Jan. 8, 1880] 



NATURE 



229 



tree stem, play a conspicuous part, after having been 

 brought, fresh painted, from the village to the feasting 

 place. Sometimes there is even a migration of the revellers 

 into another village, which generally results in a kind of 

 sham fight between the two parties. 



With regard to Betel chewing and tobacco-smoking, 

 both these habits are very prevalent, and freely indulged 

 in by the people inhabiting Maclay coast. Nevertheless, 

 the Areca palm ' is by no means abundant on the coast, 

 being, with the exception of the " Archipelago of Content- 

 ment" and a few other spots, but seldom found in the 

 villages. The process of Betel-chewing is as follows : 

 The Areca nut having been first partly masticated, is then 

 mixed with a little powdered lime, which is carried in a 

 special box formed from bamboo or a calabash gourd, 

 and, after being rolled in a Betel = leaf or two, is placed 

 between the teeth and chewed. Although the tobacco 

 plant, here called Kits' , is much cultivated, and flourishes 

 well along the whole coast, the American tobacco, pressed 

 flat into cakes, which Maclay had brought with him, was 

 so much liked and prized, that he contributed a portion 

 at almost every Ai feast. This, after being separated into 

 its component leaves, was dried over a fire, torn into little 

 shreds, and then rolled into cigarettes in green leaves, 

 also previously dried at the tire. A single cigarette makes 

 the round of a number of smokers. In smoking the 

 Papuans swallow the smoke, and blow the rest through 

 the nose. 



As the Keu has soporific qualities, the Papuans have 

 devised a means of keeping any one who has succumbed 

 to its influence in a wakeful condition. The victim to its 

 power betakes himself to a friend, who with a stalk of 

 grass tickles the cornea and conjunctiva of his eyes until 

 they become full of tears. This is repeated until the 

 patient declares that he feels no longer sleepy. This opera- 

 tion is regarded as a very pleasant one, but " whether it 

 always succeeds," remarks M. Maclay, " is another ques- 

 tion." 



J. C. Galtox 



EPIDEMICS 3 

 AXT'E are now entering on our thirtieth session, and, I 

 v v trust, with reason to believe that our progress is satis- 

 factory, and our work su:h as to prove that the Society is 

 fulfilling the main object for which it was founded. 

 Though not one of the largest, it is certainly not one of 

 the least active or important among the medical societies 

 of the metropolis, whilst the cosmopolitan range of 

 subjects embraced within the scope of its inquiry 

 renders its proceedings of far more than mere local 

 interest. 



The raison d'ttre of this Society is the investigation and 

 development of our knowledge of disease in motion. It 

 involves much, for any disease where it spreads, whether 

 among the people of a house, a ship, a village, a city, a 

 province, or a continent, is an epidemic, and comes within 

 the scope of our inquiry. Dysentery and malarious fevers 

 are typically endemic diseases, but in India they may and 

 do at times assume a dangerously epidemic character. 

 But it is not meant that our inquiries should be restricted 

 to mere epidemicity alone ; we cannot advantageously 

 study one phase of the natural history of disease and 

 exclude others. There is so much in etiology, semeio- 

 logy, and pathology both human and comparative that 

 concerns our department of research that we may not 

 ignore the means by which we gain the most important of 

 all information to the epidemiologist — namely, the means 

 of discriminating one form of disease from another. There- 

 fore, though our proceedings will naturally refer mainly to 



1 PiHOHgm the Malay lane 

 * Siri in Malay. 



3 Abstract of Presidential Address at the Epidemiological Si 

 Vi e n d °" N " ovemb ' :r 5, 1879, by Sir Joseph Fayrer, K.cs.l, 1.1.. U., 



epidemic disease, we shall thankfully receive and care- 

 fully consider all information that may tend in any way to 

 throw light on the causal relations', and on the influences 

 exercised by climate, season, locality, food, and occupation 

 on the genesis and dissemination of all diseases, not 

 excluding those of the lower animals, nor even of plant 

 life. I might illustrate this by referring to the import- 

 ance of discriminating between the different forms of 

 fever that occur in India. It is well known that the 

 greatest proportion of mortality in India is ascribed to 

 fevers. The highest death-rate 1 was registered in Bombay, 

 where it equalled 20-82 per 1000 ; in Madras the deaths 

 of 469,241 persons gave a death-rate of io - o8 per 1,000. 

 Both here and at Bombay, however, the mortality 

 recorded was greatly aggravated by famine. 



There is no doubt that, under the heading Fever, many- 

 deaths from other causes are recorded, and we may pro- 

 bably refer a large proportion of them to diseases of an 

 inflammatory character affecting the thoraic or other 

 viscera, or to complications involving inflammatory action 

 elsewhere. In a vast country like India, where the popu- 

 lation is so extensive, and the means of registration of 

 necessity limited, often not under medical supervision at 

 all, it is not to be expected that greater accuracy can be 

 ensured ; but, were it possible to discriminate among the 

 various forms of disease returned as causing the mortality 

 by fever, we should have a very different result from the 

 present. One can hardly refer to this subject without 

 expressing admiration at the great progress that has been 

 made of late years in registration under the direction ot 

 the sanitary authorities of India, and confidence that it 

 will continue to improve, and render the statistics more 

 valuable even than they are now. Of course, where the 

 registration of death is not subject to medical definition 

 discrimination between the various forms of fever or other 

 death-causes could hardly be expected ; and therefore 

 the example I have just given is hardly so good an illus- 

 tration of what I refer to as typhoid, for which we have 

 accurate medical statistics of our European troops in 

 India. It is within my recollection that attention was 

 first called to the existence of this form of fever in India, 

 and yet there can be, I suppose, no doubt that it has 

 always been there. It soon became generally recognised 

 as a new discovery in India, and people wondered how it 

 had escaped observation hitherto, whilst some perchance 

 regarded it as a new disease. But it was just this power 

 of discriminating observation that is so rare and so valu- 

 able that had been wanting ; it was this that, exercised 

 ', Jenner, Stewart, Murchison, and others after 

 them, established a new era in the nosology of fevers in 

 ; and it was this, that, a little later, in India, 

 discriminated between certain forms of remittent and 

 enteric (i.e., between malarious and specific) fevers, and 

 that will, I hope, ere long further discriminate and 

 rearrange the nosology of fevers in India and the 

 tropics. 



Now typhoid or enteric fever is an important cause of 

 mortality among our young European soldiers in India ; 

 and it raises or suggests questions of great importance in 

 regard to them — such, for example, as the right age, time, 

 and seasons for sending them to India ; to say nothing of 

 the hygienic questions as to sanitary measures arising out 

 of its causal relations. The Sanitary Commissioner's 

 Report of 1877 sa >' s that out of 233 cases of typhoid, 

 92, or 39 per cent., proved fatal ; the admission rate 

 being4'i per 1,000 of strength. It moreover appears that 

 2-45 per cent, occurred at or under twenty-four years of 

 a S e ; ' '55 at twenty-five to twenty-nine ; 0-99 at thirty to 

 thirty-four ; and a few or none above that age ; showing 

 that the disease tells most severely on the younger men — 

 in t*nis respect resembling typhoid in England. Again, 

 Bryden, in his Report of tlie Statistical History of the 

 European Army in India up to 1S76 (published 1878) 



1 Vide Report of Sanitary Commission 01 the Government of India for 1877, 



