831

showed no marked excess in any of the thirty-three largetowns. The 30 deaths from diphtheria included 15 in London,3 in Manchester, 2 in Birmingham, 2 in Bradford, and 2 inNewcastle-upon-Tyne. Two deaths from small-pox wereregistered in London, but not one in any of the thirty-twoprovincial towns ; 43 cases of this disease were undertreatment in the Metropolitan Asylum Hospitals on

Saturday last (of which 11 were admitted during the week),and 7 in the Higbgate Small-pox Hospital. The number ofscarlet fever patients in the Metropolitan Asylum Hospitalsand in the London Fever Hospital at the end of the weekwas 1227, against 1230 and 1226 on the preceding twoSaturdays; 139 new cases were admitted during the week,against 146 and 126 in the previous two weeks. Thedeaths referred to diseases of the respiratory organs inLondon, which had been 523 and 466 in the precedingtwo weeks, farther declined last week to 430, and were44 below the corrected average. The causes of 78, or 1-8per cent., of the deaths in the thirty-three towns last weekwere not certified either by a registered medical practitioneror by a coroner. All the causes of death were duly certifiedin Cardiff, Croydon, Leicester, Leeds, and in six othersmaller towns ; the largest proportions of uncertified deathswere registered in West Ham, Preston, Huddersfield, Brad-ford, and Shield.

-

HEALTH OF SCOTCH TOWNS,

The annual rate of mortality in the eight Scotch towns,which had been 24-2 and 23-4 per 1000 in the preceding twoweeks, further declined to 21-2 during the week endingApril 2nd, and was 1-0 per 1000 below the mean rate duringthe same period in the thirty-three large English towns.The rates in the eight Scotch towns ranged from 15’6 inLeith and 17-1 in Aberdeen to 235 in Glasgow and 27-5in Perth. The 589 deaths in these towns included 24which were referred to whooping-cough, 15 to measles,8 to "fever," 7 to diphtheria, 6 to scarlet fever, 5 todiarrhoea, and not one to small-pox. In all, 65 deaths re-sulted from these principal zymotic diseases, against 71and 69 in the preceding two weeks. These 65 deaths wereequal to an annual rate of 23 per 1000, which slightlyexceeded the mean rate last week from the same dis-eases in the thirty-three large English towns. The fatalcases of whooping cough, which had been 28 and 34 in thepreceding two weeks, declined again last week to 24, ofwhich 11 occurred in Glasgow, 3 in Edinburgh, and 3 inDundee. The deaths referred to measles, which had de-clined in the previous three weeks from 16 to 12, rose

again to 15 last week, and included 13 in Glaggow. The 8fatal cases of "fever" showed a further increase uponrecent weekly numbers ; 3 occurred in Glasgow, 2 in Edin-burgh, and 2 in Dundee. The deaths from diphtheria,which bad been 5 and 8 in the preceding two weeks, were 7last week, and included 3 in Glasgow and 2 in Edinburgh.Of the 6 fatal cases of scarlet fever, 5 were recorded inGlasgow. The deaths referred to diseases of the respiratoryorgans in these towns, which had been 183 and 181 in thepreceding two weeks, further declined last week to 158, andwere 8 below the number in the corresponding week oflast year. The causes of 74, or nearly 13 per cent., of thedeaths in these eight towns last week were not certined.

NEALTH OF DUBLIN.

The death-rate in Dublin, which had increased in thepreceding four weeks from 32’7 to 401 per 1000, declinedagain to 37-3 during the week ending April 2ad. Duringthe thirteen weeks of the quarter ending on Saturday lastthe death-rate in the city averaged 38-4 per 1000, the ratefor the same period being 28-2 in London and 19-8 in Edin-burgh. The 250 deaths in Dublin during the week undernoticeshowedadecline of 19 from the high number in the pre-ceding week, and included 24 which were referred to measles,3 towhooping-cougb., 2 to diarrhoea, 1 to 11 fever," and not oneeither to small-pox, scarlet fever, or diphtheria. In all, 30deaths resulted from these principal zymotic diseases, equalto an annual rate of 4’5 per 1000, the zymotic death-rateduring the same period being 2-6 in London and 1-8 inEdinburgh. The fatal cases of measles, which had been12 and 22 in the preceding two weeks, further rose to 24last week, and exceeded the number recorded in any weeksince August, 1887. The deaths referred to whooping-cough, which had been 5 in each of the previous two weeks,declined to 3 last week. The 2 fatal cases of diarrhoea

were within one of the number returned in the precedingweek, and the death referred to " fever correspouded withthe number in the previous week, The 250 deaths inDublin last week included 43 of infants under one year ofage, and 56 of persons aged upwards of sixty years; thedeaths of infants exceeded the number in any recent week,while those of elderly persons showed a marked decline.Three inquest cases and 5 deaths from violence were re-gistered ; and 91, or more than a third, of the deathsoccurred in public institutions. The causes of 25, or 1(>per ctnt., of the deaths in the city last week were notcertified.

___

VITAL STATISTICS OF CALCUTTA AND ITS SUBURBS.

Dr. W. J. Simpson, the Health Officer for Calcutta, inhis official memorandum for December last, reports that thetotal number of births registered during the month was 894,against 783 in the preceding month, giving an annual ratioof 22 9, against 20’1 per 1000 of the population. Of the 89,births, 449 were males and 445 females. The total numberof deaths (exclusive of still births) registered in Decemberwas 1380 against 1282 in the preceding month, showing anannual ratio of 35’5 per 1000. The proportion of male to,female deaths was as 136 to 100. The monthly total ex-ceeds all the corresponding figures of the past decade,excepting 1881 and 1882, and alw exceeds the decenniat-mean by 93. There were 98 deaths from cholera.against 152 in the preceding month, less than the average-of the past decade by 80. No deaths from small-

pox, but those from fever amounted to 536, against’513 in the preceding month, and in excess of the corre-sponding figures for the past ten years. There were 4f,’deaths from tetanus during the month, 41 of which were in,infants under one year of age. In the amalgamated area o$suburbs there were 486 births registered in December,.giving an annual ratio of 27’1 per 1000 of population. The’total number of deaths registered was 879, giving any

annual ratio of 49’0 per 1000. Of these deaths, 49 were.from cholera, 388 from fevers, 154 from bowel complaints,52 from tetanus, 7 from injuries, and 229 from other causes.There were no deaths from small-pox in the suburbs during;the month. According to the weekly return of deaths forthe week ending Jan. 23rd, 1892, the latest return receivedby us, the total number of deaths for the town of Calcuttaregistered during the week was 309. The general death-rate of the week was 34’5 per 1000 per annum, against 28"2,the mean of the last five year?. The general death-rate ofthe week for the amalgamated area was at the rate of 46’3per 1000 per annum, against 37’8, the mean of the last fiveyears. The general death-rate of the combined area isequal to 382. The prominent and recurring features inthese returns from Calcutta and its suburbs are the preva--lence of fevers (presumably malarial in their nature), bowelcomplaints, and tetanus, especially among the infantpopulation.

____________

THE SERVICES.

WE regret to announce the death of Deputy- Snrgeon-,General Dr. Thomas Fraser from pneumonia, on the-3rd inst., at Exeter. The deceased officer had long retiredfrom the Service. He was for a long time the surgeon othe 10th Hussars, and subsequently was in medical chargeof the Royal Military College at Sandhurst. Deputy-Surgeon-General Fraser was very popular and much-esteemed whilst in the Medical Service, and the news ofhis death will be received with much regret by those to;,whom he was known.Brigade-Surgeon-Lieutenant-Colonel T. Maunsell, in

charge of the 2nd Station Hospital at Aldershot, in anticipa-.tion of promotion to Surgeon-Colonel, succeeds Surgeon-Major-General G. L. Ilmde, Principal Medical OfficerSouth-Eastern District, who shortly retires.ARMY MEDICAL STAFF.-We understand that in future

every candidate for a commision in the Army Medical,Staff will be required to po8se,,qp, in addition to the

qualifications previously laid down, a certificate of

having acted as medical clinical clerk for Qix months andas surgical dresser for another six months, not less thsrsthree months of each period being spent in hospital wards ;also a certificate of having attended not less than threemonths’ instruction at an ophthalmic hospital, whosecourse shall include i 1strucion in the errors of refraction-

832

Surgeon-Majnr W. T. Johnston, doing duty in the Bel-gaum and Bangalore Districts, Madras command, hasbeen appointed to the charge of the Station Hospital,Rangoon; Surgeon-Major A. W. Carleton has been trans-ferred from the Station Hospital, Rangoon, on appoint-ment to the charge of the North Station Hospital at

Secunderabad, Madras command; Surgeon-Captain F. T.Skerretc has been transferred for duty in the MadrasDisttictfrom the Station Hospital at Wellington; Surgeon-:Lieutenant-Colonel H. W. A. Mackinnon, D.S.O., will, ontransfer from Canterbury to Aldershot for duty, be ap-pointed to the charge of the North Camp Hospital, viceBrigade-Surgeon-Lieutenant-Colonel F. Howard; Brigade-:Surgeon-Lieutenant-Colonel F. B. Scott, C.M.G., takescharge of the 2nd Station Hospital, vice Brlgade- Surgeon-Lieutenant- Colonel T. Maunsell; Surgeon-Captain C. W.Thifle, stationed at the 3rd Station Hospital, Aldershot,has been placed under orders for embarkation for the West,Coast of Africa; Surgeon-Captain J. W. Jennings has pro-ceeded from Worcester to Carnarvon to assume medicalcharge of the 4th Battalion Royal Welsh Fusiliers, andSurgeon- Captain R. J. Windle, from Chester to Beaumaris,in medical charge of the Royal Anglesea EngineeringMilitia; Surgeon-Captain T. Archer has been struck off thestrength of the S.E. District, on proceeding to Bermuda;Surgeon-Captain H, A. do Lom has been posted to theStation Hospital, Western Heights. Dover; Surgeon-’Captain R. Kirkpatrick has joined at Easter.road Barracksfor duty from Edinburgh Castle, and Surgeon Captain G.Wilson has joined in his place from Piershill ; Surgeon-Captain G. E. Moffett has been transferred from Perth toFort George, and Surgeon-Captain W. G. Birrell from Fort’George to Easter-road Barracks; Surgeon-Captain L. Nash,proceeded on the 25bh ult. to Hebburn, in medical chargeof troops, and Surgeon-Captain S. R. Wills has been postedto Newcastle.on-Tyne ; Surgeon-Major J. E. Nicholson has

joined the Citadel, Plymouth, for duty; Surgeon-Captain.J. H. Brannigan has arrived at Devonport for duty ; Sur-geon-Captain G. G. Adams has been transferred to Horfield4rom Cardiff; Surgeon-Captain T. W. Gibbard has joinedat Winchester, from Portsmouth; Surgeon- Captains R. C.- Johnston and R. G. Thompson have joined the ThamesDistrict for duty.—Surgeon-Major-Genpral A. M. Tippetts,having attained the age of sixty, has been placed on retiredpay.-Surgeon-Major T. J. Gailwey, M.D , Medical Staff,having left; for Cairo to take up his appointment in theEgyptian Army, will now be seconded.ARMY MEDICAL RESERVE OF OFFICERS. - Surgeon-

Captain Alfred Herbert Marsh, 3rd Volunteer Battalion,’the Cheshire Regiment, to be Surgeon-Lieutenant (datedApril 6th, 1892).NAVAL MEDICAL SERVICE.-The undermentioned Sur-

,eons have been promoted to the rank of Suaff Surgeon inHer Majesty’s Fleet):—William Manley Lory and WilliamSpencer Lightfoot.-The following appoinoments have beenmade at the Admiralty :-Staff-Surgeon Wm. S. Lightfootto the Philomel (dated March 31st, 1892); Surgeons: Edwd.Cooper to the Victory (dated April 4th, 1892) ; Joseph C.Wood to the Assaye (dated April 5th, 1892) ; Richard F.Bate to the Champion (undated).VOLUNTEER CORPS.-Royal Engineers (Fortress and

Railway Forces): 1st Aberdeenshire: William Sinclair,M.B., to be Surgeon-Lieutenant (dated April 2nd, 1892).-Rifle: 1st Surrey (South London) : Surgeon-LieutenantC S. Smith to be Surgeon-Captain (dated April 2nd,1892).&mdash;1st Volunteer Battalion the Royal Sussex Regi-ment : Charles William James Chepmell, M.D., to be Sur-geon-Lieutenant (dated April 2nd, 1892).-20th Middlesex<Artists’) : Surgeon-Captain A. R. F. Evershed resigns hiscommission (dated April 2nd, 1892).VOLUNTEER MEDICAL STAFF CORPS.&mdash;The Manchester

Division: Geo. Clements Richardson, Gent., to be Surgeon-Lieutenant (dated April 2nd, 1892).

ESSEX AND HERTS BENEVOLENT MEDICALSOCIETY.-The annual report for 1891 of this Society, forthe relief of the widows and orphans of medical men in thecounties of Essex and Hertford, shows that the total grantsfor the year amounted to &pound;375. The capital stock, in-vested in Consols, was &pound;10,053.

Correspondence.

THE OPIUM QUESTION.

11 Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-The "opium controversy" has of late attracted con.siderable attention. It was the subject of an article thatappeared in THE LANCET a few weeks ago, and also of a longdiscussion in the Indian Section of the Society of Arts. Acircular has also been widely distributed amongst membersof the medical profession, of which I have received a copy,asking us to subscribe to certain propositions regarding theeffects of the consumption of opium upon the people of India,and to sign a memorial recommending to the Government ofIndia that the growth and sale of opium in India should beprohibited by law. This document I have not felt myselfable to sign, as I am convinced that many of the statementsin the memorial and in the covering letter are erroneous,and founded upon imperfect knowledge. Probably a

large proportion of the 5000 members of the medicalprofession whom you stati3 to have signed the memorialhave done so on hypothetical grounds, and withoutany direct or personal knowledge of its merits. I havehad rather a long experience of medical practice inIndia, having had charge of native hospitals, dispensaries,and gaols in nearly all parts of the Bengal Presidency, inthe hills, in the Punjab, the North-West Provinces, LowerBengal, and Orissa, and I have always mingled freely withnatives of all classes ; so that I have had pretty full oppor-tunity of judging of the effects of the use of opium on thehealth and well-being of the people generally, and, as thesubject is of the greatest medical interest, I venture to askyou to accord me a small space in your influential journalfor this letter. I do not propose to enter into the politicaland financial side of the question. That I would leave toothers who have more special knowledge on such matters,and are more capable of forming a correct judgment.Unless, however, it can be clearly established-and thisis a medical question-that the use of opium, as we

find it in India, leads to anything like common or

widespread injury to either the moral or physical well-being of the people, we should, indeed, hesitate before weadvocate the giving up a large source of revenue whichpresses upon no one, and in its place lay additional taxationon, perhaps, the poorest, but at the same time the mostpatient, thrifty, and industrious, peasantry in the world.It would indeed be a most cruel and tyrannical exercise ofEngland’s almost unlimited power in India, perhaps only toremove a sentimental wrong.

In bringing to notice some of the medical and sanitaryaspects of the question, I will confine myself chiefly tomatters that have come under my personal knowledge andobservation. It is well known that the use of opium by thepeople of India is far from being general or universal. It isvery much restricted to certain classes and to certainlocalities ; of those who use opium, some smoke and someeat the drug. As a rule, when the people are in the habit oftaking opium they do so in great moderation; there is nogeneral tendency to exceed, any more than with the majorityof people at home who take their daily glass or two of wine orbeer there is a tendency to drink in excess. In the sameway it is, I am convinced, an erroneous notion to supposethat in the moderate quantity in which it is usually takenopium has a deleterious effect upon the health or physiqueof the people. The Sikhs in the Punjab, perhaps the mosthardy, vigorous, and warlike race in India, commonly takeopium, and they certainly show no signs of deberioration.Again, the paiki bearers of Behar and Goruckpore, men ofsmall stature and slight build, are perhaps capable of asgreat or greater physical exertion as any class of men in theworld, and that on an amount of nourishment that in thiscountry would hardly satisfy a child. They nearly all smokeopium. I have known a set of twelve men-and eight menwill do equally well-carry me in a palanquin a dhtance offorty miles in a little over ten hours. Of course they taketurns to carry, four and four about, but all the men run