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corrected average number in the corresponding period ofthe five years, 1902-06. The causes of 35, or 0-7 per cent.,of the deaths registered in the 76 towns last week werenot certified either by a registered medical practitioner orby a coroner. All the causes of death were duly certifiedin Leeds, Bristol, West Ham, Bradford, Newcastle-on-Tyne,Hull, and in 51 other smaller towns ; five uncertified deathswere registered in Liverpool, five in Sheffield, three in

Middlesbrough, and two each in London, Manchester,Birmingham, Preston, Northampton, and St. Helens.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 13 - 6 and 13 2 per1000 in the two preceding weeks, rose again to 13 8 per1000 in the week ending Oct. 12th, but was 1’ 9 per 1000below the mean rate during the same period in the 76large English towns. The rates in the eight Scotch townsranged from 7’ 5 in Perth and 11 1 in Aberdeen to 16’ 1 inGreenock and 18 - 8 in Paisley. The 479 deaths in thesetowns last week were 22 in excess of the number in theprevious week, and included 81 which were referred to theprincipal epidemic diseases, against 51, 64, and 57 in thethree preceding weeks. These 81 deaths were equal to anannual rate of 2 - 3 per 1000, which was 0 - 7 per 1000 belowthe mean rate last week from the principal epidemic diseasesin the 76 large English towns ; they included 37 which werereferred to diarrhoea, 15 to whooping-cough, 11 to "fever,"nine to measles, seven to diphtheria, and two to scarlet fever,but not any to small-pox. The deaths from diarrhoea, whichhad been 31 and 23 in the two previous weeks, rose again to 37 Iin the week under notice, and included 24 in Glasgow, three Iin Dundee, three in Aberdeen, and two each in Edinburgh, ILeith, and Greenock. The fatal cases of whooping-cough, Iwhich had been 10, 15, and 17 in the three preceding weeks,declined again last week to 15, of which seven occurred inGlasgow, four in Edinburgh, and two in Dundee. The deathsfrom " fever," which had been six, eight, and ten in the threepreceding weeks, further rose to 11 in the week under notice,and included four from cerebro-spinal meningitis, threefrom enteric fever, and two from typhus fever in Glasgow, andone from cerebro-spinal meningitis in Edinburgh and inPaisley. The fatal cases of measles, which had been six andtwo in the two previous weeks, rose again last week to nine,of which five were registered in Glasgow and three inDundee. The deaths from diphtheria, which had been

three, two, and three in the three preceding weeks, furtherincreased to seven last week, and included four in Glasgowand three in Paisley. The deaths in the eight townsreferred to diseases of the respiratory organs, includingpneumonia, which had been 58 and 65 in the two pre-ceding weeks, declined again to 51 in the week under notice,and were 29 fewer than the number in the correspondingperiod of last year. The causes of 12, or 2’5 5 per cent.,of the deaths registered in these eight towns last weekwere not certified or not stated ; in the 76 English townsthe proportion of uncertified deaths did not exceed 0 - 7

per cent. -

HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which had been18-6 6 and 21-0 0 per 1000 in the two preceding weeks,declined again to 20’ 2 per 1000 in the week ending Oct. 12th.During the 13 weeks of last quarter the death-rateaveraged 18. 7 per 1000, the rate during the same periodbeing 12’1 1 in London and 12 - 6 in Edinburgh. The 151deaths of Dublin residents registered during the weekunder notice were six fewer than the number in the previousweek, and included 30 which were referred to the principalepidemic diseases, against 13, 22, and 18 in the three precedingweeks ; they included 23 from diarrhoea, three from "fever," "two from whooping-cough, one from measles, and one

from diphtheria, but not any from small-pox or fromscarlet fever. These 30 deaths were equal to an annualrate of 4’0 0 per 1000, the death-rates last week fromthe principal epidemic diseases being 2, 0 in Londonand 1 - 1 in Edinburgh. The fatal cases of diarrhoea, whichhad been ten, 17, and 12 in the three preceding weeks,further rose last week to 23. The 151 deaths from allcauses included 42 of children under one year of age and33 of persons aged upwards of 60 years ; the deaths ofinfants were 14 in excess of the number in the preced-ing week, while those of elderly persons showed a slight

decline. Three inquest cases and four deaths from violencewere registered ; and 53, or 35’ 1 per cent., of the deathsoccurred in public institutions. The causes of three, or 2’0per cent., of the deaths registered in Dublin last week werenot certified; in London the proportion of uncertifieddeaths did not exceed 0’ 2 per cent., while in Edinburgh itwas 3 ’ 4 per cent.

THE SERVICES.

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

N. L. Richards to Bermuda Hospital. Staff Sutgeons : E. R.Grazebrook to the Pembroke, additional, to be lent to theWildfire for the Endymion; A. J. Laurie to the Tenedos.Surgeons : F. Cock to the Mars; A. B. Cox, lent to the BlackPrince, temporary.

ROYAL ARMY MEDICAL CORPS.Lieutenant James C. L. Hingston, from the Seconded List,

to be Lieutenant (dated Oct. lst, 1907).ROYAL MALTA ARTILLERY.

Surgeon-Lieutenant Robert Randon to be Surgeon-Captain (dated Oct. 5th, 1907).

DEATHS IN THE SERVICES.

Captain J. A. Dredge, I.M.S., at Glastonbury recently, inhis thirty-fifth year. He joined the service in 1897 and waspromoted to the rank of captain in 1900. He served inChina in 1900 (medal). He had latterly served as staffsurgeon at Bangalore.

Lieutenant-Colonel Edwin Oswald Milward, R.A.M.C.,aged 54 years, at Oxford, on Oct. lst. He served through theSouth African war, including the relief of Ladysmith, andalso took part in the actions of Colenso and Spion Kop, theTugela Heights, Vaal Kranz, and Pieter’s Hill (Queen’smedal with six clasps and the King’s medal with two claspsand mentioned in despatches).

ARMY MEDICAL REORGANISATION.Mr. Haldane, recently addressing his constituents at North

Berwick, dwelt, as might have been anticipated, at somelength upon his Army scheme and upon the steps which hadalready been taken to give effect to the new organisationwhich that scheme entailed. The Secretary for War tookoccasion at the same time to announce that in connexiontherewith an important movement was about to take place inthe way of a reorganised medical force. They had been forsome time past, he is reported to have said, considering howbest they could invite the medical profession to assist theterritorial army, and the Director General of the ArmyMedical Service was coming down to make a beginning withScotland by inaugurating the creation of a reorganised medicalforce for the territorial army. This territorial medical servicewas wanted in time of war, not only to treat wounds, butto secure sanitation and health preservation. The WarOffice could not proceed with this wholly on a regimentalbasis. They proposed to work on the footing of there beingone great corps, just as in the case of the Engineers. Thevarious medical units which were necessary for the divisionsof the territorial army would be raised, as far as possible,within the areas in which these divisions were to be formed.As well as the personnel of officers, non-commissioned officers,and men required for the special duties outside these units,the cooperation of experts engaged in preventive medicinewould also be sought. These experts would be asked to givetheir advice in time of war should troops be massed in thevicinity of their spheres of work, but the War Office did notpropose to make undue demands upon the time of thesedistinguished men. They were also going to ask the nursingprofession to volunteer in time of war to serve in theterritorial hospitals according to a scheme which the WarOffice would shortly put forward.

MEDICAL ARRANGEMENTS AT MANŒUVRES.The Army and Navy Gazette of Oct. 12th says that, " In

view of the inadequacy of the medical arrangements in therecent manoeuvres, it would be an advantage if Mr. Haldanewould authorise and provide money for manoeuvrea for theArmy Medical Service, such as have recently been takingplace in France, in the neighbourhood of Douai. These

particular operations began on October 2nd with conferences,

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.-at which the principal medical officers discussed with theirsubordinates the measures to be taken. M. Hassenet,technical director of the manoeuvres, dealt with the generalwork to be done and with the operations of the service in thefield, and General Ilurstel also addressed the assembledofficers. Another medical officer explained the working in-detail of the system of the advanced stations. The

troops employed for these operations were furnished.principally by a territorial regiment, which began work invery heavy rain. The bearers were instructed and trainedin the methods of finding and carrying away the wounded,-with proper precautions, to the dressing stations, and amedical officer from the auxiliary hospital at Laon was

present and gave instructions in the use of new wheelambulances, and showed how 400 wounded would be treated-at Laon. After the exercises of the bearers, came trials ofspecial apparatus, including the tortoise tent, which canshelter 28 wounded and has for support and base the wagonwhich carries it. It was brought into use with great rapidity.The Herbert tent, which is a veritable field hospital,. requiredabout three hours to instal, perhaps through the inexperience-of the men. These and other operations and trials have been- very successful and ’the men have been well exercised andtrained in the conduct of the medical service and equipmentson the road and in the field."

THE LATE MAJOR T. W. A. FULLERTON, I.M.S.The brother officers of the late Major T. W. A. Fullerton,

I.M.S., are subscribing to place a brass tablet to his memoryin the cathedral at Allahabad. It is also proposed to raise afund to secure a further memorial in the shape of a lancetwindow in the cathedral. Contributions for this object may"be forwarded to Colonel R. D. Murray, I.M.S., Otic Park,:Naini Tal, North-West Provinces, India.

THE NAVAL MEDICAL SUPPLEMENTAL FUND.At the quarterly meeting of the directors of the Naval

Medical Supplemental Fund, held on Oct. 8th, Inspector-General W. Harris Lloyd, R.N., in the chair, the sum of£50 was distributed among the several applicants.

HASLAR HOSPITAL.An advanced course for senior naval medical officers was

- commenced at Haslar Hospital on Oct. 14th. The coursewill last six weeks, 24 days being devoted to practical work.

Correspondence."Audi alteram partem."

MEDICAL PRACTITIONERS AND MEDICALREFEREES UNDER THE WORKMEN’S

COMPENSATION ACT, 1906.To the Editors of THE LANCET.

SIRS,—I regret that my absence from London has pre-vented my seeing before the leading article in THE LANCETof Sept. 28th, p. 906, referring to my letter which youkindly inserted on Sept. 21st. As the question is one

of very great importance to every class of medical

practitioner I venture to ask you to allow me to stateat somewhat greater length the opinions I have formedafter a very large experience of medical examina-tions under the Workmen’s Compensation Act of 1897and some of the reasons which have induced me to formthem. Your article was largely based on the Regula-tions which appear in Order No. 484, which apply to

appeals from the decisions of certifying factory surgeons,whereas my letter was intended to apply to the Regulations in

Order No. 433 which deal with the examinations ofL. 11,

medical referees in Workmen’s Compensation cases, where thefacts as to the amount of injury or disability are in dispute.

The question of the decisions of certifying factory surgeonsis a very small one in comparison with the great question asto awards and assessments in disputed claims for compensa-tion under the Act, which are already amounting to a verylarge number in all classes of employment. Bearing inmind that under the new Act the decisions of the medicalreferees are to be " final and conclusive I I think everyonewill agree with me that the fullest possible information as

to the medical history of every individual case should be

placed before the medical referee. My experience is that itis impossible to obtain from an injured person a trustworthymedical history, and this I say without any innuendo againstclaimants as a whole, a large majority of whose injuries arebonâ-fide, or against workmen as a class. I say it because itis practicably impossible for an injured person of any rankin life who has not had medical training to give a history ofhis case without magnifying trivialities and perhaps omittingto detail points which have an important bearing on thecase.

I therefore consider that the medical attendant of theworkman should certainly be present at an examination of aworkman by a medical referee, but I do not think that, atany rate, the great employers would be satisfied with a

decision when the medical referee had examined a workmanin consultation with the workman’s medical attendant and inthe absence of the medical practitioner " provided and paidby the employer and upon whose previous report the casewas being contested. Having this in view I suggest that theemployer should, if he thinks fit, be able to be representedby a medical man at an examination made by a medicalreferee. With all due deference to your legal adviser I amadvised that the paragraph on Forms A and B, to be sent bythe medical referee to both employer and workman, wouldfully permit an employer or workman to be represented atthe examination by a medical man, it being: " Any state-ment made or submitted by you will be considered."

In my opinion, however, the ideal method for the employ-ment of medical referees is that they should sit with thejudge as assessors, they would hear the medical evidence onboth sides, they would then examine the claimant in con-sultation and advise the judge on the purely medical points.The judge would not have to give his decision on a merewritten report but would have an opportunity of questioningthe medical referee and satisfying himself fully as to themedical aspects of the case. From my experience I do notthink your point as to the workman being unable to havefunds to pay his medical adviser would in practice be opera-tive, as contested cases are always in solicitors’ hands, andthey continually arrange for a medical man to be present onbehalf of the workman at the examinations of the practi-tioner provided by the employer, and in court medicalevidence has now to be produced in every case where theamount of injury is in dispute. It would be much less ex-

pensive for the workman to have his doctor present at theexamination of the medical referee when a final decision onthe medical points would be obtained than for the medicalattendant to leave his Dractice and come to court wheremuch time would necessarily be lost.

I am, Sirs, yours faithfully.ALBERT BENTHALL.

Fellows-road, South Hampstead, N.W., Oct. 7th, 1907.

*** Such a procedure as that suggested by Mr. Benthallwould, we have no doubt, be satisfactory and would conduceadmirably to a full and proper understanding of the case.We do not, however, quite follow the latter half of his lastparagraph ; our suggestion was that whereas under the oldActs the injured workman was usually helped to press hisclaim by a trade organisation, many cases will now be

brought forward by workmen not so supported, the classto be benefited having been enlarged. The interpretationof the words "statement submitted" is one upon which

everyone is entitled to his opinion. Apart from anyauthority, of which we are not aware, we do not thinkthat the expression" statement submitted" necessarilyallows the submission of a medical man to make a state-ment. "Making" and "submitting" seem to us to havebeen intended to distinguish between the statement madeby the workman himself, possibly orally, and those ’’ put in"

"

by him in writing. The expression used is the same in bothclasses of rules and if we referred to the regulations laiddown for appeals from certifying surgeons it was notbecause these supported the view which we advanced anymore than do the others. We note, however, that in the

regulations made under the first and second schedules of theAct the following passage occurs, R. 21, Par. 2 : " Thereference shall be accompanied by a general statement of themedical evidence given on behalf of both parties ; and if