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Metropolitan Asylum Hospitals and in the London FeverHospital at the end of the week was 1677, against1484 and 1592 on the preceding two Saturdays ; 226 newcases were admitted during the week, against 200 and 232in the previous two weeks. The deaths referred to diseasesof the respiratory organs in London, which had been 297and 304 in the preceding two weeks, declined to292 last week, and were 38 below the corrected average.The causes of 80, or 21 per cent., of the deaths in thethirty-three towns were not certified either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in Croydon, Portsmouth, Bristol,Bolton, Leeds, Sunderland, and in seven other smallertowns ; the largest proportions of uncertified deaths wereregistered in Liverpool, Manchester, Hall, and Gateshead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns.which had increased in the preceding three weeks from 21-3to 22 ’8 per 1000, declined again to 21’5 during the week endingMay 21st, but exceeded by 2-3 per 1000 the mean rateduring the same period in the thirty-three large Englishtowns. The rates in the eight Scotch towns ranged from13-9 in Edinburgh and 16-1 in Paisley to 20-8 in Leith and26-8 in Glasgow. The 598 deaths in these towns included32 which were referred to measles, 26 to whooping-cough,9 to scarlet fever, 5 to " fevsr," 4 to diarrhoea, 2 to diph-theria, and not one to smIÛ1-pox. In all, 78 deaths resultedfrom these principal zymotic diseases, against 65 and80 in the preceding bwo weeks. These 78 deaths wereequal to an annual rate of 2-8 per 1000, which slightlyexceeded the mean fate last week from the same diseasesin the thirty-three large English towns. The fatal casesof measles, which had increased in the preceding four weeksfrom 15 to 32, were again 32 last week, all of whichoccurred in Glasgow. The deaths referred to whooping-cough, which had been 30 and 24 in the previous two weeks,were 26 last week, and included 16 in Glasgow, 4 inAberdeen, and 3 in Dundee. The fatal cases of scarlet fever,which had been 5 and 2 in the preceding two weeks, roselast week to 9, of which 7 occurred in Glasgow and 2 inEdinburgh. The 5 deaths referred to different forms of" fever " showed a decline of 3 from the number in the pre-vious week, and included 3 in Glasgow and 2 in Dundee.The 2 fatal cases of diphtheria were recorded in Glasgow. Thedeaths referred to diseases of the respiratory organs in thesetowns, which had been 126 and 140 in the preceding twoweeks, declined again last week to 126, and were 19 belowthe number in the corresponding week of last year. Thecauses of 60, or 10 per cent., of the deaths in these eighttowns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had declined in thepreceding three weeks from 43’9 to 31’0 per 1000, rose againto 3 4’6 during the week ending May 2lst. During the nrstseven weeks of the current quarter the death-rate in thecity averaged 34-6 per 1000, against 20’0 in London and 18-9in Edinburgh. The 232 deaths in Dublin during the weekunder notice showed an increase of 24 upon the number inthe preceding week, and included 28 which were referred tomeasles, 5 to diarrhoea, 3 to whooping-cough, 1 to " fever,"and not one either to small-pox, scarlet fever, or diphtheria.In all, 37 deaths resulted from these principal zymoticdiseases, equal to an annual rate of 5’5 per 1000, ’’,the zymotic death-rate during the same period being3-3 in London and 08 in Edinburgh. The fatalcases of measles, which had been 40 and 24 in thepreceding two weeks, rose again to 28 last week. The5 deaths referred to diarrhoea exceeded the number recordedin any week of this year. The fatal cases of whooping-cough, which had declined from 11 to 3 in the precedingthree weeks, were again 3 last week. The 232 deathsregistered in Dublin last week included 47 of infants underone year of age, and 51 of persons upwards of sixty years;the deaths both of infants and of elderly persons consider-ably exceeded the numbers in the preceding week. Sixinquest cases and 4 deaths from violence were registered ;and 70, or nearly one-third, of the deaths occurred in publicinstitutions. The causes of 24, or more than 10 per cent.,of the deaths in the city last week were not certified. ,

THE SERVICES.

A COMPARISON.

THE Journal of the United Service Institution of Indiafor March contains a paper by Surgeon Crenel R. Harvey,M.D., Principal Medical Officer of the Panjab FrontierForce, in which a comparison is set forth between themedical arrangements for the expeditions of Lushai( 1871-72}and Miranzai (1891). with reference to the bearing of thesubject upon the efficiency of the troops and followersemployed on those occasions. After adverting to the lossof life that attended the Crimean and other campaigns, andthe reorganisation of the medical service that followed theCrimean breakdown, Surgeon-Colonel Harvey proceeds to’illustrate the difference in method between the old regi.mental and modern field hospital systems by a comparisonin their working as exemplified in the Lushai campaign of1871-72 and the late expeditions on the Samana. Thecontrast hows what immense advances have been made inrecent years. According to a tabular statement, we findthat in the Lushai expedition, out of a total strength of4564, composed of troops, coolies, and followers, 453 died, orin the ratio of 238’21 per 1000 per annum ; whereas, in thefirsb Miranzai expedition, out of a total strength of 7364troops and followers, only 6 died, a mortality rate of 7’83per 1000 per annum; and in the second Miranzai expedi.tion, out of a strength of 10,085 troops and followers,.the total deaths were 26, and of these only 10 were fromdisease, or in the ratio of 6’65 per 1000 per annum.

The paper discusses the causes to which this enormoasdifference-the great mortality of the one and theinsignificant death-rate of the other expeditions-was due.These may be summarily expressed by the scientific formula" non-conformity to environment" in the one case, 11 con-formity to environment" in the other. Had all the arrange.ments been alike in the two cases the results would havebeen similar, and the deplorable amount of suffering andloss in the Lushai campaign would have been saved. It isonly right to recognise that the Government of that daybased its arrangements and rates of provision on previousexperience, tradition, and the best advice available, with adesire, no doubt, at the same time to do things cheaply. Inthe Lushai campaign great natural difficulties had to beencountered, and the means taken to cope with them wereinadequate. In the Miranzai expedition great, though not.so great, difficulties were also met with, but the meanstaken were adequate. We have not space to enter into thedetailed information set forth, but it is satisfactory to note-that great progress, according to this paper, seems to havebeen made of late years in the hygienic and medical arrangements of our Indian Army.

THE ELECTRIC LIGHT AND THE SEARCHING FORWOUNDED.

It has long been a problem how a battlefield on the nightsucceeding a battle could best be searched and stripped ofits wounded. Many years ago an experiment was carriedout at Aldershot wivh the electric light, and quite recentlythe Austrian medical authorities have been making similarexperiments with the same end in view. It has been foundthat powerful search lights with reflectors are very effectiveaids where the country is open, but of comparatively littleuse where there are woods. An experiment has now bpeutried with portable electric lanterns, fed by accumulators,carried in the men’s knapsacks. The men of the ArmyMedical Service conducted an experiment of this kind atGratz, which is said to have been fairly successful, and islikely to be repeated.

NEW BARRACKS FOR THE CHIN HILLS.The want of proper barrack accommodation for the troops

in the Chin Hills having been much felt, a special grant forthe construction of barracks has now been sanctioned. Thework will be proceeded with as soon as possible at Forb.White and Haka.

ARMY MEDICAL STAFF.

Surgeon-Captain T. A. Perry Marsh has been appointedanalysb to the Aldershot Division.—Surgeon-Colonel A.Allan has been appointed to the Rawul Pindee District,,vice Surgeon-Major-General A. F. Bradshaw, C.B., ap-pointed Principal Medical Officer in Iadia. -Surgeon-Captain J. R. Yourdi has been posted to the charge of the

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Station Hospital, Aden; Surgeon Cttptain T. M Coikerto the Station Hospital, Hderabd; Sargeon-CtptainH. J. WyatS to the Poona District.The retirements on temporary half.pay on account of ill-

health of the undermentioned Surgeon-Captains are post-dated a.9 follows :-John Lees Hall to Sept. 3rd, 1891,Vere Eiward Honter. to June 29fh, 1891, and WhitleyBland Stokes, M.B., F.R.C.S L, to March 2nd, 1890.-TheQ’leen has approved ot the resignation of the Service byine undermentioned Officer: Surgeon-Captain HerbertWilliam George Macleod, BjEgal Medical Establishment(dated April 25th, 1892).YEOMANRY CAVALRY. - Northumberland (Hussars):

Arohur Brumell, Gent., to be Surgeon-Lieutenant (datedMay 2lst, 1892).

INDIAN MEDICAL SERVICE.

We regret to announce the death of Brigade- Surgeon Win.Dymock, retired Madical Storekeeper, with the BombayGovernment. Deceased was at one time connected with theEuropean General Hospital. He held the post of MedicalStiorpkeeper from 1870 to 1890. In addition to his dutiesM Mtidical Soorekeeper, the late cinser held the post ofProfessor of Materia Medica in the Grint Medical College.He was well versed in Arabic and Persian languages, andwas the author of the 11 Pharmacographia bdica.’The civil hospital assistants in the Punjab have me-

morialised the Surgeon-General with the Government oflndia, praying for an improvement of their emolumentsand status, on the lines sanctioned for the military branchof hospital assistants.Madras -General Orders,-SargeonMaj)f A. H. Leaping-

well, District Surgeon, Malabar, and Superintendent ofGaol, Calicut, is appointed to act as District Surgeon andSuperintendent of GaGl, Vizagapatam, during the absence ofSurgeon-Mttjor Lionel Beech onleave.-Mr. C. A. Lifienais,Assistant Surgeon, Ma!abar, is appointed to act as DistrictSurgeon, Malabar, and Superintendent of Gaol, Calicut, asa temporary arrangement, during the employment of Sar-geon-Major Leapingwell on other duty.-Surgeon-Major1’. H. Pope, M.D., Acting Chemical Examiner to Govern-ment, is appointed to acv as Superintendent, OphthalmicHospital, Madras, during the absence of Brigade-Sargeon-LieatenaHt-Colonel E. F. Drake-Brockman. - Surgeon-Captain F. J. Crawford, M.D., Second Surgeon, GeneralHospital, is appointed to act as Secretary to the Surgeon-General with the Government of Madras, during the absenceof Surgeon-Major C. M. Thompson, M.B., on leave -Sur-geon-Captain A. T. Lodgepatch, M.B., Acting Civil Sur-geon, Cosonada, is appointed to act as Civil Surgeon,Cannanore, during the emplovment of Surgeon-Major S. C.Sarkies on other duty.-The Commander-in-Chief is pleasedto direct the following postings:—Brigade-Sargeon-Lieu-tmant-Colonel G. Andrew, M.B., in medical charge of theNorth Ssation Hospital, Bangalore, to the medical charge ofthe South Station Hospital, Secunderabad; Surgeon-MajorG. D. Bjurke, in medical charge of the South Station Hos-pital, Sesuaderabad, to the medical charge of the CentralStation Hospital, Secunderabad, - Surgeon-LieutenantW. C. Sprague, M.D., has been brought on the strength ofthe BJmbay Medical Establishment from the 23rd ulb.,the date of his arrival at Bomb&y—Stirgeon-Lieuhenant-Colonel W. MeConaghy, M.D., Indian Medical Service,and Major H. C. E. Lucas, Indian Sbaff Corps, have beenpermitted by the Secretary of Sbate for India to return to’duty.—Surgeon-Captain A. Street, Indian Medical Service(in medical charge of the No. 5 Bombay Mountain Battery),left Poona en route for Neemuch on the 22nd ult., to takeover the medical charge of the 26 !)h Bombay Infantry.-Theservices of Surgeon Captain M. B. Braganza, IndianMedical Service, 24h Bombay Infantry, have been re-

placed at the disposal of the Military Department, fromFeb. 18th, on which date he was relieved of hisudties as Officiating Medical Officer of the 2nd RegimentCentral India Horse and of the Western Malwa PoliticalAgency.NAVAL MEDICAL SERVICE. - The following appoint-

ment has been made at the Admiralty:-Deputy-Inspector-General of Hospitals and Fleets Duncan Hilston, M D., hasbeen promoted to the rank of Inspector-General of Hos-pitals and Fleets in Her Majesty’s Fleet (dated My 7th,1892

Correspondence.

"THE DEBATE ON RENAL DROPSY."

Audi alteram parbem."

To the Editors of THE LANCET.SIRS,-Your leading article of last week on the debate

the Medical and Chirurgical Society on Renal Dropsymakes ib necessary for me to correct one expression whichfell from me which was far from conveying my meaning. Iam represented as thanking Dr. Broadbent for supporting,no) myself, but the trubh. Far be it from me to presumethat those who think with me therefore think right. Whatwas in my mind to say-and I regret that my haste orawkwardness of speech prevented my saying it clearly-was

, that I recognised in Dr. Broadbent, not a desire to supportmyself personally, but to support what he thought to be

. true, and claimed for myself the same aim as supremeabove personal contention. I had been careful even to

, iteration to say that there was no finality in an explanationwhich had been suggested ; that some of the questions

: before the Society were difficulb and complicated; thatfurther help from physiologists was needed. I do not

, claim to be the exponent of truth, but only a seeker for it.With what modicum of success this search has beenattended I should shrink from expressing an opinion, whichwould certainly be biased, and not improbably erroneous.

I am glad to take this opportunity of disclaiming anarrogance as foreign to my intention as inconsistent with

. my senpe of propriety,-I am, Sirs, yours truly,Mav 25th. 1892. W. HOWSHIP DICKINSON.

INCREASE OF SMALL-POX AND THE INTERIMREPORT OF THE VACCINATION

COMMISSION.

To the Editors of LANCET.

SIRS,-The two letters on the above subjects in yourissue of the 21st insb. are fraught with matter of thegreatest importance to the future of this densely populatedcountry, and I trust you will allow me to briefly allude toit. With reference to the first, I have little doubt thatwhen the force of the small-pox contagion rises, the vastamount of inefficient vaccination, as evinced by the lastsmall-pox epidemic ab Sheffield, will be terribly manifested;and with regard to the second, the isolation and destructionof propagating inntiences in places like Leicester willbe severely tested, as the present protection of thatcity is largely due to the amount of even the par-tially efficient vaccination around it, reducing thepoints of attack to a manageable number. This in-terim report, however, of the Vaccination Commission,if carried out, must lead to the complete failure of themethods now employed at Leicester to limit the small-poxcontagion, as year by year the numbers of unvaccinatedcases around the city will increase ; for within a few monthsof the suggestions of the Vaccination Commission becominglaw, anti-vaccination insurance societies will spring up,which for a very small monthly payment will readily providethe amount of the fine imposed, and as these penalties are noto be cumulative, the case will, of course, remain " unvac-cinated." I was quite prepared for this decision of theVaccination Commission, as the practical failure ofvaccination at Sheffield and the saoceas of isola-tion at Leicester must have had a great effect on

many of the members composing the Commission, and,doubtless, led some to ask, Why continue finingthose who persistently reject vaccination, when their

system of protection, when judged by results, seems sosuperior to that which cost so much in rewards aloneat Sheffield, and yet failed so signally, and that in the caseof a city whose manufactures-iron and steel-are least ofall capable of retaining or propagating the small-pox iD-

fection. Here, perhaps, I may allude to a strange anomalywitnessed in the mode of conducting inquiries in the failmeof various systems when danger to life is incurred. In mvpaper, read at the Epidemiological Society of London thisyear, entitled "What is Efficient Vaccination?" I ask a