909

113 resulted from whooping-cough, 87 from measles,61 from diphtheria, 32 from diarrhoea. 28 frcm scarletfever, and 23 from "fever" (principally enteric). Nodeath from any of these diseases was recorded lastweek either in Wolverhampton or in Leicester; in theother towns they caused the lowest death-rates in Croydon,Brighton, and Oldham, and the highest rates in Blackburn,Cardiff, Bolton, and Salford. The greatest mortality frommeasles occurred in Manchester, Cardiff, Gateshead, Bolton,and Salford ; and from whooping-cough in Salford, Bristol,Swansea, Burnley, and Blackburn. The mortality fromscarlet fever and from "fever" showed no marked excessin any of the large towns. The 61 deaths from diphtheriaincluded 37 in London, 4 in Birmingham, 4 in Liverpool,3 in Huddersfield, and 3 in West Ham. No fatal case ofsmall-pox was registered during the week under notice,either in London or in any other of the thirty-three<large towns. There were 29 cases of small-pox undertreatment in the Metropolitan Asylum Hospitals andin the Highgate Small-pox Hospital on Saturday last,March 20th, against 43 and 30 at the end of the two

preceding weeks; 2 new cases were admitted during theweek, against 18, 6, and 0 in the three preceding weeks.The number of scarlet fever patients in the MetropolitanAsylum Hospitals and in the London Fever Hospital at the end of the week was 2622, against 2817, 2745, and 2685on the three preceding Saturdays ; 206 new cases wereadmitted during the week, against 237, 211, and 218 inthe three preceding weeks. The deaths referred todiseases of the respiratory organs in London, which hadbeen 30’7 and 344 in the two preceding weeks, declined.:again to 317 last week, and were 206 below the correctedaverage. The causes of 56. or 1-4 per cent., of the deaths inthe thirty-three towns were not certified either by a regis-tered medical practitioner or by a coroner All the causesof death were duly certified in Bristol, Cardiff, Nottingham,Leeds, Hull, and in sixteen other smaller towns ; thelargest proportions of uncertified deaths were registeredin Birmingham, Liverpool, Manchester, Blackburn, andSheffield.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch town?,which had declined in the five preceding weeks from 28 8to 23’1 per 1000, rose again to 23’3 during the week endingMarch 20th, and exceeded by 4’6 per 1000 the meanrate during the same period in the thirty-three large Englishtowns. The rates in the eight Scotch towns ranged from!18’0 0 in Leith and 20’6 in Edinburgh to 24-5 in Paisley,and 32-4 in Perth The 693 deaths in these townsincluded 33 which were referred to measles, 33 to whooping- Icough, 15 to diarrhoea, 11 to " fever " (principally enteric), ’,9 to scarlet fever, and 5 to diphtheria. In all, 106 deathsresulted from these principal zymotic diseases, against 96and 83 in the two preceding weeks. These 106 deaths were- equal to an annual rate of 3-6 per 1000, which was 2 0 per 1000above the mean rate last week from the same diseases in thethirty-three large English towns. The fatal cases of measles,which had been 30 and 27 in the two preceding weeks, roseagain to 33 last week, and included 21 in Glasgow and12 in Edinburgh. The deaths from whooping-cough, whichhad been 36 and 29 in the two preceding weeks, rose to33 last week, of which 24 occurred in Glasgow, 5 in Edin-burgh, and 3 in Perth. The 11 deaths referred to differentforms of "fever" considerably exceeded the number recordedin any recent week, and included 8 in Glasgow. The fatalcases of scarlet fever, which had been 5 in each of the twopreceding weeks, rose to 9 last week, of which 2 occurred’in Glasgow, 2 in Edinburgh, and 2 in Aberdeen. Of the 5deaths from diphtheria 3 were registered in Glasgow and2 in Dundee. The deaths referred to diseases of the respira-tory organs in these towns, which had been 203 and 152in the two preceding weeks, were 155 last week, andexceeded by 39 the number in the corresponding period oflast year. The causes of 38, or more than 5 per cent., of thedeaths in these eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 45’2 and39-1 per 1000 in the two preceding weeks, rose again to’40-4 during the week ending March 20th. During the pasteleven weeks of the current quarter the death-rate in thecity has averaged 40-7 per 1000, the rate during the sameperiod being 18-6 in London and 22-3 in Edinburgh. The 271

deaths registered in Dublin during the week under noticeexceeded by 9 the number in the preceding week, andincluded 74 which were referred to the principalzymotic diseases, against 59 and 61 in the two precedingweeks ; of these, 46 resulted from measles, 20 from whooping-cough, 4 from diarrhoea, 2 from scarlet fever, 2 from fever,"and not one either from small-pox or diphtheria. These74 deaths were equal to an annual rate of 11’0 per 1000, thezymotic death-rate during the same period being 1-5in London and 3’6 in Edinburgh. The fatal cases ofmeasles, which had been 44 and 43 in the two precedingweeks, rose again to 46 last week. The deaths referredto whooping-cough, which had been 21 and 9 in the twopreceding weeks, rose again to 20 last week. Thetwo fatal cases of scarlet fever corresponded with thenumber recorded in the preceding week. The 271 deathsregistered in Dublin last week included 55 of infants underone year of age, and 49 of persons aged upwards of sixtyyears ; the deaths of infants showed an increase, while thoseof elderly persons were below those recorded in the pre-ceding week. Seven inquest cases and 6 deaths fromviolence were registered; and 65, or nearly a fourth, ofthe deaths occurred in public institutions. The causes of16, or neatly 6 per cent., of the deaths in the city lastweek were not certified.

THE SERVICES.

ARMY MEDICAL STAFF.BRIGADE-SURGEON-LIEUTENANT-COLONEL R. EXHAM,

Surgeon-Majors E. North, J. M. Jones, and H. L. Battersby,Surgeon-Captains C. W. Reilly, T. Birt, and H. E. Winterhave arrived home from India in the transport Victoria.

Surgeon-Major J. J. C. Donnett has been appointed SpecialSanitary Inspecting Officer. Poona Cantonment. Surgeon-Major N. G. Macpherson has been appointed to the ArmyMedical Department at the War Office. Surgeon-MajorTidbury has been transferred from Cork to Portsmouth.Surgeon-Captain George M. Dobson, M.B., to be Surgeon-

Major.INDIA AND THE INDIAN MEDICAL SERVICES.

Surgeon-Captain J. J. Bourke and Surgeon-LieutenantF. A. L. Hammond, whose services have been placed at thedisposal of the Chief Commissioner, are appointed InspectingMedical Officers under the rules made under the EpidemicDiseases Act, 1897, and are posted to the stations of Itarsi andNagpur respectively. Surgeon-Lieutenant H. St. J. Fraser,whose services have been placed at the disposal of the ChiefCommissioner, is posted to Hoshangabad for employmenton famine duty. Surgeon-Lieutenant C. M. Mathew, whoseservices have been placed at the disposal of the Chief Com-missioner, is posted to Raipur for employment on famineduty.To be Surgeon-Colonel : Brigade - Surgeon - Lieutenant -

Colonel George Bainbridge, M.D., Bombay Establishment

(dated Oct. 4th, 1896). To be Brigade-Surgeon-Lientenant-Colonel : Surgeon Lieutenant Colonel Charles Henry Joubert,Bengal Establishment (dated Sept. 1st, 1896). To be Surgeon-Lieutenant-Colonel: Surgeon-Major Charles Henry Beatson,Bengal Establishment (dated Sept. 30th, 1896). Surgeon-Lieutenants to be Surgeon-Captains (dated Jan. 29th, 1897)-Bengal -Establishment : George Lamb, Henry Burden, JohnFisher, Edward Surman Peck, Charles Harford Evans, StanleyArthur Harris. Ewan Cameron MacLeod, and CharlesThomson. Madras Establishment : Alfred Eugene Berry andHerbert St. John Fraser. Bombay Establishment : BernardHenry Frederick Leumann and Hugh Bennett. --LondonGazette.

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

A. G. P. Gibbs to the Victory, for the Malacca; W. G. K.Barnes to the Undaunted; ; J. J. Dinnis to the Edgar; andJ. Sugrue to the Australia. Surgeons: C. H. Rock to theUndaunted; D. J. P. McNabb to the Edgar; E. G. E.O’Leary to the Research; John Grant to the Pembroke, andafterwards to the Pelorus; Sidney T. Reid to the Hibernia;and John W. Slaughter to’, the Victory, for the Malacca, onthe voyage home.

HONOURABLE ARTILLERY COMPANY OF LONDON.The under-mentioned officer resigns his commission :-

Surgeon-Captain H. G. Read (dated March 24th, 1897).

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ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Captain H. W. Roberts to be Surgeon-Major.MILITIA MEDICAL STAFF CORPS.

Surgeon-Lieutenant J. T. Simpson to be Surgeon-Captainon increase of establishment.

VOLUNTEER CORPS.

Artillery: 2nd Kent: Surgeon-Major F. Smith, M.D., tobe Surgeon-Lieutenant-Colonel, lst Dorsetshire (SouthernDivision, Royal Artillery) : Surgeon - Lieutenant HubertHoussemayne Du Boulay resigns his commission. and is

appointed Lieutenant. lst West Riding of Yorkshire(Western Division, Royal Artillery) : Surgeon-Captain JohnNightingale resigns his commission, and is appointed SecondLieutenant. Rifle 3rd Volunteer Battalion the Queen’s(Royal West Surrey Regiment): Surgeon-Lieutenant C.Boyd to be Surgeon-Captain. 5th Volunteer Battalion theCheshire Regiment: Surgeon-Major W. R. Dambrill-Daviesto be Surgeon-Lieutenant-Colonel. 14th Middlesex (Innsof Court) : Surgeon-Lieutenant C. J. Arkle, M.D., to be

Surgeon-Captain.VOLUNTEER MEDICAL STAFF CORPS.

The London Companies: Surgeon-Captain J. E. Squire,M.D., to be Surgeon-Major on increase of establishment.Surgeon-Lieutenant H. D. Buss to be Surgeon-Captain.

THE HEALTH OF THE FRENCH ARMY IN 1896.

The medico-statistical report issued annually by theFrench War Minister has made its appearance, as usual, inthe Journal Officiel, and, generally speaking, its contents

may be said to show that the advance of the army towardssanitary perfection, which of late years has been veryconspicuous, was adequately maintained during the pasttwelvemonth. In 1887, ten years ago, the total number ofmen with the colours was 480,672, and among them 3319deaths took place, equal to 69 per 1000 ; but in 1896,although the average strength had risen to 546,500, thedeaths only numbered 2900, or 5’3 per 1000. This happyresult is chiefly due to the measures that have been

adopted for purifying the water-supply. Formerly manygarrisons-notably those at Lure, vreux, and Chilteaudun-used to be well-nigh decimated by constantly recurringoutbreaks of typhoid fever, but now they enjoy whatthe Minister describes as " absolute salubrity." Theevidence thus afforded being conclusive, it has beendecided to acquire six more sterilising apparatuses in orderthat they may be permanently installed wherever the drink-ing water is open to suspicion. According to this system ofpurification the water is rendered sterile by means of steamat high pressure, and the appliances are said to be at oncesimple in construction, durable, economical, and easilyworked. Whilst thus eulogising the latest device for com-bating water-borne disease, General Billot by no means seeksto minimise the" incontestable advantages " of the PasteurChamberland filter. The efficacy of the latter admir-able invention was placed beyond doubt by the unanimouschorus of approval from every garrison, large or small,where it was used ; but the sanitary authorities neverthelessfelt bound to take advantage of the new system which, afterseveral years of experiment under their own close supervision,had gradually been brought to perfection. Turning from theprevention of disease to its incidence, the Minister is able toannounce the steady decrease of small-pox amongst the troops.In 1876-77-78 the number of cases exceeded 1000 annually,and the deaths to be deplored were respectively 127, 92, and98. In 1895 there were only 61 cases of small-pox in thewhole army, with 6 deaths ; while last year of 57 casesonly 2 proved fatal. It is owing to re-vaccination thatthe soldiers were safeguarded while on service in Africa,Madagascar, and Tonkin, surrounded as they were by anative population, amongst whom the scourge is both endemicand deadly. As regards " croup," the fatal cases have beenreduced by more than a half. All military hospitals, as wellas every military centre, no matter how small, in France andAlgeria is now daily furnished with the special instrumentsand appliances required for anti-diphtheritic inoculation,the serum being supplied and freely renewed wheneverneeded by the Pasteur Institute. The sequel to this

enlightened procedure is plainly discernible. In 1893 themortality from " croup " in the French army amountedto 64; by 1895 it had fallen to 24; and in 1896 thenumber of deaths was only 22. Unfortunately there are

other diseases which continue to exact numerous victims.Scarlet fever, measles, and influenza are still extremelyfrequent; but mixing as the soldier does in civil life while-on leave of absence it is difficult to contend against theseproducts of insanitation. The reservists, too, are a fruitfulsource of infection ; but in spite of all obstacles the struggle.with preventable mortality is waged with unabated zeal. "It.is impossible to conceal from oneself the fact," says theMinister in conclusion, "that every cause of insalubrity inbarracks has its reflection in augmented bills of sicknessand mortality. This was well exemplified at Dijon wheninfluenza was prevalent, and also quite recently in the scarlet,fever epidemic at Gerardmer. It is likewise impossible to,conceal from oneself the fact that all amelioration in theinstallation of these same barracks has its reflection in veryconsiderable expenditure, and that my department is con-strained to keep within those limits of the budget that are.laid down annually."

THE WRECK OF THE "WARREN HASTINGS."

We called attention some time ago to this subject and to.the fact that it had most deservedly attracted the notice ofthe Queen. We may be excused for referring to it again,for it is one of which the nation and the Army maywell feel proud. It has since been made the subject of aspecial Army order in which the Commander-in-Chiefexpresses his great gratification in making known to theArmy the substance of a report received from the GeneralOfficer commanding at the Mauritius recording the remark-able courage and exemplary discipline displayed by thetroops, under the most trying circumstances, on board theRoyal Indian Marine troopship Warren Hastings, whenthat ship, steaming full speed, struck the rocks during a.-pitch-dark night and was wrecked near the village ofSt. Philippe, in the Island of Reunion, at 2 20’A. M. on Jan. 14thlast. The troops on board consisted of the headquarters andfour companies of the lst Battalion King’s Royal Rifle Corps,four companies of the 2nd Battalion York and Lancaster

Regiment, and a detachment of the Middlesex Regiment."’Lord Wolseley, after quoting from the report of CommanderHolland, the officer in command of the Warren Hastings,that the behaviour of the troops throughout was beyond allpraise, concludes his order as follows : " The Commander-in-Chief is proud of the behaviour of the troops duringthis trying time ; he regards it as a good example ofthe advantages of subordination and strict discipline, for itwas by that alone, under God’s providence, that heavy lossof life was prevented. The Commander-in-Chief cannot closethis order without expressing his admiration of the coolness,courage, and resource shown by Commander Holland, andsympathy with him and his brave officers."

PLAGUE ON A TRANSPORT.

The announcement that the transport Dilwara is beingdetained at Suez, owing to the occurrence of a fatal case ofplague on board the vessel after she left Bombay, willtend to accentuate the supposition that if this disease isintroduced into England it is not at all unlikely that troopsreturning from India may be responsible for its introduction.It therefore behoves the naval and military authorities totake every possible precaution to ensure that all troopshipscoming from infected ports shall be carefully dealt with inaccordance with modern notions, and in harmony with theproceedings adopted by our best - equipped and bestadministered port sanitary authorities. We are notaware that up to the present the military and navalauthorities have made any arrangements independentlyof the port sanitary authorities, for dealing with cases ofplague or suspicious ‘&deg; pestis minor"; but we have heardthat they have approached the Southampton port sanitaryauthority with a view to the isolation of any cases ofplague which may be brought to that port. As South-ampton is at present the port at which the majority of ourtroopships arrive it is obviously important that adequatearrangements shall be made beforehand, and that there shallbe a thorough understanding as to what steps are to betaken to deal without delay with an infected troopship.The Southampton port sanitary authority is, we believe, oneof the best equipped in the kingdom and is well able toafford the necessary assistance. Quarantine is dead in sofar as the national method of dealing with infected vesselsis concerned, and all vessels must be dealt with on similarlines if England is to maintain a consistent attitude in thereyes of the wolld.

911

A VOLUNTEER MEDICAL OFFICER WANTED.On the occasion of the presentation of prizes to the

.3rd Essex Volunteers on the 13th inst , at Portway, Lieu-tenant-Colonel Henry Palmer, 3rd Volunteer Battalion theEssex Regiment, took occasion to mention that no medicalgentleman in West Ham had applied for a commission inthe 3rd Essex. The lst Essex bad its medical officer, the:3rd Essex had none.

VOLUNTEER MEDICAL OFFICERS AND THE WAR OFFICE.A correspondent writes to us under date March 22nd, a

letter, in which he propounds the question : Is the VolunteerMedical Service either loyal to the medical profession itself orto the Army Medical Department in doing professional workfor nothing ? " I am inclined to think," he says, " that themedical officer is decidedly wrong in giving his services toeither his country or to individuals for nothing. In the lattercase it may be but right that he should retain his individualliberty, but in the former case he has given himself away, asin a number of corps he pays an annual subscription. Isthe profession right in devoting a very considerable part of’its time to the working up of bearer companies, each ofwhich occupies the entire attention of at least one medicalofficer for probably four or five hours a week teaching bothby drill and lectures. This year there has been a veryimportant addition made to the duties of medical officers-i.e., the examination of recruits. This examination, thoughnot intended to be anything like as thorough as for recruitsfor the regular forces, still takes some time, and also neces-sitates the attendance of a medical officer at headquartersweekly."

THE HEALTH OF THE ARMY IN INDIA.

Surgeon-Major Whitehead, in the report of the depart-mental committee on venereal disease, sums up his experi-ence during the five years of his appointment as Assistant-Professor of Military Surgery at Netley, during which he had,unrivalled opportunities of studying the question of the

prevalence of syphilitic disease among our troops, with thefollowing conclusions : "(1) That the disease is more

prevalent at present than formerly among foreign invalids ;- (2) that the type is more malignant ; and (3) that the healthand efficiency of the soldier are in many cases absolutelyruined by this disease, and even if he so far recover aftera bad attack as to return to duty there is a great probabilityof his again breaking down." When we consider that this

contagious and hereditary disease is largely preventable wemay well urge the extreme importance of some measures

being taken to put a stop to the present scandalous state ofsafrairs.

REVISED SCALES OF PAY FOR THE ARMY MEDICAL STAFFIN INDIA.

The Times of India of the 6th inst. states that the revisedscales of pay approved by the Secretary of State for theArmy Medical Staff in India and certain grades of the IndianMedical Service will come into effect from April lt. An

Army circular will shortly be published showing the new’-rates.

The transport Victoria arrived on the 18th inst. She

brought 320 patients for 1he Royal Victoria Hospital, Netley.The transport Diln’a1’a left Bombay on the llth inst. with

293 invalids for Netley. Her arrival will probably be post- :poned in conseqnence of a case of bubonic plague havingoccurred on boatd.

Dr. S. Wilks, President of the Royal College of Physicians,Sir Dyce Duckworth, Sir Wm. Priestley, and Dr. JohnAnderson visited the Royal Victoria Hospital, Netley, onSaturday last, in connexion with the inquiry which has beeninstituted with rfgard to the prevention of contagiousdiseases among the men of the Army in India.

CARDIFF PORT SANITARY AUTHORITY. - Themedical officer of health for the Cardiff port sanitaryauthority has just issued his report for 1896. Dr. Walfordestimates the floating population of the port to be 7000, andstates that during the year 6222 vessels were inspected ; ofthese 5271 were in a good or fair condition and 951 in amore or less insanitary state. The systematic inspection ofshipping in the Bute and Penarth Docks was efficiently per-formed by the chief inspector and his assistants. In onlyfive cases was it necessary to take legal proceedings. Nine

patients were admitted to the infectious diseases hospital,- one of the cases terminating fatally.

Correspondence." Audi alteram partem."

"THE MEDICAL STAFFS OF HOSPITALSAND HOSPITAL ABUSE."

To the Editors of THE LANCET.SIRS,-Mr. Horder assumes that I was in error in statirg

that Sir William Fergusson’s committee recommended thatmedical officers attending the out-patients should be paid.I have before me as I write the report of the committeeappointed to inquire into the subject of Out-patient HospitalAdministration in the Metropolis in 1871, igned by AlfredMeadows, M.D., chairman, J. H. Stallard, M.B., and HeywoodSmith, M.B., honorary secretaiies. The report states : " Thefollowing resolutions embody in brief form the conclusionsat which your committee have arrived and which theyrecommend for adoption." No. 6 of these resolutionsruns as follows : "That the governors of hospitals ought inall cases to provide some honorarium for the staff of the

out-patient department." You will see, therefore, that Mr.Horder, and not myself, is in error, and I am rather

surprised to find that he has not procured a copy of thereport in question, and that he is evidently not familiarwith its terms.On another point raised by Mr. Horder I desire to impress

upon the medical profession that so long as we have honorarymedical staff attached to our great hospitals-that is, unpaidstaffs-so long will the hands of the managing committees betied, so far as initiative is concerned, in the work ofreforming the out-patient departments unless the medicalprofession commence proceedings by making representationsto the managers. This fact makes me strongly in favour ofthe abolition of all honorary medical service, at any rate sofar as the great London hospitals are concerned. I am sure onthe grounds of economy, although it might cost the hospitals&pound;60,OOO a year to pay for the necessary medical service,such a step would in the end tend to reduce rather than toincrease the average cost per bed. The medical professionnow have a unique opportunity, which may not recur, of con-ferring together and formulating a definite policy in regardto out-patient relief and other matters of pressing importanceaffecting the administration of our hospitals. I wrote myletter because I realised this position of affairs, and wished,if possible, to induce the medical profession in its owninterests, and in the best interests of the hospitals and allconnected with them, to take up a strong position after duedeliberation and conference by formulating a policy in

regard to these matters. The governors and committeeswould thus be placed in a position to institute every reform.which may be found desirable or necessary in the bestinterests of the patients, the profession, and the public. Idesire to thank Mr. Horder, and through him the membersof his committee, for their statesmanlike determination topostpone for a time the public conference which it was proposed to hold this summer.The writer of the leading article in THE LANCET ot

March 20th, no doubt unintentionally, does me less thanjustice. I have never stated, nor do I hold the opinion,that "the Hospital Sunday Fund and the Prince’s Fundhave at present but little responsibility for the use

of what they collect." On the contrary, it is becauseI am deeply impressed with the responsibility attaching tothe distribution of these funds, and to the paramountnecessity of providing that our voluntary charities shallbe as free, as it is humanly possible to make them, from allpreventable abuses, that I ventured to write you the letterwhich appeared in THE LANCET of March 13th, and tostate the grounds upon which I gave my entire support toyour proposal, that a conference should take place in thenear future of the members of the honorary medical staff,attached to every hospital of repute in the metropolis.I joined issue with Dr. Glover on the out-patientquestion, so far as the Hospital Sunday Fund was con-

cerned, because I realise, that without such a conferencenot only the Hospital Sunday Fund, but the hospitalcommittees throughout London, must remain practicallypowerless to enforce the reforms in the out-patientdepartments, which he has so much at heart. Prematureaction and an attempt at interference without the necessaryauthority to enforce needful reforms, are calculated to.prove