended to last only a year, and is to contain—
(a) The total admissions into hospital from January 1 to December 31,
inclusive of the year.
(b) The cases are to be numbered in Column 1 continuously from January
1 onwards.
(c)The first case entered in each year must be put down as No. 1.
(d) The 2nd column is to contain the regimental number of the patient.
(e) The 3rd column, for the rank and name of the patient, is to be filled
up according to the instruction.
(f) Care must be exercised in filling up columns 4 and 5, so that the
completed years of age and service are accurately given
.
(g) The four columns for the dates must show, as accurately as possible,
the precise time when the disease began, as well as the date of admission
into and discharge from hospital, and of recovery or death.
(h) The death of every man borne on the strength of the regiment
must be recorded in this book, although the man may not have been admitted
into hospital.
(i)Particulars of cases of drowning, suicide, &c., must be entered as in
ordinary cases.
124
REPORTS AND RETURNS.
[SECT. XX.
(j.) The date of death should be accompanied by a statement as to whether
the man died in the Regimental Hospital, on sick furlough, in a General or
Depôt Hospital, or elsewhere.
(k.) The Surgeon should take means of ascertaining the date of death of
men on sick furlough, and should fill up the date as soon as he obtains it.
86. Certificates of deaths, recoveries, and discharges (see Medical Certi
- f i c a t e B o o k ) a m o n g m e n s e n t f r o m t h e r e g i m e n t t o a n y G e n e r a l H o s p i t a l , o r
left in charge of any other medical officer, will be sent to the Regimental Sur
-geon by the Registrar of the hospital, or by the medical officer in whose charge
the man has been left, as soon as the death recovery or discharge has occurred,
and immediately on the receipt of the information, the facts and the dates
must be entered in the Admission and Discharge Book.
The column for diseases should contain both the disease for which the
man was admitted into hospital, and also the connected secondary diseases
with which the patient may have been attacked while in hospital.
Operations must also be entered with any subsequent disease from which
the patient may have suffered.
If a patient admitted for one disease, such as ulcer, is attacked by another
disease, such as erysipelas, unconnected with the former, the man must not be
discharged, the new disease must simply be entered as another admission, and
the date of the recovery for the first disease (ulcer) must not be filled up
until the ulcer is healed. At the same time as the entry of the new disease
(erysipelas) is made, a note must be written in the discharge column of the
admission for ulcer, simply referring to the new number under which the
case is entered thus (see No. ). The date of recovery from the second
disease, erysipelas, must be entered in the column opposite that disease,
where the date of the man's discharge will also appear.
The duration of the case should be given in days; but if less than a day,
the duration should be expressed in hours as fractions of a day—2/24, 3/24, &c.
The state of health of the patient when discharged from hospital, and his
fitness, or otherwise, for duty, should be noted, and also his destination,
whether on sick furlough, invalided, discharged the service, left in Depôt
Hospital, or transferred to General Hospital.
The column for observations should contain tersely any information that
can be given as to the cause of the disease, whether from defects in diet,
clothing, or shelter, from exposure, local sanitary defects, marsh miasm, bad
water, fatigue, &c.
The post mortem appearances should also be very shortly stated, as these
will have to be entered in detail in the Medical Case Book.
SECT. XX.]
REPORTS AND RETURN.
125
All cases recorded in the Case Book must be referred to by a number in
column, thus : see Case Book No.
87. As a certain number of cases will necessarily be left in hospital on
December 31 of each year, it will be impossible to enter the results in the
Admission and Discharge Book at that date.
88. For the purpose of including the results of the cases so left, the
Surgeon may retain the Admission and Discharge Book in his possession for two
months, to February 28, on which date, or as soon after as possible, it is to be
transmitted to the Inspector General through the Principal Medical Officer of
the station, with the results of the cases entered up to the date of transmission.
89. He will then transcribe all the cases remaining incomplete at that date
in the Medical Certificate Book, to be filled up as the cases terminate, and to
be transmitted, when the results are known, to the Inspector General.
Care must be taken that none of the cases left in hospital on December
31 are re-entered in the Admission and Discharge Book of the following year.
90. Each yearly Admission and Discharge Book is to contain the admis
-sions within the year only, and the results of the cases admitted.
91. Each book is, in fact, to be complete in itself.
The Surgeon will be supplied by the Administrative Medical Officer of his
station with a new Admission and Discharge Book in sufficient time before
the end of the year.
FORM I. (No. 28.)
Medical Certificate Book.
92. Is intended to facilitate the registration of cases by supplying the
results of those cases left behind by a regiment leaving any barrack or station,
and is to be filled up in conformity with the memorandum printed on the back.
FORM K. (No. 34.)
General Hospital Admission and Discharge Book.
93. This Form is to be filled up precisely in the same manner as Form G.,
except that the regiment or corps from which the man has been received
must be stated in the second column ; and that in the fourth column, in
addition to the rank and name, the station from which the man came is to be
entered.
FORM L. (No. 29.)
Medical Case Book.
94. The Medical Case Book is intended to contain the details of every acute
or important case received into any Regimental, General, or Depôt Hospital.
95. The medical officer should study to make his report of every such
case clear and graphic, and to express it in as few words as possible.
126
REPORTS AND RETURNS.
[SECT. XX.
96. He should record the etiology of the case, the symptoms on admis-
sion, the daily changes in the symptoms, the diagnosis, the prognosis, the
diet, regimen, medical or surgical treatment, operation, remedial agents applied,
with their daily effect.
97. He should note carefully the pathological changes, the development,
crisis, decline, and terminations of the disease ; and he should, moreover,
carefully record the morbid changes discovered after death in all fatal cases,
accompanying his description of the morbid anatomy with an account of the
microscopic and chemical analysis of morbid products, so far as he may have
an opportunity of doing so.
98. The Medical Case Book will be called for by the Inspector General,
from time to time, in order that any remarkable cases or experience which it may
contain may be abstracted and published for the benefit of the service ; and
the best recorded cases will be selected and published, with the authors' names.
STATISTICAL FORMS REQUIRED FOR THE ARMY MEDICAL
DEPARTMENT.
FORM M. (No. 21.)
Weekly Classified Return of Diseases and Deaths.
99. The form is intended to receive the medical statistics of the regiment
for one week. The week ends with Friday night, 12 P.M.
STATISTICS OF AN ARMY IN THE FIELD.
FORM N. (No. 24.)
100. I n a ddi t i on t o t he us ua l We e kl y Re gi me nt a l St a t e s f or di s e a s e s , i t i s
necessary to classify and register wounds and injuries received in action,
according to the regions of the body injured, and the nature of the weapon or
projectile. For this purpose the particulars in Form N. must be carefully
filled up and transmitted to the Principal Medical Officer of the Army at
such time as he may appoint.
FORM O. (No. 25.)
101. Is intended to contain a classified return of wounds and injuries of
every kind received in action and admitted into hospital with their results.
It is to be filled up and transmitted to the Principal Medical Officer of the
Army at such time as he may appoint.
FORM P. (No. 26.)
1 0 2 . T h i s F o r m i s f o r c l a s s i f y i n g o p e r a t i o n s w i t h r e s u l t s , a n d s h o u l d b e
made up at such times as the inspector General may direct, and sent to the
Inspector General through the Administrative Medical Officer.
SECT. XX.]
REPORTS AND RETURNS.
127
103. LOCK HOSPITALS.—Medical Officers in charge of Lock Hospitals
will keep the following records :—
1. Admission and Discharge Book.
2. Letter Book.
3. Circular Book.
4. Return Book.
5. Case Book, Europeans.
6. „ „ Natives.
7. Prescription Book.
8. Historical Register.
9. Contingent Bill Book.
10. Pay Abstract Book.
1 1 . D i e t . R o l l b o o k .
104. Monthly returns of sick will be furnished to Deputy Inspectors
General of Circles, as for Civil Hospitals (Form No. 35.)
105. Annual returns and reports are due after 31st December in each
year. The annual report will contain remarks on the influence of the Lock
Hospitals in diminishing the prevalence of venereal diseases amongst troops,
European and Native, and of civil populations.
Civil Hospitals.
106. RECORDS.—Medical officers in charge of Civil, Hospitals and Dis-
pensaries, which are aided by Government, will keep the following records :—
1. Nominal Register of In-patients.
2. Nominal Register of Out-patients.
3. Letter Book.
4. Prescription Book.
5. Case Book.
6. Return Book.
7. Historical Register.
8. Cholera Register.
9.
, , R e p o r t s C h e q u e B o o k F o r m s .
107. MONTHLY RETURNS.—Monthly returns of sick (in and out-patients)
are to be furnished to the Administrative Medical Officer of the Circle, within
three days of the period when they become due (Form No. 35.)
108. At the end of the calendar year, the annual returns of the year, accom-
panied by a medical report, are to be despatched to the Administrative
Medical Officer of the Circle, not later than the fifteenth day of January.
109. ANNUAL MEDICAL REPORT:—The medical report will embrace the
following subjects :—
I. Observations on the climate and season of the past year, and the