568 VITAL STATISTICS.-THE SERVICES.

the rate was 20’0 per 1000 and corresponded with the meanrate in the thirty-two provincial towns. The lowest rates inthese towns were 12’2 in Portsmouth, 14’6 in Derby, 16 5 inCardiff, 16’6 in West Ham, and 16’8 in Gateshead ; the highestrates were 24’8 in Liverpool, 25’5 in Plymouth, 25’7 in Preston,26’5 in Burnley, and 294 in Wolverhampton. The 4002deaths included 476 which were referred to the principalzymotic diseases, against 432 and 423 in the precedingtwo weeks ; of these, 163 resulted from whooping-cougb, 111from measles, 84 from diphtheria, 43 from scarlet fever, 40 fromdiarrhoea, 23 from "fever" (principally enteric), and 12 fromsmall-pox. No fatal case of any of these diseases occurred lastweek in Halifax; in the other towns they caused thelowest death-rates in Brighton, Portsmouth, and Gates-head, and the highest rates in Salford, Birkenhead, Ply-mouth, West Ham, and Wolverhampton. The greatest mor-tality from measles occurred in Wolverhampton, Leicester,Birkenhead, and Salford ; from scarlet fever in Burnleyand Sunderland ; and from whooping-cough in Shef-field, Swansea, Cardiff, Bolton, and Plymouth. The mor-tality from " fever " showed no marked excess in any of thelarge towns. The 84 deaths from diphtheria included 42 inLondon, 11 in West Ham, 7 in Manchester, and 4 in Salford.Four fatal cases of small-pox were registered in Birmingham,3 in West Ham, 2 in London, 2 in Bristol, and 1 in Notting-ham ; but not one in any other of the thirty-three large towns.There were 81 cases of small-pox under treatment in the Metro-politan Asylum Hospitals and in the Highgate Small-

pox Hospital on Saturday last, the 24th ult., against 82, 77,and 78 at the end of the preceding three weeks; 18 newcases were admitted during the week, against 15 and 17 inthe preceding two weeks. The number of scarlet feverpatients in the Metropolitan Asylum Hospitals and in theLondon Fever Hospital, which had been 2491, 2387, and2270 at the end of the preceding three weeks, had furtherdeclined to 2181 on Saturday last; 180 new cases were

admitted during the week, against 224 and 199 in the pre-ceding two weeks. The deaths referred to diseases of therespiratory organs in London, which had declined from 762to 340 in the preceding six weeks, rose again to 408 lastweek, but were 89 below the corrected average. Thecauses of 76, or 1-9 per cent., of the deaths in the thirty-three towns were not certified, either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in Brighton, Portsmouth, New-castle-upon-Tyne, and in four other smaller towns; the

largest proportions of uncertified deaths were registered inBirmingham, Liverpool, Sheffield, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had declined in the preceding three weeks from 21’0to 19’2 per 1000, rose again to 20’6 during the week endingFeb. 24tb, and was 0 -6 per 1000 above the mean rate duringthe same period in the thirty-three large English towns. Therates in the eight Scotch towns ranged from 9 6 in Paisleyand 19-2 in Greenock to 24-2 in Dundee and 30-8 in Perth.The 588 deaths in these towns included 45 which were re-ferred to whooping-cough, 12 to diphtheria, 7 to diarrhoea, 4to scarlet fever, 4 to "fever," 1 to measles, and not one tosmall-pox ; in all, 73 deaths resulted from these principalzymotic diseases, against 74 and 67 in the preceding twoweeks. These 73 deaths were equal to an annual rate of 26per 1000, which slightly exceeded the mean rate last week fromthe same diseases in the thirty-three large English towns.The fatal cases of whooping-cough, which had been 28 and 35in the preceding two weeks, further rose to 45 last week, ofwhich 25 occurred in Glasgow, 6 in Edinburgh, 5 in Aber-deen, and 4 in Leith. The deaths referred to diphtheria,which had been 17 and 9 in the preceding two weeks,rose again to 12 last week, and included 9 in Glasgowand 2 in Dundee. The 4 deaths referred to different formsof I fever," showed a slight further decline from thoserecorded in recent weeks and included 2 in Glasgow. Thefatal cases of scarlet fever, which had been 11 and 8 in thepreceding two weeks, further fell to 4 last week, of which3 occurred in Glasgow. The deaths referred to diseases ofthe respiratory organs in these towns, which had been 12land 122 in the preceding two weeks, further rose to 127last week, but were 8 below the number in the correspond-ing week of last year. The causes of 51, or more than 8 percent., of the deaths in these eight towns last week were notcertified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 33’1 and 33-3per 1000 in the preceding two weeks, declined again to 29’2.during the week ending Feb. 24th. During the past eightweeks of the current quarter the death-rate in the city has.averaged 32-8 per 1000, against 21-7 in London and 18.9 inEdinburgh. The 196 deaths in Dublin during the weekunder notice showed a decline of 27 from the number in the

preceding week and included 14 which were referred to.the principal zymotic diseases, against 21 and 23 in thepreceding two weeks ; of these 14 deaths, 5 resulted from.whooping-cough, 5 from "fever," 2 from measles, 2 fromdiarrhoea, and not one either from small-pox, scarlet fever,or diphtheria. These 14 deaths were equal to an annualrate of 2’1 per 1000, the zymotic death-rate duringthe same period being 2’6 in London and 1-9 in

Edinburgh. The fatal cases of whooping-cough, whichhad been 8 and 10 in the preceding two weeks, declinedagain to 5 last week. The deaths referred to differentforms of "fever," which had been 4 and 3 in the precedingtwo weeks, rose again to 5 last week. The 2 fatal cases ofmeasles were within one of the number in the preceding week.The 196 deaths registered in Dublin last week included 27 ofinfants under one year of age and 60 of persons aged up-wards of sixty years; the deaths both of infants and of elderlypersons were below those recorded in the preceding week.Five inquest cases and 5 deaths from violence were regis-tered ; and 71, or more than a third, of the deaths occurredin public institutions. The causes of 12, or more than 6,per cent., of the deaths in the city last week were notcertified.

THE SERVICES.

MOVEMENTS OF THE MEDICAL STAFF.

THE following officers have arrived from India in theMalabar : Surgeon-Lieutenant- Colonel Fawcett and Surgeon-Captains Barefoot and Donaldson. Brigade-Surgeon-Lieu-tenant-Colonel Hughes and Surgeon-Captain Greig havearrived at the Straits Settlements. The following officershave embarked in the Euphrates for India: Brigade-Sur-geon-Lieutenant-Colonel Gunning and Surgeon - Lieutenant

Stalkartt. Surgeon-Captain Hallaran has been posted toNetley on return from foreign service. Surgeon-MajorM’Laughlin has been transferred from Woolwich to Glasgow.The following officers have joined at Aldershot from Netleyto undergo instruction in ambulance drill : Surgeon-Lieu-tenants Anderson, Browning, McMunn, Master, Prynne,Green, Clark, Boyle, Bennett, Simpson, Fox, Fleury, Tibbits,and Cameron. Brigade-Surgeon-Lieutenant-Colonel Holmes.has been posted to the Royal Infirmary, Dublin, and Surgeon-Captain Bate to Ireland. Surgeon-Captain S. E. Duncan,A.M.S., having embarked for Cyprus on the 9th ult., is.struck off the Netley strength from the 10th ult. Surgeon-Captain W. Hallaran, A.M.S., having joined at this station,is posted to the Surgical Division of the Royal Victoria.Hospital for duty, and to No. 4 Company Medical Staff Corps.as Subaltern.

INDIA AND THE INDIAN MEDICAL SERVICESThe Viceroy and Governor-General has made the following

appointments on his personal staff : to be Honorary Sur-geons : Surgeon-Major-General A. F. Bradshaw, C.B.,,A. M. S. ; Surgeon-Colonel A. C. Gaye, A M. S. ; Surgeon-Colonel G. C. Chesnaye, I M S. ; Surgeon-Colonel R. Harvey,M D , D.S O, 1 M S. ; Brigade-.Surgeon-Lieutenant-ColonelD. O’C. Raye, M.D., I M.S. ; Brigade-Surgeon-Lieutenant-Colonel D. D. Cunningham, M.B., C.I.E., I.M.S.; and Sur-geon-Lieutenant- Colonel A. J. Wilcocks, M.D., I.M.S. Thefollowing appointments are announced : Surgeon-CaptainA. W. T. Buist-Sparks, Officiating Resident Surgeon of theEden Hospital, Calcutta, temporarily to act as Civil Surgeonof Palamau. Surgeon-Captain B. H. Deane to act as DeputySanitary Commissioner, Northern Bengal Circle until furtherorders. Surgeon-Major J. B. Gibbons, Police Surgeon, to bean Official Visitor of the Presidency Gaol. Surgeon-MajorJ. W. Evans to act as Superintendent, Lunatic Asylum,Madras. Surgeon-Major J. C. Marsden to be District Sur-geon, Rajahmundry, sub pro tem. Surgeon-Captain W. C.Vickers, M.B., M.C., to be Civil Surgeon, Coconada, subpro tema. Surgeon-Captain J. B. Jameson, M.B., C.M., toact as Civil Surgeon, Jacobabad, in addition to his own

569"AERIAL CONVECTION OF SMALL-POX FROM HOSPITALS."

duties. The services of Brigade-Surgeon-Lieutenant-ColonelA. Cameron M.D., Civil Surgeon of Benares, are placedtemporarily at the disposal of the Military Department.

NAVAL MEDICAL SERVICE.The following appointments are notified: Staff-Surgeon

Robert Bentham, to the Raleigh. Surgeons : Daniel J. P.M’Nabb and Christopher L. W. Burton, to the Baleig7t;Samuel W. Johnson, M.B., to the Impregnable; Geo. B. D.Levick, Morris C. Langford, Percy H. Boyden, M.B., andHenry N. Stephens, to the Victory, additional ; Alfred H.Jeremy, B.A, M.B., to Plymouth Hospital ; Thos. D.Halsham, B.A., M.B, to the Pembroke; James P. Willis,M.B., to the St. Vincent, additional; Walter R. Knightly, tothe Excellent, additional ; Edward A. Rogers, to the Vivid,additional ; Arthur Gaskell, to the Excellent, additional ; andJ. D. Menzies, to the Euphrates.

VOLUNTEER CORPS.

Artille,ry 2nd Middlesex: Surgeon- Lieutenant- ColonelJ. W. Barnes resigns his commission ; he is permitted toretain his rank, and to continue to wear the uniform of theCorps on his retirement.-4th West Riding of Yorkshire(Western Division Royal Artillery) : Surgeon-Lieutenant H.Lockwood resigns his commission.-Rifle: 3rd VolunteerBattalion, the Queen’s (Royal West Surrey Regiment) :Campbell Boyd, Gent., to be Surgeon-Lieutenant.-2nd Volun-teer Battalion (the Suffolk Regiment) : Surgeon-LieutenantE. G. Barnes, M.D., resigns his commission.-3rd VolunteerBattalion (the Bedfordshire Regiment) : Surgeon-MajorH. F. Holland, M.D., to be Surgeon-Lieutenant-Colonel.-3rd Volunteer Battalion, the Queen’s Own (Royal West KentRegiment): Surgeon-Major W. R. Smith, M.D., to be Sur-geon-Lieutenant-Colonel -2nd (Berwickshire) Volunteer Bat-talion, the King’s Own Scottish Borderers : Jas. Marr, M. B.,to be Surgeon-Lieutenant.

VOLUNTEER MEDICAL STAFF CORPS.The London Companies : Surgeon-Captain D. Power, M.B.,

resigns his commission ; Howard Decimus Buss, Gent., to be’Surgeon-Lieutenant.

’

ARMY PHARMACY.A small committee is to assemble in Calcutta for the pur-

pose of drawing up suggestions for a revised edition of theBritish Pharmacopoeia, with a view especially to eliminatingfrom compound medicines all articles of an inert characteror possessing little or no therapeutic value. It has oftenbeen a matter of surprise to us, considering the greatimportance of reducing the number and bulk of drugs andmedicines taken on field service, that compressed medicinesare not utilised more than they appear to be in the publicmedical services. The subject has been frequently advertedto by medical officers and others. On field service in timesof war, when soldiers are subjected to careful medical in-.spection beforehand, and are at once sent from the front tohospitals in rear if at all seriously sick or wounded, thenumber and amount of drugs and appliances really requiredwith a fighting force are relatively small. A reduction inthis direction, and the substitution of the more active andcompressed preparations of the present day for the bulkydrugs and compounds in ordinary use, seem to be a desirablereform if it could be effected. Surgeon-Colonel R. Harveyhas been nominated as the president, with the senior medicalofficer, British troops, and the medical storekeeper at Calcutta,as members of the committee to assemble there.

BRITISH AND INDIAN MEDICAL SERVICES COMPETITIVEEXAMINATION.

The following is a list of successful candidates for com-missions in the Medical Staff of Her Majesty’s Army at therecent examination in London :-P. Evans (2849), J. P. Silver(2462), J. M. Buist (2391), H. W. Vaughan Williams (2390),.J. Walker (2365), T. E. Milner (2360), S. W. Sweetman (2860),F. Dove (2345), C. K. Morgan (2282), and G. H. C. Thom(2178) The following gentlemen successfully passed the recentexamination for the Indian Medical Service : G. Ramsay(3120), D. W. Sutherland (2754), W. Selby (2606), H. J. K.Bamfield (2604), W. D. Hayward (2565), A. H. Moorhead(2475), T. A. Granger(2470), H. M. Moore (2462), A. W. F.Russell (2384), D. C. Johnston (2304), C. R. Pearce (2304),J. W. Grant (2294), V. B. Bennett (2246), and W. E. Scott-Moncrieff (2192).

THE NAVAL MEDICAL SERVICE IN WEST AFRICA.We may mention in connexion with the late reverse in

West Africa, when Fleet-Surgeon White was wounded in theexpedition against Fodi Silah, that this officer has in conse-quence to be relieved. Fleet-Surgeon W. R. White, B.A.,M.B., of the Raleigle, entered the Royal Navy in 1871, becamea staff-surgeon in 1883 and a fleet-surgeon in 1892. He was ap-pointed to the Raleigh in September, 1891, and will be relievedby the surgeon of H. M. S. Coloss7is. The steamship PembrokeCastle is to proceed to Bathurst with a Royal Marine detach-ment and seamen, and will embark at Plymouth Staff-SurgeonBentham, and Surgeons McNabb and Bunton, together withsick-berth stewards and attendants. According to the latestintelligence, there appears to have also been some fightingat Bathurst, and the British force at that place is to be

strengthened by troops from Sierra Leone and Royal Marinesfrom the Cape.

UNIVERSITY FELLOWSHIPS.

Surgeon-Major H. W. B. Boyd, F.R.C S.Irel., Surgeon-Colonel D. E. Hughes, M.D., F.R.C.S.Edin., and W. Kay,M.D., have been nominated to be Fellows of the Uni-

versity of Bombay. Surgeon-Lieutenant-Colonel GeraldBomford, M.D. Lond., Principal of the Calcutta Medical

College, has been appointed a Fellow of the CalcuttaUniversity.

H. M. S. Malabar arrived at Portsmouth on the 22nd ult.with forty-seven patients for Netley.

Correspondence.

"AERIAL CONVECTION OF SMALL-POXFROM HOSPITALS."

"Audi alteram parbem."

To the Editors of THE LANCET.

SIRS,—Regarding Dr. Sisley’s queries as to what he callsmy "conclusions" on this subject, I have to premise thatthey only purport to be of a very tentative and provisionalcharacter. They are governed generally by the introductoryreservation "Summing up the evidence, so far as it is possible tosum up on a subject as to which so much is still to be learned " ;and again, " In endeavouring to summarise the agencieswhich have to do with this result (aerial convection), it isnecessary to bear in mind that other unknown agencies mayalso be involved, and that sometimes the joint action of allthe known agencies may not be necessary, special activity ofsome, perhaps, atoning for relative deficiency, or absence,and vice versâ, of others." In particular, as to the "conclu-sion " which troubles him most, what I have said in thebody of paper my is as follows : " In view of such facts, itis obvious that there is still much to learn regarding the wholequestion, and it is open to us to speculate whether the rhythmof epidemic and non-epidemic periods includes, as by analogywe may easily believe it to include, shorter rhythms of ebband flow of infectivity, having to do not with whole seasons,but with weeks or days." This possible agency would, how-ever, have been better and more clearly stated had it beennumbered by itself, and not classed as subdivision (e) of (1).These extracts appear to me to contain the answer to Dr.Sisley’s question, "Does Dr. McVail mean to imply thatthere are, or may be, facts about the method of spread ofsmall-pox of which we are ignorant ? " Speaking not as

’’ we,’’ but for myself only, most undoubtedly such ignoranceis exactly what 1 do mean to imply, and indeed I not onlyimply it, but I state it. The facts of which I speak above aresimply as referred to in my paper. The meteorological con-ditions (as to whose probable influence Dr. Sisley agrees withme) which twice previously at Fulham, and also in Water-house’s experience in the last century, had seemed to deter-mine the occurrence of an outburst (1’asting not for monthsor weeks, but only for days), recurred subsequently withinthe special area. Yet at Fulham, even with an increasednumber of acute cases in the hospital, no similar outburstfollowed such recurrence. Therefore, bearing in mind thatrhythm is a law of nature, and that this law is applicableto individual cases of disease, and especially of infectiousdisease, and that, indeed, epidemics are themselves examplesof the law, it seems to be no very far-fetched suggestionthat possibly-as there are always rhythms within rhythms,lesser within greater, shorter within longer-the differences in