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was no recurrence of anginous pain, and the pressure wasfrom 122 to 124. The second patient was seen on May 14th.She was a woman aged thirty-one years. Pressure was156 mm. Hg. ; exertion brought on præcordial pain extendingto the inner aspect of the left forearm ; the apex was a

quarter of an inch outside the nipple line ; the second soundat the base was accentuated in both areas ; the bowelsacted once daily, the motions being always liquid andbrown; she had general rheumatic pains and refused toeat and to speak; she cried frequently and was generallyvery depressed. She had headache at the vertex on wakingevery morning. On June 28th the pressure was 122 ; the

patient was very cheerful and in good health ; there wasno anginous pain ; the apex was half an inch within thenipple line; the heart sounds were normal; the motionswere healthily formed ; and there was no headache.

In both these cases remedies were given to retard theaction of the bowels and to promote intestinal antisepsis, inconjunction with small doses of iodide of potassium and3 gr. daily of nitrite of sodium. The first patient, inaddition, had some artificially prepared Nauheim baths. I

may add that prior to reading Dr. Craig’s article I hadsuffered for two months from headache at the vertex, comingon daily at about 6 A.M. and subsiding after my morning bath.On taking my pressure at bedtime I found it to be 170mm.Hg. I took 2 gr. of nitrite of sodium and woke the follow-

ing morning with a clear head. After breakfast the pres-sure was 122 mm. Hg. The two following nights I took nonitrite with the result that I had headache in the mornings.Since then I have taken 1 gr. each night with good results.At the present moment (midnight), 24 hours since taking thelast dose, the pulse pressure is 130 mm. Hg.

I am, Sirs, yours faithfully,Upper Brook-street, W., July 4th, 1898. W. BEZLY THORNE.W. BEZLY THORNE.

"THE ALLEGED DEARTH OF QUALIFIEDASSISTANTS."

To the Editors of THE LANCET.

SIRS,-If " Practitioner’s "ex-employer was making only.E700 a year and yet had more work than one man couldpossibly do," one cannot help thinking that his fees musthave been a good deal below the ordinary standard. And Icannot understand how a man should have to work " practi-cally night and day" to earn £8400 a year unless under similarcircumstances. My own income is just about that figure, butthough I walk my rounds and do everything myself Icannot complain of want of leisure. When men find that itis impossible to get an assistant unless they pay him suffi-cient to give him a moderately respectable return upon hisinvested capital of money, brains, and hard work, they willbegin to find, too, that branch practices, sixpenny fees, andpenny clubs are as unremunerative as they are selfish and

undignified. The result will be that everybody will have thechance of making a modest but sufficient income. Therecent action of the General Medical Council seems (if thejeremiads which some of your correspondents are pouringinto our ears be not exaggerated) likely to bring about thisresult. It is a consummation devoutly to be wished.

I am, Sirs, yours faithfully,July 10th, 1898. -

PRACTITIONER Too.

To the Editors of THE LANCET.

SIRS, - Practitioner " gives another, but hardly thereverse, side of the picture. No one questions that there arethousands of practitioners for whom a young man may actas assistant with the greatest satisfaction and mental profit.But that is hardly the point in question. The practical pointis the obvious injustice of a man, such as "Practitioner" "

himself, spending some seven or eight years in study andprobably about £1000 to learn his profession, and then onlyreceiving a small pittance which can leave him no margin tosave. If he serves with a definite understanding that hewill receive a share of the practice in time the matter is notaltogether objectionable, but a very large majority of assist-ants have no such understanding, but give their servicessimply for cash and because they have not the wherewithal tobuv themselves a practice. The public squeezes the principaland the principal the assistant, and so things will go on untilthe profession is so flat that it can be squeezed no more, andthen perhaps it will begin to resist the pressure. One would

like to know how much the parish and the clubs were paying"Practitioner’s" hard-used principal. I have little doubt thatit was Poor-law work done at a loss and club work at someridiculous price which compelled the unfortunate man to sosqueeze his assistant. If there is now a dearth of qualifiedassistants the principals will have to bear the pressure them-selves and I hope they will soon begin to resist. It is onlythe threat of advertising for another medical man whichkeeps many of the Poor-law medical officers from demandinga reasonable wage, and if they could be assured that therewas no longer a cloud of aspirants hovering over them readyto pounce on the smallest appointment they would begin toresist the ever-increasing pressure. The effect would soonbe felt all round and ’’ Practitioner’s description of theprofession as a life of hardship, a scanty income, constantharass, and too often but little gratitude, accurate enoughnow, would soon cease to be true.

I am curious to learn what fee, if any, will be paid themedical officers who are to call on the unvaccinated infantswith offers of gratuitous glycerinated lymph. This wouldseem a good opportunity for them to ask a reasonable feeand one which would at least cover their travelling expenses.Probably they will be asked to do it for nothing on theground that it will be a splendid advertisement. " Practi-tioner " has my hearty sympathy if he has to do the work oftwo men to earn a net income of £200 a year, but let meurge him not to attempt to lessen the pressure by placingpart of it on a younger man, but rather take the manliercourse of demanding a fair wage from those who use hisservices. I know it is folly for a man to quarrel with hisbread-and-butter, but it is passing strange that the coal-miner will leave his work and starve rather than take a pennyless than what he believes is his due, while the hard-workedpractitioner dare hardly hint at the request for a slightincrease in his starvation wages. With apologies for such alengthy letter,

I am, Sirs, yours faithfully,July 9tb, 1898.

____

ANOTHER G.P.

To the Editors of THE LANCET.

SIRS,-I think there is little doubt that the average incomeof medical men, especially those living in country parts, doesnot exceed C400 a year. The contrast between this amountearned in large towns and in the country is very considerable,as in the former case this income can be obtained on foot orwith occasional hiring, whereas in the country it means thenecessity of keeping two horses, which, with their necessaryexpenses of groom, &c., reduces the income by quite a third.In addition to this, in many of the country parts lack ofeducational facilities necessitates a man with a family sendinghis children to boarding schools instead of day schools, bywhich the expense is greatly increased. I speak from ex-perience and say were I not fortunate enough to have someprivate means I am unable to see how I could haveeducated my family, as it is with great difficulty I have giventhem a fair general education at a cost of about £1500, butcannot afford to bring them up to a profession, consequentlymy two sons have gone abroad. At the commencement of

my career I was an assistant for several years at .660 a yearin-door and was treated as a gentleman except in oneinstance. My opinion is that from .660 to E80 a year in-doorsought to be fair remuneration for an assistant, as it does notdiffer much from what the average practitioner really gets,as board and lodging with proper treatment ought to repre-sent £100 per annum. I think a fair estimate of a countrypractitioner’s expenses would be : horses, grooms, and drugs,180 ; rent, rates, and taxes, ;E60 ; leaving E160 for house-hold and other expenses.

I am, Sirs, yours faithfully,July llth, 1898. MEDICUS.

NOTES FROM INDIA.

(FROM OUR SPECIAL CORRESPONDENT.)

The Plague in Bombay, Calcutta, and Karachi.-Degrees ofVirulence ditrinq an Epidemie.-Medieal llen and Nurseson Plague Duty.IN Bombay the general health of the population has

greatly improved. A few cases of plague still continue to bereported, which must remind the authorities that this

176

disease has not yet been exterminated from the city.An increased number of cases of relapsing fever haveoccurred, but the mortality from this disease is small.In Calcutta the plague seems to be very gradually increasing.It will be remembered that a very gradual developmentcharacterised the first outbreak in Bombay. The totals nowstand at 104 cases and 77 deaths-a mortality of 74 per cent.Inoculation with Haffkine’s prophylactic fluid is becomingmore popular, the total number inoculated up to June 9thbeing 1239. Large numbers of the people continue to leavethe city and judging by the favourable results of clearing outlarge sections of a population and putting them in health-camps the greatest safety after all probably lies in night. Itis interesting to note the rise in virulence of the plague asan epidemic advances. In Karachi the present outbreak com-menced at the end of March. For the first week in Aprilthe mortality of plague cases was 55’5 per cent., for thesecond week 63-3 per cent., for the third week 74’6 percent., for the fourth week 66’7 per cent., for the fifth week77’9 per cent., for the sixth week 79’8 per cent., and for theseventh week 89’8 per cent. This fearful mortality occurredjust after the highest plague figures had been recorded.From this time, however, the epidemic rapidly declined.For the eighth week the mortality of plague cases sinks to77’5 per cent., which it also maintains for the ninth week, andfor the tenth week it sinks to 73’7 per cent. The epidemichas been shorter in duration but more severe in characterthan the outbreak last year. The numbers show that com-

pared with the population it has been twice as deadly aseven the second outbreak in Bombay. The later season

and the exodus of people probably account for its shorterduration. The mortality of this outbreak has been 87’4 percent. ; last year it was 81 per cent.

Considering the various dangers which the English medicalmen and nurses engaged in attendance on plague cases haveincurred nut only from plague and other diseases but in verymany instances from physical injury, it would be justly areward of merit if the Government of India were to

recognise their services by some mark of distinction. Theduties of both medical men and nurses have beenarduous and for the most part uninteresting: the climateis trying for new-comers and the pay is not onlyconsiderably lower than their position warrants butis inadequate to the services rendered. Should plaguedevelop as the colder weather advances, and should theGovernment of India require further assistance, I stronglyadvise both medical men and nurses not to come to India at1he present rates of pay. Expenses are heavy, it is onlya temporary appointment, there is no prospect after theplague is over, inconveniences are numerous, and you areperhaps isolated from all your friends.June 16th.

LIVERPOOL

(FROM OUR OWN CORRESPONDENT.)

The Mayor of Bootle.DR. JOHN McMURRAY, the popular mayor of Bootle, will

be formally presented at an early date with his portraitreproduced in oils. A short time ago a number of repre-sentative gentlemen in Liverpool organised a subscriptionfur the purpose. The painting has been executed by Mr.C. J. Orchardson and is to be exhibited in the Walker Art

Gallery at the forthcoming Liverpool autumn exhibition.Health of Birken7tead : -Dr. Marsden’s Report for 1897.The annual report of the medical officer of health of

Birkenhead on the sanitary condition of the borough justissued records a steady improvement in the health of theinhabitants, the death-rate being lower than in any year.ince 1881 with the single exception of 1894. The densityuf the population is now 28’83 per acre over the whole

borough, against 20’06 at the time of the incorporationtwenty years ago, the population being then 77,260 comparedwith 111,000 in the middle of 1897. The pressure is chieflyfelt in the townships of Birkenhead and Tranmere: thedensity in Birkenhead being 50’62 per acre, against 39’33 in1878, and in Tranmere 31’83 per acre, compared with 17’64inthe same year. During the year 1897, 4982 nuisances werereported, 4666 being abated without compulsion. Dr.Marsden remarks that in some hotels girls follow theiroccupation for upwards of 100 hours a week, and he con-siders it desirable that the benefits of the Shop Hours’ Act

should be extended to them also, restricting their workinghours to 74 per week. The medical officer states that the

quality of the water is excellent and that the average supply -

is 17 gallons per head. As far as bacteriological examina.tion of the water is concerned it was found that the

Spring Hill well is the most perfect, the Borough-roadcoming next in order. Dr. Marsden has not confidencein the future quality of the Flaybrick-hill source.

Altogether the report as affecting the water-supply is

very satisfactory. During the past year 402,652 lb.of meat were condemned as unfit for human food, repre-senting 124,6621b. more than were seized in the previousyear. The total number of seizures of unwholesome fooctwas 1618. Of the total quantity of meat seized 377,869lb.were condemned at the Woodside and Wallasey lairages.During the year numerous complaints had been received ofoffensive effluvia from open sewer ventilators. The medicalofficer expresses the opinion that the ventilators are a

.

nuisance and in narrow streets a distinct danger and

suggests that the whole of the grids should be closed andall interceptors between house drains and the sewers re-

moved. Every ventilating shaft attached to the housedrains would then act as a ventilator for relieving thegaseous pressure in the sewers, while affording absoluteimmunity from the danger of forcing the house-traps,During the year 2028 cases of infectious diseases were

notified, being 1050 less than in 1896. The birth-rate was31’68 per 1000 of the population for the whole borough andthe death-rate was 18’39 per 1000 of the population. Thebirth-rate was 0’8 per 1000 lower than the average for thepreceding ten years, and the death-rate was 1’5 per 1000lower.

Children’s Convalescent Home, B’est Kiirby.The Lord Mayor of Liverpool and the Lady Mayoress

visited the West Kirby Convalescent Home on June 29th andexpressed themselves highly pleased with all the arrange-ments provided for the comfort of the children. Last year832 children received the benefits of the institution, stayingan average time of three and a half weeks. The averagenumber of children in the home during the year was 57.There are 76 children in residence at the present time, andso great is the demand for admission that all the prospectivevacancies are filled up to the end of July. The committee

contemplate the extension of the building by the erection of _

a new wing at a cost of .63500, which will be begun as soonas the sum of 2000 shall have been guaranteed. Snb-

scriptions amounting to £ 900 have already been receivedtowards this purpose.

Bequests to Liverpool Hospitals.By the will of the late Mr. Andrew Gibson, shipowner, of

Liverpool and West Kirby, the following charities havereceived L100 each : the Liverpool Royal Infirmary, the

Royal Southern Hospital, and the Liverpool Northern

Hospital.New Cheshire Infirmary.

Mr. W. H. Verdin, D.L., is about to present to the townsof Winsford and Middlewich a new infirmary, which byspecial permission of Her Majesty is to be called theAlbert Infirmary. Mr. Verdin will also provide for the

furnishina of the infirmary with a complete equipment. TheDuke of Westminster has consented to perform the openingceremony.July 12th.

_______________

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)r

Meeting of the British. Medical Association at Edinburgh.THE recent Army Warrant dealing with the reconstruction

of the Army Medical Service has given rise to the hope insome quarters that a corresponding alteration will ere lougbe made in the Volunteer Medical Service. With a viewto discussing the position it is hoped that a meeting ofVolunteer medical officers may be held in Edinburgh duringthe visit of the Association. Information regarding thismeeting may be obtained in the reception room.

Hawkhead Asylum.The hospital in connexion with this asylum was formally

opened on July 8th. A large company of ladies andgentlemen, including the representatives of the Govan Parish