1345VITAL STATISTICS.-THE SERVICES.

105, or 2’2 per cent., of the deaths in the thirty-three townswere not certified either by a registered medical prac-titioner or by a coroner. All the causes of death were

duly certified in Brighton, Cardiff, Leeds, Sunderland, andin seven other smaller towns; the largest proportions ofuncertified deaths were registered in Birmingham, Leicester,Liverpool, and Hull. -

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased from 18 ’2 to 20 ’3 per 1000 in the pre-ceding three weeks, further rose to 24’3 during the week endingNov. 18th, and was 0 3 per 1000 above the mean rate duringthe same period in the thirty-three large English towns. Therates in the eight Scotch towns ranged from 18’5 in Dundeeand 21 7 in Aberdeen to 28-6 in Paisley and 36 0 in Perth.The 684 deaths in these towns included 27 which werereferred to whooping-cough, 12 to scarlet fever, 11 to diph-theria, 10 to diarrhoea, 6 to "fever," 1 to measles, and1 to small-pox. In all, 68 deaths resulted from these

principal zymotic diseases, against 52 and 61 in the pre-ceding two weeks. These 68 deaths were equal to anannual rate of 2’4 per 1000, which was slightly below the meanrate last week from the same diseases in the thirty-threelarge English towns. The fatal cases of whooping-cough,which had increased from 9 to 19 in the preceding three weeks,further rose to 27 last week, of which 19 occurred in Glasgowand 4 in Edinburgh. The deaths referred to scarlet fever, whichhad been 5 and 10 in the preceding two weeks, further in-creased to 12 last week, of which 7 occurred in Glasgow.The 11 fatal cases of diphtheria corresponded with thenumber in the preceding week, and included 3 in Aberdeen,2 in Glasgow, and 2 in Dundee. The deaths referred todifferent forms of "fever," which had been 5 and 7 in thepreceding two weeks, were 6 last week, of which 2 occurredin Glasgow and 2 in Dundee. The fatal case of small-poxwas recorded in Leith. The deaths referred to diseases ofthe respiratory organs in these towns, which had been 103and 141 in the preceding two weeks, further rose to 212last week, and exceeded by so many as 75 the number in thecorresponding week of last year. The causes of 60, or nearly9 per cent., of the deaths in these eight towns last week werenot certified.

____

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 26 8 and 26’7per 1000 in the preceding two weeks, rose again to 27 6during the week ending Nov. 18th. During the past seven weeksof the current quarter the death-rate in the city has averaged24-9 per 1000, against 19-8 in London and 19-4 in Edinburgh.The 185 deaths in Dublin during the week under noticeshowed an increase of 6 upon the number in the previousweek and included 16 which were referred to the prin-cipal zymotic diseases, against 27 and 19 in the precedingtwo weeks ; of these, 6 resulted from whooping-cough, 3from "fever," 3 from diarrhoea, 2 from measles, 2 from

diphtheria, and not one from small-pox or scarlet fever.These 16 deaths were equal to an annual rate of 24 per1000, the zymotic death-rate during the same periodbeing 3’2 in London and 2-0 in Edinburgh. The fatalcases of whooping-cough, which had been 2 and 8 in thepreceding two weeks, declined again to 6 last week. Thedeaths referred to different forms of "fever," which hadbeen 10 and 4 in the preceding two weeks, further declinedto 3 last week, a smaller number than in any week sinceAugust last. The 3 fatal cases of diarrhoea also showed afurther decline from recent weekly numbers. The 185 deaths

registered in Dublin last week included 27 of infants underone year of age and 46 of persons aged upwards of sixtyyears ; the deaths of infants corresponded with those recordedin the preceding week, while those of elderly persons exceededthe number in any recent week. Five inquest cases and 2deaths from violence were registered ; and 54, or nearly athird, of the deaths occurred in public institutions. Thecauses of 19, or more than 10 per cent., of the deaths in thecity last week were not certified.

FOOTBALL FATALITY.-A youth aged eighteenyears, of Normanby, near Middlesbrough, has died from in-juries sustained on llth inst. during a match between Nor-manby and the Acklam Swifts.

THE SERVICES.

SURGEON-MAJOR POWELL and Surgeon-Captains Hosie andWhaite have reported their arrival from India on completionof a tour of foreign service. The following officers havereceived orders to embark for India in the lTclabar Sur-geon-Colonel Gore, Surgeon-Lieutenant-Colonel Thomsett,Surgeon-Major Carleton, Surgeon-Captains Way, Fitzgerald,Tyacke, and Healy. Surgeon-Captain Long has reported hisarrival in England after a tour of service on the West Coastof Africa. Surgeon-Captain Pinching, Egyptian Army, hasre-embarked for Egypt on termination of leave. Surgeon-Lieutenant-Colonel Kirwan has been posted to the North-Eastern District. Surgeon-Major Coates has been transferredto Cork, and Surgeon-Captain Shine has arrived in Malta.The following officers have rejoined their several stations fromleave of absence : Surgeon-Major-General Wade, Brigade-Surgeon-Lieutenant-Colonel Mackinnon, and Surgeon-Majors.Ellis and Cree, Aldershot; Surgeon-Lieutenant McNaught,Curragh, and Surgeon-Lieutenant Mansfield, Eastern District.At Netley Surgeon-Lieutenant L. P. Moore is transferred frcmNo. 5 Company to No. 4 Company, Medical Staff Corps, forduty. Under the authority of the Director-General, A.M.D.,Surgeon-Captain D. Semple has been relieved of the commandand pay duties of No. 4 Company, Medical Staff Corps, bySurgeon-Captain G. Cree.

MOVEMENTS IN THE MEDICAL STAFF.The next examination for admission to the Army Medical

Staff will be held at the Medical Hall, Victoria Embankment,on Feb. 9th next and following days.

INDIA AND THE INDIAN MEDICAL SERVICES.The following appointments are announced : Brigade-Sur-

geon-Lieutenant-Colonel T. Ffrench Mullen, M.D., I.M.S.(Bengal), Civil Surgeon of Bikanir, to officiate as Residency

: Surgeon in the Western States of Rajpntana until furtherorders. Surgeon-Major H. N. V. Harington, I. M.S. (Madras),Medical Officer of the Deoli Irregular Force, and of theHaraoti and Tonk Pol Agency, on being relieved of his.

appointment as Officiating Agency Surgeon in Ulwar to-officiate as Civil Surgeon of Bikanir. Surgeon-Captain J.Chaytor-White, M.B., LM.S. (Bengal), on being relieved ofhis appointment as Officiating Civil Surgeon of Ajmere, andOfficiating Medical Officer of the Merwara Battalion, reap--pointed to cfficiate as Medical Officer of the Meywar BhilCorps. Brigade-Surgeon-Lieutenart-Ccl&neI Lethbridge has.resumed Charge of the Thagi and Dacoity Department onreturn from England. The following postings and trans-fers of Medical Officers are ordered : Surgeon-Lieutenant-Colonel H. Johnstone to be Civil Surgeon, Rangoon ; z.Surgeon-Major S. H. Dantra, Officiating Civil Surgeon,Rangoon, to revert to his substantive appointment of JuniorCivil Surgeon, Rangoon; Surgeon-Captain J. H. Sellick,Officiating Junior Civil Surgeon, Rangoon, to be Civil Sur-geon, Myingyan, and Surgeon-Captain R. H. Castor, CivilSurgeon, Myingyan, to be Civil Surgeon, Yamethin. Sur-geon-Colonel Harvey, now discharging the duties of Surgeonto the Viceroy, will take up the post of Inspector-General ofCivil Hospitals in Bengal. Surgeon-Colonel A. A. Gore,A. M. S., has been appointed an Administrative Medical Officerin the Bombay Presidency, in succession to Surgeon-ColonelJ. Davis, Principal Medical Officer, Mhow District, whohas been selected for the appointment of Principal MedicalOfficer, Madras Army. Surgeon-Captain S. E. Prall hasreceived Charge of the Shikarpur Gaol. Surgeon-Captain.W. H. M. Ingham, I.M.S., has been transferred to the

permanent half-pay list. Surgeon-Major A. Watt, Sappers.and Miners, Bengal, is promoted to the rank of Conductor-in succession to Conductor J. Macqueen, transferred to the-pension establishment.

NAVAL MEDICAL SERVICES.

The following appointments are announced : Fleet-Surgeon,George B. Murray to the Resolution (Dec. 5th). Staff-Surgeons : A. H. Miller to the Audacious (Dec. 28th) vJ. J. Dinnis, to the J1jlexible (Dec. 5th). Surgeons : C.

Alsop, to the Malta Hospital (Nov. 15th), H. Harries, to the-4felita (Nov. 15th); P. Bassett-Smith, to the Royal MarineDivision, Plymouth (Nov. 15tb) ; J. C. Durston, H. N.Stephens, E. A. Rogers, G. D. B. Levick, M. C. LangfordP. H. Boydon, A. H. Jeremy, M.B.. J. P. Willis, M.B., W. R.Knightley, J. W. W. Stanton, A. Gaskell, and T. D. Halahan,to the Haslar Hospital (all Nov. 25th) ; Charles Facey, to the-

1346 THE PRESENT EXAMINATION SYSTEM.

Resolution, and Francis H. A. Clayton, to the Superb (to dateDec. 5th) ; and George D. Trevor-Roper, to the Moharvk (to,date Dec. 1st).

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Major Andrew Clark to be Surgeon-Lieutenant-’-Colonel ; Surgeon-Major Samuel Smith to be Surgeon-Lieu-tenant-Colonel ; and Surgeon-Captain Robert Wm. Edginton,TM.D, lst Worcestershire and Warwickshire Volunteer.Artillery, to be Surgeon-Major.

VOLUNTEER CORPS.Fortress and Railway Forces (Royal Engineers) :

1st Gloucestershire : Surgeon-Lieutenant W. Cox to be

Surgeon- Captain. --Rifle: 2nd Volunteer Battalion, the Sher-- wood Foresters (Derbyshire Regiment) : William TweedHannah, M.B., to be Surgeon-Lieutenant.

SURGEON TO THE VICEROY OF INDIA.

The Earl of Elgin has appointed Surgeon-Major Franklin,!I.M.S., as Surgeon to serve upon the Viceregal Staff.

OUR MILITARY EDUCATIONAL INSTITUTIONS.

The reports of the Board of Visitors to the Royal MilitaryCollege at Sandhurst and the Royal Military Academy, Wool-’wich, just published, will not prove altogether pleasant read-ing for those concerned. The Board of Visitors evidentlymade a minute and thorough inspection of these establish-ments. They comment adversely upon several points con- nected with the system in force at Sandhurst, more particu- Ilarly the extravagant conduct of the mess, the entertain-ments called "gymkhanas," the insufficient time devoted tostudy, and other matters. As regards the appearance andhealth of the cadets and the sanitary condition of the

College the report is, however, quite satisfactory, The Boardof Visitors report, on the other hand, that they are quite.satisfied with the mess system at Woolwich, but they again,call attention to the insufficient and bad hospital accommoda-tion provided for the cadets at the Royal Military Academy,to various points connected with some of the equipmentsupplied to the institution for instruction purposes, and tothe course of study pursued at the Academy. The health ofthe cadets was very good.

The following gentlemen who competed at the examina-tion held on Nov. 6th and following days at ExaminationHall, Victoria Embankment, for appointment as Surgeon in’the Royal Navy, have been successful : J. P. Willis, 2952wnarks ; W. R. Knightley, 2692 ; J W. W. Stanton, 2663 ; A.Gaskell, 2622 ; T. D. Halahan, 2448 ; J. C. Durston, 2418 ;H. N. Stephens, 2401; E. A. Rogers, 2398 ; G. D. B. Levick,2317 ; and M. C. Langford, 2246.

H.M.S. Eupferates sailed from Bombay on the 4th inst.with ninety invalids for Netley.

Correspondence.

THE PRESENT EXAMINATION SYSTEM.

"Audi alteram partem."

To the Editors ot THE LANCET.

SIRS,-The large and increasing proportion of rejections is;at last attracting attention. When we reflect on the fact:that rejections have run up to some 30 per cent. of the,examined-twice what the proportion was twenty years ago,: three times what it was thirty years ago-it goes withoutsaying that there is something wrong in the present system,of examination, or in the teaching, or in their relation to,each other. It is not the student’s blame. He is not less.industrious than when I knew him twenty, thirty or fiftyyears ago. The views of one who has had experience inteaching and in examining and who is free to speak mayperhaps be of some use at the present time.

I believe that the present system of examination fails.seriously to secure the desired results, and that it is injuriousto good medical education. The education is the main

- thing, but the education is regulated by the examinations,more and more so as these are multiplied. Using the word"cramming " deliberately, I hold that the present examina-tion system leads to and rewards cramming; that it does

so (a) by the multiplication of examinations, and (b) bywrong method at the examinations.

(a) I am not here suggesting any departure from the generalrecommendation made by the General Medical Council, andadopted by the various examining bodies, that there should,in the new five-year course, be four examinations. The evillies in the boards having allowed subdivision of these fourexaminations, and in intervals between the four examinationsnot having been prescribed. The result is that the candidatemay take the examinations bit by bit, one subject at a time,for which he crams.

Thus, under the regulations of the Conjoint Board, the firstexamination may be taken in England in four parts atdifferent times, in Scotland in three parts, the third examina-tion at both boards in three parts, and the fourth examinationin four parts at the Scotch Board. For each of these bit-by-bit examinations the student crams up, and the teaching hasto be shaped accordingly ; student life consists not in study-ing to know his profession, but in the distractions of pre-paring for this or that bit of examination, and the teacherhas too commonly fallen to the rank of a " grinder." The evil of the bit-by-bit system comes out most mani-

festly in the examination in medicine, surgery, and mid-wifery being allowed to be taken in three parts atdifferent times. Of what real value is the kind of surgicalor medical or obstetric knowledge that the candidate couldnot carry in his head, or prove with his hands, beyond thethree or the six or more months that may intervene betweenthe first, the second and the third bits of the examination?It is the examination for the general practitioner, and theaim of the examination should be to test the man’s wholefitness to practise his profession. The permission to take thepreliminary examination bit by bit led to such abuse thatwe had to put a summary stop to it and require the whole tobe passed at one time. The four examinations already giveas much subdivision of the professional examination as oughtto be allowed ; I would say they are one too many unless thefourth is to be strictly clinical. It belongs to the schools tosee that their students take the classes in the proper order,and to each teacher to see that his students are working.The object in the examinations held by a licensing beardshould be to test, not what the student can cram, but, afterdue time allowed for study, to test what he has retained.

While thus criticising the regulations of the London Con-joint Board in regard to the bit-by-bit system, towards whichthey appear to stand in loco parentis, I would ask the con-sideration of other boards to two admirable rules in theseregulations : 1. Intervals are prescribed between the fourexaminations ; six months between the last bit of the firstexamination and admission to the second; two yearsbetween the second and third examinations ; and a yearbetween the third and the final examination. 2. Thisfinal examination is exclusively a clinical examination inmedicine and surgery, and in midwifery and gynæcologyif that subject has not been taken with the previous generalexamination in medicine and surgery and allied subjects atthe end of the fourth year. It is the only board, so far as I amaware, that has ensured the carrying out of the recommenda-tion of the General Medical Council that the fifth year shouldbe devoted to clinical work at hospitals or dispensaries or, itmay be, half of it spent in pupilage with a practitioner.Except in regard to a weakness in securing efficient teachingin the auxiliary sciences (at present a question for the GeneralMedical Council to deal with), and except in regard to the bit-by-bit system, which may be easily dropped, I would hold upthe regulations of the English Conjoint Board as typical ; as onthe wbole the best we have in the United Kingdom, those ofno university excepted, for producing the best article foradmission to the medical profession. The special points ofmerit are the compulsory intervals, and, by the last of these,securing the fifth year exclusively for practical work.

(b) Still more injurious to education and futile in results Ihold to be the present method of conducting the examina-tions. Far too much importance is attached to the writtenpart. What we wish is real knowledge, not merely word know-ledge. Written examination, so far as I could learn, is notemployed in medical examinations in France or in Germany,and is of comparatively modern use in this country. Ithas grown vastly at some boards, and much might be said asto its baneful antecedent influence on the teaching. Longexpeiience in teaching and in examining at various boardshas taught me to attach little weight to written examination.It has the seductive recommendation of saving the time ofthe examiners. I would continue it for that purpose in a.