1188

past six months ; the highest death-rate last week from thiscause was 1’ 5 per 1000 in Grimsby. The number of scarletfever patients under treatment in the Metropolitan AsylumsHospitals, which had shown a continuous increase from 2658to 4752 in the 23 preceding weeks, had further risen to 4995at the end of last week ; the new ca-es admitted during theweek numbered 820, against 787, 759, and 752 in the threepreceding weeks; these numbers greatly exceed the admis-sions in any previous four weeks. The deaths in Londonreferred to pneumonia and other diseases of the respiratorysystem, which had risen from 116 to 175 in the six precedingweeks, declined again to 167 in the week under notice, andwere 56 below the corrected average number in the corre-sponding periods of the five years, 1902-06. The causes of38, or 0’ 8 per cent., of the deaths registered in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in London, Leeds, West Ham, Bradford,Newcastle-on-Tyne, and in 51 other of the 76 towns; sevenuncertified deaths were registered in Birmingham, four inin Liverpool, three in Manchester, in Sheffield, and inGateshead, and two in Portsmouth, in Preston, and inBirkenhead.

___

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 13’ 2 and 13’ 8 per1000 in the two preceding weeks, further rose to 14’ 0 per1000 in the week ending Oct. 19tih, but was 1.7 per 1000below the mean rate during the same period in the 76large English towns. The rates in the eight Scotch townsranged from 11.7 in Aberdeen and 12 8 in Edinburgh to19.8 in Dundee and 24.0 in Perth. The 486 deaths inthese towns last week exceeded by seven the number in theprevious week, and included 61 which were referred to theprincipal epidemic diseases, against 57 and 81 in thetwo preceding weeks. These 61 deaths were equal to anannual rate of 1’ 8 per 1000, which was 0’ 6 per 1000below the mean rate during the same period in the 76large English towns; they included 26 which were

referred to diarrhoea,, 10 to "fever," eight to measles, eightto diphtheria, six to whooping-cough, and three to scarlet fever,but not any to small-pnx. The deaths from diarrhoea, whichhad been 23 and 37 in the two preceding weeks, declined againto 26 in the week under notice, and included 14 in Glasgow,four in Dundee, three in Edinburgh, and two in Paisley.The fatal cases of "fever," which had been six, eight, ten,and 11 in the four preceding weeks, numbered ten last week,and included seven which were attributed to cerebro-spinalmeningitis ; four of these occurred in Glasgow, two in Leith,and one in Edinburgh. The deaths from measles, which hadbeen two and nine in the two preceding weeks, declinedagain to eight in the week under notice, and included fourin Glasgow and four in Dundee. The fatal cases ofdiphtheria, which had been two, three, and seven in thethree preceding weeks, further rose last week to eight, ofwhich three were registered in Glasgow and two in Paisley.The deaths from whooping-cough, which had been 15, 17, and15 in the three preceding weeks, fell to six last week, andincluded three in Glasgow. The deaths in these eight townsreferred to diseases of the respiratory organs, includingpneumonia, which had been 65 and 51 in the two previousweeks, rose again to 71 in the week under notice, but were26 below the number in the corresponding period of last

year. The causes of 16, or 3’2 per cent., of the deathsregistered in these towns last week were not certified or notstated ; in the 76 large English towns the proportion of un-certified deaths did not exceed 0’ 8 per cent.

HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which had beenequal to 18 - 6, 21’ 0, and 20 ’ 2 per 1000 in the three pre-ceding weeks, was 20 ’ 3 per 1000 in the week ending Oct. 19th.During the first three weeks of the current quarter the death-rate has averaged 20.5 per 1000, the rate during the sameperiod being 13.9 in London and 13 0 in Edinburgh. The152 deaths of Dublin residents registered during the weekunder notice were one in excess of the number in the previousweek, and included 19 which were referred to the principalepidemic diseases, against 22, 18, and 30 in the three precedingweeks ; of these, 15 resulted from diarrhoea, two from whoop-ing-cough, one from scarlet fever, and one from" fever,"but not any from small-pox, from measles, or from

diphtheria. These 19 deaths were equal to an annualrate of 2’ 5 per 1000, the death-rate last week fromthe principal epidemic diseases being 1.8 in Londonand 0’ 9 in Edinburgh. The fatal cases of diarrhoea, whichhad been 17, 12, and 23 in the three preceding weeks,declined again last week to 15, while the two deaths fromwhooping-cough were equal to the number in the precedingweek. The 152 deaths from all causes included 44 ofchildren under one year of age and 29 of !persons agedupwards of 60 years ; the deaths of infants slightly ex-

ceeded the number in the previous week, while those ofelderly persons showed a decline. Five inquest cases andfive deaths from violence were registered ; and 65, or 43 percent., of the deaths occurred in public institutions. Thecauses of four, or 2 6 per cent., of the deaths registered inDublin last week were not certified ; in London all thecauses of death were duly certified, while in Edinburgh theproportion of uncertified deaths was 4’ 7 per cent.

THE SERVICES.

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

H. Clift to the Cyolops on commissioning; Staff-SurgeonE. R. Grazebrook to the Dido.We understand that at the forthcoming examination for

commissions in the Royal Navy Medical Service, to be heldon Nov. llth, 15 vacancies will be filled by successful candi-dates. It is necessary that intending candidates shouldapply at an early date to the Medical Department of theRoyal Navy.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel Reginald J. Windle is seconded whilst

holding the appointment of physician and surgeon at the

Royal Hospital, Kilmainham (dated Oct. 1st). Lieutenant-Colonel Frederick S. Heuston, C.M.G., from the SecondedList, to be Lieutenant-Colonel (dated Oct. 1st). Lieutenant-Colonel George H. Sylvester retires on retired pay (datedOct. 19th). Captain Thomas Biggam is placed on temporaryhalf-pay on account of ill-health (dated Oct. 18sh). Lieu-tenant J. M. Jones has been appointed Principal MedicalOfficer to the forces in Egypt, vice Colonel J. Magill, C.B.Major R. C. Thacker, at Karachi, and Major H. E.Winter, at Bombay, have been appointed for duty in con.nexion with the embarkation and disembarkation of troopsand invalids during the season 1907-08.

VOLUNTEER CORPS.

Rifle: 3rd Volunteer Battalion the South Staffordshire

Regiment: Supernumerary Surgeon-Major (Honorary Captainin the Army) C. A. MacMunn (Brigade Surgeon-Lieutenant-Colonel, Senior Medical Officer, Staffordshire Volunteer

Infantry Brigade), to be Surgeon-Lieutenant-Colonel,remaining supernumerary (dated May 28th, 1907). 2ndVolunteer Battalion the East Lancashire Regiment : Sur-

geon-Lieutenant R. L. FitzGerald to be Surgeon-Captain(dated Sept. 18th, 1907). 2nd Volunteer Battalion, theEast Surrey Regiment : Supernumerary Surgeon-Lieutenant-Colonel and Honorary Surgeon-Colonel W. Gandy (BrigadeSurgeon-Lieutenant-Colonel. Senior Medical Officer, East

Surrey Volunteer Infantry Brigade), resigns his commission,with permission to retain his rank and to wear the prescribeduniform (dated Sept. lst, 1907). 13th Middlesex (Queen’aWestminster) Volunteer Rifle Corps: Surgeon-Major P. P.Whitcombe is granted the honorary rank of Surgeon-Lieutenant-Colonel (dated August 6th, 1907). lst VolunteerBattalion the Manchester Regiment :; Andrew Edward Hodderto be Surgeon-Lieutenant (dated Sept. 24th, 1907). 4thVolunteer Battalion the Durham Light Infantry : Surgeon-Captain T. Benson is retired, under the conditions of para-graph 103, Volunteer Regulations (dated Sept. 26th, 1907).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Scottish Command : Glasgow Companies : Lieutenant

R Y. Anderson to be Captain (dated Oct. 15th, 1907).Western Command : Manchester Companies : CaptainHarold P. W. Barrow, R.A.M.C., to be Adjutant, vice CaptainR. W. Clements, R.A.M.C., whose tenure of that appoint-ment has expired (dated Oct. 12th, 1907). East SurreyBearer Company : George Alfred Edsell (formerly Snrgeon-Captain, 2nd Volunteer Battalion the Oxfordshire LightInfantry) to be Captain (dated Sept.,25th, 1907).

1189

MEDICAL STORES FOR SHIPS UNDERGOING STEAM TRIALS.

Medical stores for ships undergoing steam trials are nowsupplied from the respective naval hospitals instead of fromthe barracks, as heretofore, and the two sets of surgicalinstruments, which were formerly kept for loan to shipsduring trials, have been returned to the naval hospitals.These two sets of surgical instruments, together with twomedicine chests and two emergency surgical dressing chests,are held at the naval hospitali in readiness for immediateissue for the purpose, and the medical officer detailed forthe trial is held responsible that the stores are on board theship before the trials commence.

HYGIENE IN THE ARMY.The first of a series of lectures on hygiene and sanitation

was given at the Raglan Barracks, Devonport, on Oct. 14th,when Lieutenant-Colonel Robert Caldwell, R.A.M.C., gavean interesting address on Food. There was a numerous

attendance and amongst those present were Major-GeneralSir John Leach, K.C.V.O., commanding Plvmouth CoastDefences, and Lieutenant-Colonel F. S. Maude, C.M.G.,D.S.O. The lecture was repeated at the Drill Hall Citadel,Plymouth, on Oct. 17th, and on Oct. 19th at the CrownhillSchoolroom. On Oct. 21st a lecture was given on Water.The Broad Arrow announces that the new military hos-

pital, the Alexandra, which has been built on the southernslope of Portsdown Hill, above Cosham, is to be opened foruse in November.An examination of candidates for not less than 30 commis-

sions in the Royal Army Medical Corps will be held onJan. 30th, 1908, and following days. Applications to com-pete should be made to the Secretary, War Office, London,8.W., not later than Jan. 20th next, on which date the li-twill be closed. The presence of candidates will be requiredin London from Jan. 28th.

Correspondence."Audi alteram partem."

THE NEEDS OF LONDON MEDICALSTUDENTS.

To the Editors of THE LANCET.

SIRS,-A vacancy having arisen in the representation ofthe Faculty of Medicine on the Senate of the University ofLondon, Professor E. H. Starling, F.R.S., has become a candi-date and has circulated a statement setting forth the

grounds upon which he seek3 support. That Professor Starlingis distinguished in science, capable in organisation, and, whatis of at least equal importance at the present uncture, a manwho knows his own mind, will be admitted by everyone ; butthese personal qualities ought not to prevent any electorfrom subjecting his programme to critical analysis.London, as a centre of medical study, has two great

needs-a degree readily accessible to all her studentsand a proper systematisation of the teaching of the pre-liminary and intermediate subjects. It is a scandalthat an examination of the standard of the ConjointBoard Final should not entitle a successful candidate to becalled, except by courtesy, doctor. It is equally true thatthe teaching of the preliminary and intermediate medicalsubjects in London is wasteful both as regards force andmoney. Both these evils have been fostered and maintainedby the action of the Senate- of the University of Londonsince the reconstitution of that body. This has been publiclydemonstrated by Dr. W. H. Allchin-himself for ten years amember of the Senate-in his inaugural address at King’sCollege on Oct. lst of this year. The next day Sir WilliamGowers at the University College Hospital dinner made aneloquent appeal to the University to throw open its medicaldegrees, under proper conditions, to holders of the Conjointdiploma. There is thus at last some hope that leaders ofthe profession are beginning to realise the chief needs of theLondon medical student and diplomate and the true inward-ness of the depletion of the London medical schools.What is Professor Starling’s attitude towards these two

vital questions He expresses a pious hope that the Londonmedical degree may become more accessible to students.And he adds a few nebulous platitudes-remarkable in a

man so distinguished as a clear thinker-regarding therelations between the University and the medical schools.But if he is vague upon this matter he is definiteenough on the other great question. Here he is thefrank exponent of a policy which has recently receivedtwo open defeats in the fdculty which he seeks to

represent. Even as the word metabolism overshadowsmuch that is uncertain and obscure in the science of phy-siology so does concentration hang like a dark cloud overthe intellects of many who are responsible for the presentpolicy of the University. The facts are simple enough. Whenthe University was reconstituted there was a general feelingin the London medical schools in favour of the establishmentof a university centre at South Kensington for teaching thepreliminary and intermediate subjects. An appeal was madefor £375,000 ; of this huge sum £70,000 have been obtainedmainly from one source. In the meantime many of themedical schools have realised the impracticability of theoriginal scheme and have abandoned it in favour of thealternative of teaching these subjects in a few institutions inthe principal quarters of the metropolis. The University hasalso been compelled to realise that its plan cannot be carriedout, but the Senate does not appear to possess the moralcourage to admit this once and for all and to return themoney. It is compelled, therefore, to cast about for somemeans of spending it and to this end proposes to build a newsmall institute at South Kensington. It is obvious thatwhereas the original institute would have been intended toreplace present preliminary and intermediate schools theone now suggested would simply act as a rival anda competitor. It is as if, in order to systematise thecomplicated network of railways with London termini,it had been proposed to build an enormous new centralstation, and when this had been found impracticablethe alternative had been adopted of setting up a smaller oneat South Kensington necessitating the laying down of newlines, the development of new machinery, and an increasedcomplication instead of a simplification of the trafficproblem.Those who support Professor Starling may therefore be

clear as to the course he will pursue in this matter ; whereasin the other, and more important, they will have to besatisfied with his benevolent aspirations. His election would

strengthen the party of reaction in their efforts to fossilisethe University. I am, Sirs, yours faithfully,

Welbeck-street, W., Oct. 22nd, 1907. BERTRAM ABRAHAMS.

THE FREQUENCY OF CHILD-BEARING ATA LATE AGE.

To the Editors of THE LANCET.

SIRS,-The usual standard for calculating the legitimatebirth-rate is the number of married women between the agesof 15 and 45 years. The adoption of the higher age limit(45 years) presupposes that child-bearing has ceased by thattime. Duncan in Sterility in Women " (p. 27, ed. 1884) statesthat child-bearing ceases between the thirty-sixth and forty-first years. I find, however, that in 1855 a considerable numberof children were born of Scotch mothers aged from 50 to 55years, and the Swedish returns indicate that child-bearingcontinues for some years after the term set by Duncan. Ihave been searching through the books at my disposal buthave been unable to find any evidence as to the frequency ofchild-bearing by English mothers at those late ages. Iventure therefore to appeal to your readers to furnish mewith any figures, or references to any figures, which willenable me to arrive at an estimate of the frequency of

child-bearing by women aged from 45 to 50, and 50 to 55vears.-I am. Sirs. vours faithfullv.

REGINALD DUDFIELD, M.B. Cantab., F.S.S.,Blomfield-road, Maida Vale, W., Oct. Slat, 190’/.

ETHER INHALATION IN PULMONARYTUBERCULOSIS

To the Editors of THE LANCET.

SIRS,—Permit me to refer, somewhat late, to the corre-spondence of Dr. R. H. Hodgson in THE LANCET of Sept. 14th,p. 794, in which he suggests the use of sulphuric ether byinhalation for the treatment of pulmonary consumption.The same suggestion was made by Pearson in 1794, in his11 A Short Account of the Nature and Properties of Different