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VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5772 birthsand 3736 deaths were registered during the week endingFeb. 19th. The annual death-rate in these towns, which hadsteadily declined in the preceding six weeks from 26’5 to19’5 per 1000, rose again last week to 21’1. During the firstseven weeks of the current quarter the death-rate in thesetowns averaged 22’1 per 1000, and was 2’3 below themean rate in the corresponding periods of the ten years1877-86. The lowest rates in these towns last week were17-2 in Derby, 17-9 in Salford, 17’9 in Leicester, and 18’1 inBrighton. The rates in the other towns ranged upwardsto 25’7 in Plymouth, 25’8 in Liverpool, 28’6 in Manchester,and 29’6 in Preston. The deaths referred to the principalzymotic diseases in the twenty-eight towns, which haddeclined in the preceding five weeks from 485 to 340,rose again last week to 371; they included 125 from whooping-cough, 107 from measles,47 from scarlet fever, 36 from diarrhoe a,.32 from diphtheria, 23 from "fever" (principally enteric),and only 1 from small-pox. The lowest death-rates from theseprincipal zymotic diseases were recorded last week in Brighton,Derby and Leicester; and the highest rates in Bristol,Huddersfield, and Liverpool. The greatest mortality fromwhooping-cough occurred in Sunderland, Huddersfield, andPlymouth; from measles in Hull, B uddersfield, and Liver-pool ; from scarlet fever in Salford, Blackburn, and Bristol;and from "fever" in Preston. The 32 deaths from diph-theria in the twenty-eight towns included 15 in London,3 in Portsmouth, 2 in Birkenhead, 2 in Liverpool, and 2 inPreston. Small-pox caused 1 death in Newcastle-upon-Tyne, but not one in London and its outer ring, or in anyof the twenty-six other large provincial towns. Only 4small-pox patients were under treatment on Saturday lastin the metropolitan hospitals receiving cases of this disease.The deaths referred to diseases of the respiratory organs inLondon, which had been 364 and 373 in the preceding twoweeks, further rose last week to 392, but were 149 belowthe corrected average. The causes of 95, or 2’0 per cent., ofthe deaths in the twenty-eight towns last week were notcertified either by a registered medical practitioner or by acoroner. All the causes of death were duly certified inBristol, Blackburn, Norwich, and in four other smallertowns. The largest proportions of uncertitied deaths wereregistered in Brighton, Leicester, Salford, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 19’8 and 22.0 per 1000 in the preceding twoweeks, further rose in the week ending Feb. 19th to 24’3;this rate exceeded by 3’2 the mean rate during the sam.eweek in the twenty-eight large English towns. The ratesin the Scotch towns last week ranged from 13’7 in Greenockand 14’6 in Perth, to 26-6 in Aberdeen, 27 0 in Glasgow, and28-2 in Paisley. The 607 deaths in the eight towns lastweek showed a further increase of 57 upon the numbersreturned in the preceding two weeks, and included 32which were referred to whooping-cough, 25 to scarlet fever,23 to measles, 14 to diarrhoea, 5 to diphtheria, 4 to " fever"(typhus, enteric, or simple), and not one to small-pox;in all 103 deaths resulted from these principal zymoticdiseases, showing a further increase upon the 66 and 76returned in the previous two weeks. These 103 deathswere equal to an annual rate of 4’1 per 1000, whichexceeded by 2’0 the mean rate from the same diseasesin the twenty-eight English towns. The fatal cases

of whooping-cough, which had been 19, 23, and 28 in thepreceding three weeks, further rose last week to 32, ofwhich 22 occurred in Glasgow, 4 in Aberdeen, and 3 inEdinburgh. The deaths from scarlet fever and from measlesalso showed a considerable further increase upon recentweekly numbers; the 25 fatal cases of scarlet fever included16 in Edinburgh, 5 in Glasgow, and 3 in Dundee; of the23 deaths from measles, 12 occurred in Glasgow and 9 inAberdeen. The 14 deaths attributed to diarrhoea included7 in Glasgow, 3 in Dundee, and 3 in Aberdeen. Three ofthe 5 fatal cases of diphtheria and 2 of the 4 deaths from"fever," were returned in Glasgow. The deaths referredto acute diseases of the respiratory organs in the eight towns,which had been 126 and 133 in the preceding two weeks,further rose last week to 146, but were 7 below the number

returned in the corresponding week of last year. Thecauses of 69, or more than 11 per cent., of the deathsregistered during the week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 29’7 and27’3 per 1000 in the preceding two weeks, rose to 35’3 inthe week ending Feb. 19th. During the first seven weeksof the current quarter the death-rate in the city averaged31’5, the mean rate during the same period being but20’9 in Londou and 21-8 in Edinburgh. The 239 deaths inDublin last week showed an increase of 54 upon thenumber in the previous week, and included 4 which werereferred to "fever" (typhus, enteric, or simple), 3 toscarlet fever, 3 to diarrhoea, 2 to whooping-cough, 1 tomeasles, 1 to diphtheria, and not one to small-pox. Thusthe deaths from these principal zymotic diseases, whichhad been 13 and 17 in the preceding two weeks, de-clined again last week to 14; they were equal to anannual rate of 2’1 per 1000, the rates from the samediseases being 1’5 in London and 4’0 in Edinburgh, Thedeaths referred to " fever," corresponded with the number inthe previous week, while the fatal cases of scarlet fever,diarrhoea, and whooping-cough each showed a decline. Thedeaths of infants exceeded the number returned in anyprevious week of this year, and those of elderly personsalso showed an increase upon recent weekly numbers.Five inquest cases and 2 deaths from violence were

registered; and 81, or more than a third, of the deathsoccurred in public institutions. The causes of 33, or nearly14 per cent., of the deaths registered during the week werenot certified.

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THE SERVICES.

THE following is added after paragraph 1244 of the Regula-tions for the Army Medical Department, 1885:-Whenever a.

medical officer is required to report, in the case of individualsinjured in the Service, upon their capability, or otherwise,to contribute to their own support, the greatest care will beobserved by him in forming and recording an opinion, as itis mainly upon such opinion that the important question ofgranting compassionate allowances or gratuities has to beconsidered.Deputy Surgeon-General J. B. C. Reade, C.B., has handed

over his charge at Umballa and proceeded on leave ofabsence, and has been replaced at Umballa by Deputy Sur-geon-General J. Landale, M.D.Surgeon-Major F. A. Turton has been brought in from the

temporary half-pay list, and has joined the Northern Districtfor duty at Birmingham in charge of the detachment therestationed.WAR OFFICE.-Army Medical Staff : The undermentioned

Surgeons have been seconded for service with the EgyptianArmy: William Henry Phillips Lewis, Aylmer Ellis Hayes,Arthur Maher Kavanagh, and Richard Edward RickettsMorse..

INDIA OFFICE.-The Queen has approved of the retire-ment from the Service of the undermentioned officer of theIndian Military Forces: Surgeon-Major John ProudfootStratton, M.D., of the Bombay Medical Establishment. The

Queen has also approved of the undermentioned officersbeing granted a step of honorary rank on retirement: DeputySurgeon-General Charles Planck, Deputy Surgeon-GeneralAlfred James Dale, and Deputy Surgeon-General John Brake,all of the Bengal Medical Establishment, and Deputy Sur-geon-General Henry Cook, M.D., of the Bombay MedicalEstablishment, to be Surgeons-General; Brigade SurgeonJames Fairweather, M.D., Brigade Surgeon James Browne,M.D., and Brigade Surgeon Robert Sander Bateson, all of theBengal Medical Establishment, to be Deputy Surgeons-General ; and Surgeon-Major John Proudfoot Stratton,M.D., of the Bombay Medical Establishment, to be BrigadeSurgeon.ADMIRALTY.-The following appointments have been

made :-Surgeon John N. Corbetr, to the Orwell; Mr.Patrick J. Sheridan to be Surgeon and Agent at Kilmore;and Mr. George C. Dickson to be Surgeon and Agent atWhitehaven.ARTILLERY VOLUNTEERS.—1st Banff: Acting Surgeon

James Hitchcock, M.B., resigns his appointment. - lstVolunteer (Hampshire) Brigade, Southern Division, Royal

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Artillery: Surgeon Burford Norman is granted the honoraryrank of Surgeon-Major.—1st North Riding of Yorkshire:Friend Edward Streeten, Gent., to be Acting Surgeon.ENGINEER VOLUNTEERS. - The Volunteer Submarine

Miners (the Humber Division): Edward Furniss Potter,Gent., to be Acting Surgeon.RIFLE VOLUNTEERS.—1st Volunteer Battalion, Princess

Charlotte of Wales’s (Royal Berkshire Regiment): James

Hopkins Walters, Gent., to be Acting Surgeon; FrederickWilliam Dyce Fraser, M.D., to be Acting Surgeon.-2ndCambridgeshire (Cambridge University) : James HaywardHough, Gent., to be Acting Surgeon.-4th Cheshire : KennethMaclean, Robert Alexander Murray, M.B., and John Keay,to be Acting Surgeons.—1st Midlothian (Leith): James Mill,1I.B., to be Acting Surgeon.-2nd Shropshire: Surgeon andHonorary Surgeon-Major F. J. Sandford, M.D., resigns hiscommission; also is permitted to retain his rank and to

continue to wear the uniform of the corps on his retirement.

Correspondence.ASPIRATION OF THE URINARY BLADDER.

" Audi alteram partem."

To the Editors of THE LANCET. ]

SIRS,- At the meeting of the Medico-Chirurgical Societylast luesday, Mr. William H. Bennett read a paper on a caseof aspiration of the bladder which ended fatally, and in the course of his remarks said that the text-books taught thataspiration of the bladder was a harmless operation. Owingto the discussion on Mr. Morris’s important paper, there wasno opportunity of replying to Mr. Bennett, and I therefore,with your permission, beg leave to state that in my articleon Retention of Urine, in Mr. Christopher Heath’s " Dictionaryof Practical Surgery" (vol. ii, p. 335), I am careful to saythat "fatal extravasation and abscess have been known tofollow a second aspiration," and I based this remark upona case published some years ago by Dr. Macfie Campbell ofLiverpool. Other fatal cases of aspiration have been pub-lished (e.g., by Mr. Treves, THE LANCET, August, 1880), inall of which 1 find that over-distension of the bladder wasallowed to recur after the relief obtained by aspiration. If,after aspiration, the bladder is kept free from over-distensionby the introduction of a catheter-often easy enough whenthe urgent symptoms have been relieved-or by a second or athird aspiration, the operation is a safe one. I am wellaware that a bladder has been aspirated twenty times inimmediate succession safely; still, I do not consider such aproceeding good practice, and, in the article above referredto, I advise that in the event of more than two or threeaspirations being required, supra-pubic puncture with trocarand cannula should be performed. Mr. Bennett’s case f ur-nishes valuable additional evidence that aspiration must notbe inconsiderately resorted to, but the operation is such a safeand useful one in certain rare cases of retention where aninstrument cannot at the moment be introduced by theurethra, that it is a pity it should in any way be discredited.1 make no reference to the treatment of a rotten bladder(the expression used by Mr. Bennett), because I am notaware of the existence of such a condition in acute retentionof urine. By the time a bladder deserves to be called rottenNature has anticipated the surgeon and has relieved herselfby rupture, requiring appropriate treatment, which is cer-tainly not aspiration. I am, Sirs, yours truly,

G. BUCKSTON BROWNE.

THE MEMBERS OF THE COLLEGE OF SURGEONS. To the Editors of THE LANCET.

SIRS,-We trust that you will forgive us for offering afew further details as to the signatures (now over 4600)received to the petition of the Members of the College ofSurgeons to the Privy Council. By the end of last year thenumber was 1430, chiefly obtained by personal solicitation;but we felt then that we might expect a very much largertotal than this, and consequently issued about 9000 formsof the petition to Members of the Royal College of Surgeonsin the United Kingdom who had not already signed, thisnumber covering all those whose addresses appear in the

Medical Directory. It has been most satisfactory, seeingthe usual fate of a circular, that over one-third of thisnumber have been returned to us, and that we have whatmay fairly be called almost half of the Members resident inthe United Kingdom, whose present addresses are discover-able, as signatories to the petition. We make no manner ofdoubt that by a "house-to-house visitation," as you sug-gested a few weeks ago, the overwhelming majority wouldbe in our favour. But we do not think the expenditure ofenergy and money at all necessary, the more especially as theprobable result of such a measure is clearly shown by the fol-lowing statistics :--Out of 503 Members of the Royal Collegeof Surgeons placed on the local list of the Medical Directoryfor 1387 as resident in the following eighteen pro-vincial towns-viz., Bath, Bolton, Bradford, Bristol (andClifton), Cardiff, Chichester, Great Malvern, Middlesborough?Ramsgate, Scarborough, Shrewsbury, Southampton, Swan-sea, Wigan, Windsor, Worthing, Yarmouth, and York-359have signed, which, allowing for about 23 of the 503 beingeither marked as " retired," or with an asterisk, as ofuncertain address, gives a proportion of three-fourths whohave signed-75 per cent. We instance these places, as inthem our local hon. secretaries have been very active ingetting the question ventilated ; and it is far more just toargue from such localities than from very large, unwieldycities or country districts, where our circular is the onlyintimation Membeis have had that such a movement was onfoot, and where, consequently, their interest has not yetbeen aroused in it. Ot the towns mentioned above, wewould especially lay stress on Bristol, from which and fromClifton our local hon. secretary, Mr. Samuel Smith, sent usthe petition, signed by sixty Members-i.e., by half of theMembers residing there,—twenty-four of the remaining halfsending their signatures later on our circular forms. TheCouncil of the College are really responsible for this wide-spread expression of opinion; for, had they moved forwardmore quickly with their application for a new Charter, weshould not have had the time to get our aims so widelyknown. Shall we call this generosity on their part? Asto any feeling contrary to our proposals existing amongthe Members, we may inform you that we have had onlyfourteen expressions of objection to the memorial-fourteenagainst 4600.-We are, Sirs, your obedient servants,

WARWICK C. STEELE,WM. ASHTON ELLIS,

Hon. Secs., Assoc.of M.R.C.S.

Western Dispensary, Westminster, S.W., Feb. 16th, 1887.

LUNACY ACTS AMENDMENT BILL, 1887.To the Editors of THE LANCET.

SIRS,—Permit me to draw the attention of workhousemedical officers to the injustice which it is proposedin the Lord Chancellor’s Lunacy Act Amendment Billto perpetrate on them by the provisions contained inClause 14, Sections 5, 6, 7, 8, page 13, whereby it is arrangedthat they shall be debarred by statute from receiving anyremuneration whatever for the examination and certificationof a lunatic received into the workhouse of which they arethe medical officers, and that they shall be subjected to afine of .610 for any day or part of a day they neglect tosupply a certificate for nothing. Some forty-five to fiftyyears ago a similar proviso was made, but, the great injusticeimplied therein having been made manifest, the restrictionwas removed, and guardians were permitted-nay, encou-raged-by the Commissioners in Lunacy to allow theworkhouse medical officer to perform this duty and to

pay him a fee varying from 10s. 6d. to 21s. Thereason given for the prohibition in the first instanceand for its repetition now is the feeling entertainedby certain persons in the medical and legal professions thatthe workhouse medical officer would abuse his position forthe sake of the fees above named in certifying that all and

sundry of the inmates of the house were of unsound mind,wholly oblivious of the fact that when certified to they atonce pass under the skilled superintendence of the principalmedical officer of the asylum to which they may be sent,who would speedily report upon any abuse of authority bythe workhouse medical officer or by his substitute. Beforeconcluding, I should like your readers to understand that,with the rare exception where an inmate becomes insane,all persons admitted to a workhouse alleged to be of unsoundmind go there with a certificate from the district medicalofficer, the divisional surgeon of police, or by the order of a