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Paisley. The deaths from diarrhoea, which had been 11,16, and 36 in the three preceding weeks, declined againlast week to 21, of which 12 occurred in Glasgow, six inDundee, and two in Leith. The fatal cases of whooping-cough, which had been 12 and 23 in the two previousweeks, fell to 13 in the week under notice, and included fivein Leith, three in Glasgow, and two in Dundee. The deathsfrom diphtheria, which had been ten, seven, and none inthe three preceding weeks, rose last week to nine, of whichthree were registered in Glasgow and three in Paisley. Thefatal cases of "fever," which had been five and seven in thetwo preceding weeks, increased to eight in the week undernotice, and included three deaths from enteric fever in

Glasgow, two from cerebro-spinal meningitis in Leith, andone in Paisley. The deaths in the eight towns referred todiseases of the respiratory organs, including pneumonia,which had been 104, 106, and 137 in the three precedingweeks, further rose to 167 in the week under notice, andwere 41 in excess of the number in the corresponding periodof last year. The causes of 25, or 3.5 per cent., of thedeaths were not certified or not stated; in the 76 Englishtowns the proportion of uncertified deaths did not exceed 1-2per cent.

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HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which had beenequal to 18-4 and 21’ 6 per 1000 in the two precedingweeks, further rose to 26’ 7 per 1000 in the week endingDec. 7th. During the first ten weeks of the currentquarter the death-rate has averaged 21’ 3 per 1000, the ratesduring the same period being 14 -? in London and 13.8in Edinburgh. The 200 deaths of Dublin residents registeredduring the week under notice were 38 in excess of thenumber in the preceding week, and included nine whichwere referred to the principal epidemic diseases, against11, 10, and four in the three preceding weeks; theyincluded three from whooping-cough, three from " fever,"two from diphtheria, and one from diarrhoea, but not anyfrom small-pox, from measles, or from scarlet fever.These nine deaths were equal to an annual rate of 1 - 2 2

per 1000, which was also the rate in London duringthe same period from the principal epidemic diseases,the corresponding rate in Edinburgh being 0’ 6 per 1000.The 200 deaths from all causes included 45 of childrenunder one year of age and 64 of persons aged upwardsof 60 years ; the deaths both of infants and of elderly personsexceeded the number in the previous week. Eleven inquestcases and six deaths from violence were registered ; and61, or more than 30 per cent., of the deaths occurred in

public institutions. The causes of seven, or 3 ’ 5 per cent.,of the deaths registered in Dublin last week were not

certified; in London only one death was uncertified, whilein Edinburgh the proportion was 2’ 5 per cent.

THE SERVICES.

THE REPORT OF THE ARMY MEDICAL DEPARTMENT.THE report of the Army Medical Department has under-

gone a great change which is, as we think, a distinct

improvement. It is far more interesting in that it dealswith its subject from a broader view, goes more directly tothe point, and supplies more clearly that kind of informa-tion which it is most desirable to know. The reports havebeen hitherto too much overlaid with a mass of figures anddetails which rather served to obscure than to elucidate thepurpose which official publications of this nature shouldreally have in view. As the Director-General points out inhis letter to the Secretary of State for War which prefacesthe report, previous reports have consisted in the main oftwo parts-a letterpress and a series of statisticaltables. These tables were in the form of abstracts ofthe detailed statistics furnished by various stations athome and abroad and gave figures relating to thechief diseases or classes of disease without mentioning theless important individual diseases in detail. The letterpressconsisted largely of a discussion of these abstracts. Thepresent report also consists of letterpress and a series oftables, the former giving a general history of the health ofthe army, mentioning the chief causes of disease, theirincidence as compared with various years, and the generallines on which the problem of their prevention has beenapproached. In addition to the tables, which have been

compiled on lines similar to previous years, details have beenadded which give the individual causes of admission tohospital for three of the five groups into which for thispurpose the army has been divided. Four of these correspondto the four most important geographical areas occupied bythe army-namely, the United Kingdom, the MediterraneanBasin, South Africa, and India. The fifth group is composedof those smaller stations scattered throughout the worldwhich by the comparatively small figures furnished by themare not of sufficient epidemiological importance to meritindividual mention.

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ROYAL NAVY MEDICAL SERVICE.The following qualified candidates for the Royal Navy

Medical Service have been appointed surgeons in His

Majesty’s Fleet :-Geoffrey Carlisle, Guy Tyrrell Verry,Gilbert Bodley Scott, Francis Harold Holl, Geoffrey PalmerAdshead, John McCutcheon, Harold Hubert Babington,William Charles Carson, James Herbert Wright, CharlesHenry Lambert Petch, and George Augustus StewartHamilton (dated Nov. 19th, 1907).

ROYAL ARMY MEDICAL CORPS.

Captain Frederick H. Merry is placed on temporary half-pay on account of ill-health (dated Dec. 7th, 1907).

Lieutenant-Colonel Michael Dundon retires on retired pay(dated Dec. llth, 1907).

VOLUNTEER CORPS.

Royal Garrison Artillery (Volunteers): lst Fifeshire :Surgeon-Major J. W. Moir to be Surgeon-Lieutenant-Colonel(dated Oct. 21st, 1907). Surgeon- Lieutenant- Colonel J. W.Moir is retired, under the conditions of paragraph 103,Volunteer Regulations, with permission to retain his rankand to wear the prescribed uniform (dated Oct. 22nd, 1907).8th Lancashire: Surgeon-Lieutenant-Colonel and HonorarySurgeon-Colonel A. R. Hopper (late 8th Lancashire RoyalGarrison Artillery (Volunteers), from the retired list, to beSurgeon-Lieutenant-Colonel, with the honorary rank ofSurgeon-Colonel (dated Sept. 26th, 1907). lst East Riding ofYorkshire: Surgeon-Major T. McC. Foley to be Surgeon-Lieutenant Colonel (dated July 20 th, 1907).

Rifle: 1st Surrey (South London) Volunteer Rifle Corps :Robert James William Oswald to be Surgeon-Lieutenant(dated Oct. lst, 1907). 6th (Fifeshire) Volunteer Battalion,The Black Watch (Royal Highlanders): Surgeon-Major(Honorary Captain in the Army) C. E. Douglas to be Surgeon-Lieutenant-Colonel (dated Oct. 18th, 1907). 2nd VolunteerBattalion, The Highland Light Infantry : William SeatonPaterson to be Surgeon Lieutenant (dated Nov. lst, 1907).George Jubb to be Surgeon- Lieutenant (dated Nov. 1st, 1907).lst Cadet Battalion, The Buffs (East Kent Regiment):The undermentioned officer is removed from the Volun-teer Force on the disbandment of the battalion :-Surgeon-Lieutenant C. W. Scott (dated June 14th, 1907).1st Volunteer Battalion, The Royal Warwickshire Regiment :Surgeon-Lieutenant C. H. Howkins to be Surgeon-Captain(dated Oct. 29th, 1907). lst Bucks Volunteer Rifle Corps :Surgeon-Lieutenant J. C. Baker to be Surgeon-Captain(dated Oct. 23rd, 1907). 5th Middlesex (West Middlesex)Volunteer Rifle Corps: Surgeon-Captain C. E. Goddardresigns his commission (dated Nov. 6th, 1907).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Western Command: Manchester Companies : Lieutenant

A. F. Thompson, to be Captain (dated Sept. 5th, 1907);Surgeon-Lieutenant H. G. Smeeth, from the 4th VolunteerBattalion, The Cheshire Regiment, to be Lieutenant (datedNov. lst, 1907). Staffordshire Bearer Company : HowardHenry Congreve Dant (late Lieutenant, 3rd VolunteerBattalion, The South Staffordshire Regiment) to be Captain(dated Oct. 13th, 1907).

TENURE OF APPOINTMENT.

The following has been substituted for Article 312 of thePay Warrant :-The appointment of Director-General of the Army Medical Service

shall be for three years, unless the term is specially extended by theArmy Council for a further period not exceeding two years or for suchtime as may be necessary to enable the holder to complete 30 years’service.

MEDICAL MEN AND THE TERRITORIAL FORCE.There was a largely attended meeting held at Exeter on

Dec. 4th under the presidency of Earl Fortescue (LordLieutenant of the county of Devon), when Sir AlfredKeogh, K.C.B., Director-General of the Army MedicalService, gave an interesting address on the Army Council’s

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scheme for providing the medical organisation requiredunder the new Territorial and Reserve Forces Act. Amongstthose present were Surgeon-Colonel J. Raglan Thomas, V.D.,Brigadier.General Lord Clifford, Brigadier-General Kirk-

patrick, C.B , Dr. H. Davy, and Dr. P. M. Deas. Surgeon-Colonel Raglan Thomas reported that by the authority of theLord Lieutenant he sent out between 500 and 600 circularsto medical men in the greater part of Devonshire and partsof Somerset, Dorset, and Cornwall, and the replies hadbeen most gratifying. After the lecture a proposition wascarried unanimously expressing approval of the scheme anda committee, consisting of Dr. Davy, Dr. J. D. Harris, Mr.E. A. Brash, Surgeon-Colonel Raglan Thomas, and Surgeon-Captain R. Pickard, was appointed to consult with theDirector-General and to organise the scheme. Later SirAlfred Keogh was entertained at dinner at the New LondonHotel.

Sir Alfred Keogh addressed a largely attended meeting ofmedical men at Plymouth on Dec. 5th and again fully ex-plained the Army Council’s scheme for organising themedical service of the Territorial Force. Mr. Paul Swainpresided and among those present were General Sir J. Leach,K.C.V.O., Colonel G. D. Bourke, C.B, R.A.M.C., Surgeon-Colonel Raglan Thomas, Lieutenant-Colonel F. S. Maude,C.M.G., D.S.O., Lieutenant-Colonel R. Caldwell, R A.M.C.,and Lieutenant-Colonel W. B. Day, R A.M.C. The meetingwas much in sympathy with the scheme and a nucleus of acommittee for the district was appointed, consisting of Mr.Swain, Mr. W. L Woollcombe, Dr. A. B. Soltau, Dr. E. L.Fox, Mr. F. M. Williams, and Mr. A G. Rider.As Sir Alfred Keogh’s exposition of his proposed medical

service for the Territorial Force has already been fullybefore our readers we need only summarise his remarkson these two occasions. He said that the subject uponwhich he had to speak might be called "the organisationof the medical profession for home defence." The medicalservice for years had demanded reorganisation. Diseasehad never yet been properly prevented in war. They hadlearnt a lesson from the Japanese as to what really couldbe done in maintaining the fighting strength of the army.The Director- General then proceeded to ask them to con-sider what the medical service did, the present volunteermedical organisation, and the proposals made to put mattersright. Many men during the South African war whoshould have been in the fighting line were engaged lookingafter their colleagues. That would not occur again. Thework would be done by the medical corps itself andalso the work on the lines of communication. No manwho was a fighting man would be utilised in these ways.After wars they always had a Royal Commission, sometimeswhile the war was on, and always the report was that thework of the Army Medical Corps was done very badly. Itwas not true that they had done badly-certainly not in theSouth African war. He proposed that instead of having aRoyal Commission at the end of a campaign or during theprogress of a campaign the gentlemen of the commission hadbetter go out at the beginning of the war and stop that forwhich they had blamed the medical staff. As far as theVolunteer force was concerned there was not a single ho--pital provided, no sanitary organisation, no administrationwhatever, and he thought that the medical men should c et theexample in this respect. Their whole training should be tobe methodical and look ahead. But however skilled themedical corps might be they could not fight disease unlessthe. officers of the whole army themselves cooperated withthem, and it was impossible for them to do so unless theywere educated up to the standard which the medical menrequired. He wished them all to be sanitary missionaries,spreading the true gospel of science, and impre. sing the factthat modern sanitation rested upon a sure scientific basis.After some discussion Dr. C. Childs moved a vote ofthanks to the Director-General which was seconded bySurgeon-Lieutenant-Colonel Webb, V.D., and carried withacclamation.

In the evening Sir Alfred Keogh was entertained at dinner.Mr. Swain proposed the health of the guest of the eveningand Mr. C. Whipple, senior surgeon, South Devon andEast Cornwall Hospital, proposed the health of ColonelBourke, C.B., administrative medical officer for the district.After dinner a conversazione took place and many points ofinterest in the scheme were discussed and elucidated.On Wednesday, Dec. 10th, Sir A. Keogh visited Liverpool

and met with an excellent reception from the medical menof tha locality.

THE VOLUNTEER AMBULANCE SCHOOL OF INSTRUCTION.’ At the headquarters of the London Rifle Brigade om’ Dec. 9th Sir Alfred H. Keogh, K.C.B., Director-General’

of the Army Medical Service, inspected the classes of’

the Volunteer Ambulance School of Instruction which

paraded in good strength with a full complement ofofficers at 130, Bunhill-row, London, E.C. After an

inspection of the ranks the prizes were distributed.The Maclure Challenge Shield for the advanced class.was won by the Royal Fusilier V.I. Brigade Bearer

Company. The Hamilton Challenge Bowl was won bythe lat Cadet Battalion King’s Royal Rifles. The Com-

,

mandant’s Cup for the best man in the school wa&

secured by Corporal A. W. Brown, Royal Fusilier V.I..

Brigade Bearer Company. The Director-General compli-mented the school, the staff of which had worked so

, well and for so many years under official discourage-ment and without recognition. But in the future that

’

would not be so, for they would have both support andofficial recognition, and he was happy to say that ColonelP. B. Giles would be the principal medical officer of one ofthe London divisions of the Territorial Force. He was verypleased with the smartness of the men and their steadiness.The number of special certificates gained showed goodwork on the part of the instructors. Colonel Giles, the.Commandant, in thanking the Director-General, said thatthe teaching of sanitation had been made a special feature inthe school, and he hoped that some of the members who hadobtained certificates would in the future help in the instruc-tion. He desired to thank the staff for their loyalty andgood work. The school is just completing its twenty-firstyear of existence, and no less than 750 officers have obtainedcertificates of proficiency after instruction, many havingcome for that purpose from the King’s dominions beyond the,seas.

FLORENCE NIGHTINGALE, O.M.A military correspondent writes : " Some notice of Miss,

Florence Nightingale’s appointment to the Order of Meritshould certainly be made in the columns of THE LANCETdevoted to the discussion of medico-military affairs. It isa subject of universal satisfaction that the King has beengraciously pleased to confer the Order of Merit on Miss.Florence Nightingale who by her signal services hasenshrined herself not only in the hearts of her own country-men but, it may even be said, in those of the civilised world.The debt of all armies to her is tremendous and there is noneed to tell of her exploits, for her mere name calls up re-collections of them. Their lesson has still, perhaps, to beindelibly stamped upon the memory of nations-viz., that just-in proportion as any future campaigns approach to the un-preparedness for war and neglect of the most elementarylessons of sanitation and experience which characterised theCrimean war may the same disastrous results be expected tofollow."

MOSCOW MILITARY HOSPITAL’S BI-CENTENARY.On Nov. 21st (Dec. 4th) the Moscow Military Hospital

celebrated the tvo hundredth year of its existence which

synchronises with the jubilee of the first medical school andinstitution in Russia which was established by Peter the-Great. On the same day there were published a "Historyof the Moscow Military Hospital " and a History of Medi-cine in Russia."

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Correspondence."Audi alteram partem."

THE TREATMENT OF PUERPERALSEPSIS.

To the Editors of THE LANCET.SIRS,-Your generous notice of my pamphlet on municipal

maternity homes by leading article in THE LANCET ofDec. 7th (p. 1624) has, it is needless to say, filled me withgratitude to you and hope for the future of my scheme.Your excellent analysis of the contents of the pamphletcontains all that is essential and all that is relevant to theneeds of the great urban communities in this country, andyour favourable notice calls the attention to my

" Plea " of avast professional public which the local pamphleteer couldnever have hoped to reach. I hope and trust that the resultwill justify the proceeding. But even if the scheme of