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corrected average for the corresponding week in the four pre-ceding years 1902-05. The causes of 41, or 1’ 1 per cent.,of the deaths registered in the 76 towns during the weekwere not certified either by a registered medical practitioneror by a coroner; in London the cause of but two of the1060 deaths were not duly certified. All the causes ofdeath was duly certified in Manchester, Leeds, Bristol,Bradford, Newcastle-upon-Tyne, and in 50 other smallertowns. The proportion of uncertified deaths showed, how-ever, a marked excess in Reading, Birmingham, Liverpool,Bootle, Sunderland, South Shields, and Gateshead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 15 6, 15’ 8, and16’ 0 per 1000 in the three preceding weeks, declinedto 14’5 in the week ending June 30th, which exceeded by2’ 1 the exceptionally low rate in the 76 large Englishtowns but was considerably lower than the rate in theseScotch towns in any previous week of this year. The ratesin the eight Scotch towns last week ranged from 11 - 9 and12’ 0 in Aberdeen and Leith, to 15’ 2 in Dundee and 21’1 1in Perth. The 497 deaths in the eight towns showed adecline of 50 from the number returned in the previousweek, and included 22 which were referred to diarrhoea,11 to measles, 10 to "fever," nine to whooping-cough,six to diphtheria, three to scarlet fever, and not one tosmall-pox. In all, 59 deaths resulted from these principalepidemic diseases, showing a decline of 10 from thenumber in the previous week; they were equal to an annualrate of 1 7 per 1000, which was 0’ 5 above the mean rateduring the week from the same diseases in the 76 Englishtowns. The 20 deaths attributed to diarrhoea in the Scotchtowns were five fewer than those in the previous week andincluded nine in Glasgow, seven in Edinburgh, and three inAberdeen. Of the 11 fatal cases of measles seven occurred in

Glasgow and three in Edinburgh; and of the 10 deathsreferred to I I fever " nine were returned in Glasgow, of whichlatter eight were certified as fatal cases of cerebro-spinalfever. Of the nine deaths from whooping-cough four werereturned in Glasgow and three in Aberdeen; and of the sixfrom diphtheria four in Glasgow and two in Edinburgh. Twoof the three fatal cases of scarlet fever occurred in Glasgow.The deaths in the eight towns referred to diseases of the

respiratory organs, including pneumonia, which had been’95, 80, and 69 in the three previous weeks, further declinedlast week to 64, and were four below the number returnedin the corresponding week of last year. The causes of 19,or 3’ 8 per cent., of the deaths registered in the eight townslast week were not certified, the proportion of uncertifieddeaths in the 76 large English towns during the same weekbeing only 1 1 per cent. -

HEALTH OF DUBLIN.

The annual death-rate in Dublin, which had been equalto 16’ 4 and 20’ 2 per 1000 in the two preceding weeksdeclined again to 16’4 in the week ending June 30th.During the 13 weeks of the past quarter the death-ratein the city averaged 21 4 per 1000, against 14 8 in Londonand 17 - in Edinburgh. The 119 deaths of Dublinresidents during last week showed a decline of 28 fromthe number returned in the previous week, and includedtwo which were referred to "fever," two to diarrhoea, oneto whooping-cough and not one to measles, scarlet fever,diphtheria, or small-pox. These five deaths from epidemicdiseases were equal to an annual rate of but 0 ’ 7 per 1000,the rate from the same diseases being I - 2 in London and2’ 3 in Edinburgh. The two fatal cases of "fever" " in Dublinlast week showed an increase upon recent weekly numbers.The 119 deaths from all causes in Dublin included 12 ofinfants under one year of age and 27 of persons aged upwardsof 60 years; both these numbers showed a considerabledecline from those retnrned in the previous week. Three

inquest cases and three deaths from violence were registered,and 42, or 36 per cent., of the deaths in the city occurredin public institutions. The causes of four, or 3’ 4 per cent.,of the 119 deaths were not certified by a registered medicalpractitioner or by a coroner, the proportion of uncertifieddeaths being but 0-02 per cent. in London and 3’1 inEdinburgh.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified : Deputy-

Inspector-General J. 0. B. Williams to Chatham Hospital(temporary). Surgeon E. R. Townsend to the Sapphire.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel William T. Johnston retires on retired

pay (dated July 4th, 1906).I

Lieutenant-Colonel W. L. Reade, from Bangalore, takesover the office of Senior Medical Officer, Madras Brigade.Captain S. A. Archer is appointed for duty in the Dublindistrict.

INDIAN MEDICAL SERVICE.Colonel T. J. H. Wilkins, principal medical officer of the

Burmah Division, has been transferred to the SecunderbadDivision as principal medical officer, vice Colonel A. F.Dobson, retired; Lieutenant-Colonel W. O’Hara has beenappointed principal medical officer, Bangalore and SouthernBrigades ; and Lieutenant-Colonel N. Chaterjie has beenappointed to officiate as principal medical officer of theBurmah Division.

ARMY miSJDIUAD J:l,l!;8l!;UVl!; UF Uj!’j!’lUl!;U8.

Surgeon-Captain John S. Mackay to be Surgeon-Major(dated June 23rd, 1906); Surgeon-Lieutenant Leonard A.Avery to be Surgeon-Captain (dated June 24th, 1906).

VOLUNTEER CORPS.

Royal (Jarrison rtillery (Volunteers): : lst Cheshire :Surgeon-Major A. M. Archer is granted the honorary rankof Surgeon-Lieutenant-Colonel (dated June 29th, 1906).Surgeon-Major and Honorary Surgeon-Lieutenant-ColonelA. M. Archer resigns his commission, with permission toretain his rank and to wear the prescribed uniform (datedJune 30th, 1906).

Rifle 1st Volunteer Battalion the Leicestershire Regi-ment : William Frederick McAllister- He wlings (formerlyCaptain) to be Surgeon-Lieutenant (dated June 30th, 1906).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Gloucester and Somerset Bearer Company : Captain A. W.

Dalby to be Major (dated June 30th, 1906).THE BIRTHDAY HONOURS.

The list of Birthday Honours included the names ofDeputy Surgeon-General John McNeale Donnelly, C.B.,I.M.S., retired, and Surgeon-General Alfred H. Keogh, C.B.,Director-General of the Army Medical Service, who havebeen promoted to be Knights Commanders of the Bath;of Surgeon-General W. Simson Pratt. A.M.S., P.M.O. of theSouthern Command; and Colonel H. Kellock M ’Kay, C.LE.,1.M.S., who receive Companionships of the Bath; and ofLieutenant-Colonel David Prain, I.M.S , Director of theBotanical Survey of India, who is made a Companion of theOrder of the Indian Empire.

II I RESERVISTS AS SANITARY INSPECTORS.I Dr. J. S. Purdy writes to us as follows: "If the Local

Government Board recognised a diploma in Sanitation gainedi by a non-commissioned officer in the army by passing an

examination equivalent to that prescribed by the SanitaryInstitute I am sure that not only would the country benefit byreservists being eligible for appointments as civil sanitaryinspectors but also great encouragement would be given to thestudy of hygiene in the army. more especially among the menof the Royal Army Medical Corps. One of the most efficientsanitary inspectors I ever knew was an ex-sergeant, MMdiploma, at Tottenham. Men trained in the army are .

disciplined and do what they are told, and do not as

civilians are more apt to do, show a tendency eitherto pose as amateur experts on medical subjects or exceedorders. In a recent conversation with Colonel Hamilton,I.M.S., he expressed himself as favourable to the idea, soI trust that other men in the Army Medical Service willassist in bringing the subject to the notice of the authorities.The fact that a course of hygiene at the Roval Army MedicalCollege qualifies an officer to sit for the D.P.H ought to besufficient precedent for allowing a non-commissioned officerof the same corps to sit for the sanitary diploma prescribedfor civil inspectors." There is sound good sense in Dr.Purdy’s views. And the more our army, from top to bottom,becomes familiar with the precepts of sanitary teaching, the

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greater will be the chances of the men escaping during timesof war from the horrors of epidemic disease. We understandthat Colonel Hamilton intends to bring the subject beforethe War Office.

MEDICAL SCIENCE IN WAR.Mr. Brodrick’s letter to the Tinces of June 6th under the

heading of "Medical Science and Military Strength" didgood service in arousing public attention and in elicitingsome strong expressions of opinion as to the limita-tions under which medical science labours in actual war.While gratefully recognising the great services whichthe late Secretary for War had rendered in the wayof improving the Royal Army Medical Corps we said thatthe Army Medical Service was still not an ideal one. InMr. Brodrick’s scheme the Director-General of the ArmyMedical Service had a place on the Army Council. Hehas since been relegated to a far more subordinate positionin the Adjutant-General’s Department. Now everything inwar depends upon preparedness and the views and recom-mendations of the medical service on questions of such

importance as the sanitation and health of the army in

preparation for war should be of a direct and personalkind and not have to be filtered through any oneof the heads of departments. The functions and re-

sponsibilities of a director-general as the representativeof the Army Medical Service are of an altogetherexceptional and responsible kind, and nowadays, as we

all know, it is not the adjutant- general or head of any otherWar Office department who is blamed in case of any medicalfailure in a campaign but the medical service itself. Althoughit may have had an amount of responsibility out of all pro-portion to any power which it may have possessed to alter orto control the course of events, the medical service may con-fidently count upon having all, or an undue share, of anyblame in the future. Army retrenchment is apparently theorder of the day but the present Secretary of State may stillgive heed to the lessons of our past medical experience inwar and make some announcement thereon in his forthcomingstatement about the army.

JOURNAL OF THE ROYAL ARMY MEDICAL CORPS.The June number of this journal, edited by Colonel David

Bruce, R.A.M.C., C.B., F.R.S., is a very good one. Itcontains a number of papers on a variety of subjects ofscientific, army medical, and current interest, together withthe usual corps news.NEW CHIEF FOR RUSSIAN MILITARY MEDICAL ACADEMY.The committee of senior ordinary professors has chosen

A. Ya. Dacielieffsky. now occupying the chair of MedicalChemistry, as principal of the Military Medical Academy,The Pharmazevtitaheski Jo2trnal adds to this informationthat Protessor Danielieffsky was a student in the ImperialUniversity of Kharkoff. He was appointed Extraordinary Pro-fessor of the University of Kazan in the chair of MedicalChemistry and Physics in 1865. After being transferred tothe chair of Pharmacology in 1868 he again took the chairof Physiological Chemistry. He was professor of MedicalChemistry in Kharkoff from 1885 to 1892, since which yearhe has occupied a similar position in the Military MedicalAcademy.Major F. A. Saw, R.A.M.C., who has recently retired on

retired pay, served in the operations in South Africa underSir Frederick Carrington in medical charge of the Mashona-land Field Force, which suppressed a native rebellion in 1896(medal and clasp), and also during the campaign of 1899 to1901 (medal and clasp). At the fight at Stormberg weunderstand he brought in the wounded in the only ambulancewagon then available.

INTERNATIONAL EXHIBITION OF HYGIENE,MONTEVIDEO.—We are informed by the Consul-Generalffjr Uruguay that an International Exhibition ofHygiene will be annexed to the Third Latin-AmericanMedical Congress, to be held in Montevideo, in the Republicof Uruguay, from Jan. 13th to 20th, 1907. The exhibitionwill last two months and will comprise exhibits of apparatus,models, foods and drinks, industrial, chemical, and pharma-ceutical products, medical, surgical, and orthopaedicapparatus, and industrial processes relating to hygiene andpresented for commercial purpose. Firms wishing to registertheir names as exhibitors should apply by writing to the

Secretary-General of the Congress, Palacio del Ateneo,Montevideo, before Sept. lst.

Correspondence.

THE CAUSES OF LEPROSY.

" Audi alteram partem."

To the Editors of THE LANCET.

SlES,—I have to thank you warmly for the able and com-prehensive review of my book on Leprosy which appearedin THE LANCET of June 16th and also for your verykindly references to myself. The spirit of candid inquiryand of desire for the truth which your article manifestsencourages me to hope that you will not be unwillingto allow me to answer briefly the objections which yourreviewer specifies against the creed which I advocate.Several of my critics who have avowed themselves not

wholly convinced have been content with the vague state-ment that there are weak points in the arguments, withoutnaming any one of them. You have, on the contrary,in a manner which shows much familiarity with the

subject, stated clearly in what respects the suggestion ofthe fish-food causation of leprosy appears to be unsupportedby facts. I am especially glad that this has been done,because I feel confident that only a very few words ofexplanation as regards each several allegation are needed.To take first the statement that Dr. Francis Day whilst

travelling in Burmah never saw a case of leprosy althoughthe Burmese are fond of fish. The simple fact is that

although Dr. Day did not see them there were plenty if theyhad been looked for. I answered Dr. Day’s most carelessstatements a quarter of a century ago. He made the sameassertion as regards the Straits Settlements at a time whenin reality there were many lepers there. Dr. Day was a goodnaturalist and an authority on fish, but he did not inquireas to leprosy. It is easy enough for a traveller to see nothingof this disease unless he searches for it, and others besidesDr. Day, even some who have resided long in Burmah,have made similarly absurd statements. There is, how-ever, not the slightest doubt as to the facts. The Bur-mese eat much bad fish and they have a great deal of leprosy.

In reference to Dr. Vincent Richards’s conclusions 1 havemuch pleasure in agreeing with you that he was an able andpainstaking inquirer but he collected his statistics on theerroneous assumption that if leprosy were due to fish it oughtto prevail most where fish food is most abundant. Para-doxical as at first sight it may appear, there are manyconditions in which the reverse is true. It is not the quantitybut the quality of the. fish which is in question. Dr. Richardswrote two reports. Your reviewer has perhaps seen only thefirst. In the second he admitted that the facts 11 certainlyseem to indicate that the consumption of fish does exercise sometMemoe in producing the disease." "As regards the Sandwich Islands, the balance of evidence

is, I believe, to the effect that in them, as in most of thePacific groups, leprosy has always been an indigenous disease.I may admit, however, that it did not prevail extensivelyuntil the advent of Europeans and Chinese, and also thatprior to that advent a great deal of fish was eaten. Let usask, however, in what condition was it eaten ? 7 As yourreviewer is careful to state "especially raw." Now, freshraw fish is not suspected as a cause of leprosy, and it is onrecord that the islanders never practised fish-curing in anyform and that they would eat their fish as soon as taken out ofthe water and almost before it was dead. It was the immigrantChinese and Europeans who introduced the practice of curing,and it is very possible that some of the Chinese may havebeen lepers and may have tainted the food which theyhandled. At any rate they introduced the practice of fish-curing with all its risks.

I will not say anything more as to the denials of fish-eatingby Indian lepers and others, than that I think that Ihave produced sufficient evidence that their statements arenot in the least trustworthy (see page 155 et ). Youwrite, quite correctly, that" caste ordinances again militateagainst the use of fish in many who have become lepers."It is true that they do " militate against it," but they do notwholly prevent it, and it is unquestionable that throughoutIndia the castes which are professedly vegetarian suffer farless than others.You cite the well-known case recorded by Dr. Benson and

those by Professor W. Osler as if they were proofs of the