1301VITAL STATISTICS.-THE SERVICES.

of scarlet fever showed a further slight decline, but caused Edeath-rates equal to 1 - 2 in Leyton and to 1- 5 in Wallasey.The 35 deaths attributed to diarrhoea exceeded those i

in the previous week by’five, and the 21 deaths referred (

to "fever also showed a slight increase ; the deaths from 1"fever" included three in Birmingham and three in (

Huddersfield. The number of scarlet fever patients under r

treatment in the Metropolitan Asylums and London lFever Hospitals, which had steadily declined in the <

20 preceding weeks from 5581 to 2887, had further i

fallen to 2861 on April 25th; 332 new cases were, bow-ever, admitted to these hospitals during the week under 1notice, against 297 and 328 in the two preceding weeks. :The deaths in London referred to pneumonia and otherdiseases of the respiratory organs, which had been 274in each of the two preceding weeks, rose to 301 in the week Junder notice, and corresponded with the corrected averagenumber in the corresponding week of the five years 1903-07.The 31 deaths directly referred to influenza in London showeda further decline from the numbers in recent weeks. Thecauses of 62, or 1’3 3 per cent., of the deaths registered inthe 76 towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in Bristol, West Ham, Bradford, Newcastle-on-Tyne, and in 47 other smaller towns ; 12 uncertifiedcauses of death were, however, registered in Birmingham,nine in Liverpool, eight in Gateshead, and seven in Sheffieldduring the week under notice.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 19 7, 18’ 8, and16 - per 1000 in the three preceding weeks, rose again to18’ 8 in the week ending April 25th, and exceeded by 3’4the mean rate during the same week in the 76 large Englishtowns. Among the eight Scotch towns the death-rate

during the week under notice ranged from 11’ 4 and 12’ 3in Aberdeen and Leith, to 20’ 7 in Perth and 21’ 4 in

Paisley. The 663 deaths in these eight towns showed anincrease of 85 upon the number returned in the previousweek, and included 77 which were referred to the principalepidemic diseases, corresponding with the number in the

previous week ; of these, 34 resulted from measles, 14 fromdiarrhoea, 12 from whooping-cough, seven from "fever," sevenfrom diphtheria, and three from scarlet fever, but not onefrom small-pox. These 77 deaths were equal to an annual rateof 2 - 2 per 1000, while the mean rate from the same diseasesin the 76 English towns during the week did not exceed 1 - 2.The 34 fatal cases of measles showed a further decline fromthe numbers in recent weeks, and included 25 in Glasgow,seven in Edinburgh, and two in Paisley. The 14 deathsattributed to diarrhoea, exceeded the number in the previousweek by three. The 12 fatal cases of whooping-cough were,however, fewer than in any recent week; four occurred bothin Glasgow and in Edinburgh and two in Dundee. Theseven deaths referred to "fever" were all returned in

Glasgow; of these, five were certified as cerebro-spinal menin-gitis and two as enteric. Of the seven fatal cases ofdiphtheria three occurred in Glasgow and two in Dundee;and all the three deaths from scarlet fever were returned inGlasgow. The deaths referred to diseases of the respiratoryorgans in the eight towns, which had been 128 and 121 inthe two preceding weeks, further declined to 113 in the weekunder notice, but exceeded by one the number returned inthe corresponding week of last year. The causes of 24, or3’6 per cent., of the deaths in these eight towns during theweek were not certified or not stated; in the 76 Englishtowns the proportion of uncertified causes of death in theaame week did not exceed 1’ 3 per cent.

HEALTH OF DUBLIN.The annual rate of mortality in Dublin, which had

been equal to 22 - 5 and 23’ 1 per 1000 in the twopreceding weeks, declined to 21-1 1 in the week endingApril 25th. During the first four weeks of the currentquarter the death-rate in Dublin averaged 23’ 2 per 1000 ;the mean rate during the same period did not exceed 15’ 4in London and 15-6 6 in Edinburgh. The 160 deaths ofDublin residents registered in the week under notice showeda decline of 15 from the number returned in the previousweek, and included seven which were referred to the

principal epidemic diseases, corresponding with the numberin the previous week. These seven deaths were equal to

an annual rate of 0 9 per 1000, the rate during the weekfrom the .same diseases being 1’3 in London and 1, 9in Edinburgh. Of these seven deaths from epidemicdiseases in Dublin three resulted from measles, two fromwhooping-cough, and two from diarrhoea, but not one

either from scarlet fever, diphtheria, "fever," or small-pox.The fatal cases of measles corresponded with the num-ber in the previous week, while those of whooping-cough were fewer by one. The 160 deaths from all causesin the city during the week included 26 of infants under oneyear of age and 43 of persons aged upwards of 60 years;the number of deaths of elderly persons showed a consider-able decline from the numbers in recent weeks. Twoinquest cases and two deaths from violence were regis-tered, and 82, or 51 3 per cent., of the deaths occurredin public institutions. The causes of seven, or 4’ 4per cent., of the deaths registered in the city during theweek under notice were not certified ; all but one of the1420 deaths in London last week were duly certified, andin Edinburgh the proportion of uncertified deaths didnot exceed 1’6 6 per cent.

THE SERVICES.

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

Surgeons : C. Bradley to the Caesar, on recommissioning;J. L. Smith M.V.O., to the President, additional, for threemonths’ course at West London Hospital ; H. B. Beatty toRoyal Marine Division, Chatham; and R. Miller to theMagnificent. Staff-Surgeons: S. Roach to the President,additional, for three months’ course at West LondonHospital ; N. J. Roche to the Victory, additional, for Ports-mouth Dockyard ; W. K. Hopkins to the Edgar, temporary;E. G. E. O’Leary to the Sqttlpj, on recommissioning ; andE. S. Miller to the Cornmallis, on recommissioning. Sur-geons : G. E. Hamilton to the Hannibal; W. N. Blatchfordto the Sutlej, on recommissioning ; C. K. Bushe to the Corn-7vallis, on recommissioning ; P. D. Ramsay to the Vivid; andW. T. Haydon to the T’t, additional, and to the <7<ss<M’, on

recommissioning.INDIAN MEDICAL SERVICE.

The King has approved of the following retirements :&mdash;

Lieutenant-Colonel Alfred Ernest Roberts (dated April 21st,1908). Lieutenant-Colonel William Alexander Lee (datedApril 7th, 1908). Lieutenant-Colonel Kavasji HormasjeMistri (dated March 4th, 1908).

VOLUNTEER CORPS.

-Rifle: 3rd (Duke of Connaught’s Own) Volunteer Bat-talion, The Hampshire Regiment: Surgeon-Captain BonnerH. Mumby to be Surgeon-Major (dated March 17th, 1908) ;Surgeon-Lieutenant-Colonel and Honorary Surgeon-ColonelCharles Knott resigns his commission, with permission to

retain his rank and to wear the prescribed uniform (datedMarch 20th, 1908). 5th (Isle of Wight, Princess Beatrice’s)Volunteer Battalion, The Hampshire Regiment: James AlbertGibson to be Surgeon-Lieutenant (dated March lst, 1908).2nd Volunteer Battalion, The Essex Regiment : KennethSimonds Storrs to be Surgeon-Lieutenant (dated March 6th,1908).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Bedford Bearer Company : Supernumerary Captain Edmund

F. Bindloss (Brigade Surgeon-Lieutenant-Colonel, SeniorMedical Officer, Bedford Volunteer Infantry Brigade) to beMajor, remaining supernumerary (dated Feb, lst, 1908).

ROYAL ARMY MEDICAL CORPS AMBULANCE SECTION.Permission has been given for the formation of an Ambu-

lance Section of the Royal Army Medical Corps at Camborneand Redruth in connexion with the Plymouth Field Ambu-lance, R.A.M.C. The head-quarters will be at Camborne.

LITERARY INTELLIGENCE.-Messrs. Casselland Co, are issuing almost immediately a new and revisededition of 11 hygiene and Public Health," by Dr. B. ArthurWhitelegge and Dr. George Newman. The same pub-lishers are also producing a new volume by Dr. G. ErnestHerman, entitled "The Student’s Handbook of Gynasco-logy," based upon the author’s "Diseases of Women." Itcontains 172 illustrations.

1302 THE EPIDEMIOLOGY OF DIPHTHERIA.

Correspondence.

THE EPIDEMIOLOGY OF DIPHTHERIA.

" Audi alteram partem."

- . - To the Editor of THE LANCET. _ _ISiR,&mdash;Dr. L. W. Sambon’s article on " The Epidemiology of

Diphtheria in the Light of a possible Relationship betweenthe Diphtheritic Affections of Man and those of the LowerAnimals," which appeared in THE LANCET of April 18th,p. 1143, will not, I hope, be regarded as one of mere academicinterest. To neglect to inquire into the truth or otherwise ofhis statements could only be regarded as a criminal dis-

regard of warnings based upon facts put forward with a con-vincing accuracy and acumen that nothing but close scientificinvestigation can substantiate or refute. We are becoming soaccustomed to hear of, and to be shown, the close inter-relationship between, and the intermutability of, diseases ofmen and animals that Dr. Sambon’s contention comes as nosurprise to us. Because there is no direct proof thatdiphtheria in the pigeon and other animals causes disease inman we are not justified in throwing the subject aside.Inductive and deductive arguments since the more material-istic forms of acquiring knowledge-viz., bacteriology,chemistry, and the microscope-came into more general useare apt to be slighted. We are inclined to judge at the

present day by our senses only, whilst our reasoning is

granted but little favour. Of course, there are theorists andtheorists, but Dr. Sambon’s theory, if so practical and con-vincing an argument as he presents can be styled a meretheory, is no fiction but a grouping of facts and an expositionof conclusions based on these facts arranged in logicalsequence which must either be refuted or acted upon. Thereis no intermediate position and, as his facts are irrefutable,the brunt of the consequence likely to ensue by the neglectof these facts lies with those in authority who fail to actupon the evidence. The transmutability of diphtheria tomen from animals has long been suspected and Dr. Sambonhas shown how the epidemiology of diphtheria, which hashitherto been so obscure, may be explained. The fowl andthe egg are incriminated in the process and it is interestingto note that the eastern counties of England where diph-theria in man is most common are the chief poultry-raisingdistricts of Britain. It is to these counties, moreover, thatthe migratory pigeons mostly come. An interesting andoriginal suggestion is the part played by eggs in the trans-mission of disease. I have myself noticed" blemishes " in thewhite of many eggs, mostly pink patches of delicate mem-brane, which I was wont to regard as signs of commencingembryonism. Recently, however, Professor Blanchard hasshown that these patches contain a nematode worm(Heterakis papillosa). The explanation carries but littlecomfort to us, as we have hitherto regarded fresh eggs asbeing a food impossible of contamination by infection.Poultry and eggs as articles of diet require therefore to beinspected as carefully as beef, mutton, pork, and fish, andthe proper place at which the inspection should be carriedout is not in the market-place or shop but in the districtin which the fowls are bred and reared. The fowl-house and the eggs must, if we are to act rationally,be legislated for as carefully as in the case of the cowand the milk when dealing with tuberculosis prophylaxis.Our supplies of fowls and eggs are largely derived from thesouth of Russia and from many districts around theMediterranean, especially the north African shores. These

supplies we cannot control hygienically but we can, andought to, see that the sources of supply in Britain are whole-some and free from disease. It would be a great advantagecommercially were our home poultry industry guaranteed tobe sound, and it should be the endeavour of poultry farmersfrom a monetary point of view alone, leaving the health ofthe people out of the question, to have their farms placedunder official inspection. The answer to this note of alarmis that fowls and eggs are cooked before being eaten and,therefore, there is no need for alarm. Assuming thatall eggs are cooked before being consumed, which, ofcourse, is not the case, we have still the fowlto deal with, and from the fowl other animals and manmay be directly infected by one of the most terrible of ourmaladies. An inquiry is imperative if only to allay alarm fbut from the immense number of facts recorded not only by JDr. Sambon but by many observers in several countries, it 1would only be in accordance with the proved relationship of (

the intermutability of other diseases between men andanimals were it positively shown that the<MMM!<s are thehosts of the diphtheritic poison which they not infrequentlycommunicate to man. I am, Sir, yours faithfully,London, April 27th, 1908. - JAMES CANTLIE.JAMES CANTLIE.

To the Editor of THE LANCET.

SIR,-I have read Dr. L. W. Sambon’s communication in, THE LANCET of April 18th, p. 1143, on the Epidemiology of

Diphtheria with much interest and taking advantage of the, quotation which heads your correspondence column I venture

to offer a few remarks. Dr. Sambon says, " In an

inquiry of this kind I should like to see the veterinarysurgeon of the modern school take his full share of researchwork rather than adopt, as in the past, a negative hostileattitude which would be ridiculous in the face of the scantyand crude information at present available on the diphtheriticaffections of animals." This, after an attempt to show thatdiphtheria is a disease of the lower animals, sounds as if theveterinary profession had studiously ignored the presence ofdiphtheria in the lower animals, although to Dr. Sambon thedisease is so rampant that it is actually calling out to bediagnosed. In his efforts to show that diphtheria iscommon in the lower animals he quotes not only froma comedy of Plautus but even also from Numbers andit would appear that he would have the veterinaryprofession take its bacteriology and pathology from thesesources. Because pigs suffered and died from very sorethroats, according to Plautus, and the Israelites took quailthat disagreed with them we are to believe that diphtheriaexisted in the lower animals. How easy it is to work up thehistory of disease when we see references which may havesome bearing upon the subject and require only a littlestretch of imagination to make them tally exactly with ourpreconceived notions. The historical references and most ofDr. Sambon’s quotations will not bear inspection for amoment.

Before pointing out some of the errors in the articlereferred to I should like to inform Dr. Sambon that bydiphtheria I understand an infection due to the ravages ofthe Klebs-Lofller bacillus, an organism that not infrequentlyleads a saprophytic existence and may be observed in theperfectly normal human fauces. The term diphtheria hasunfortunately been used for conditions observed in the loweranimals which are due to causes other than the Klebs-L6fher bacillus. Indeed, I think I am correct whenI say that the cases observed in the lower animalsdirectly traceable to the Klebs-L6ffler bacillus may becounted on the fingers of one hand, and in these cases

there is grave reason to believe that they were related todirect infection from a human source. Of course, I shall beat once consigned to the old school of veterinarians by Dr.Sambon for such an opinion, but then those of us who

spend our days making post-mortem examinations and work-ing with the pathological material obtained from the loweranimals can only preach the faith that is in us and takefacts as we find them. I quite agree with the opinionexpressed by Friedberger and Frohner (which Dr. Sambonquotes) relating to the transmission of diphtheria from animalsto man-i. e., animal diphtheria is "a mere assumption dueto ignorance of veterinary pathology." Let us examine theevidence the writer has brought forward in support of hiscontention that the lower animals do suffer from unrecogniseddiphtheria. The only evidence that is worth considerationis that given by men who are in a position to give an opinion.What Noah Webster thought in 1800 and what many of thewriters of reports to the Local Government Board of laterdate believe may be dismissed in a word. Their opinionsare framed on hearsay evidence or on incomplete clinicalrecords. In many cases the conclusions savour of thepost hoo, ergo propter hOG.

Dr. Sambon says diphtheria is known to occur in thehorse. The only case which needs reference is that of Dr.Louis Cobbett where was found in the nasal discharge theKlebs-L&ouml;ffier bacillus. This does not prove, however, thatthe horse was suffering from diphtheria despite the fact thatthe daughter of the owner had diphtheria and it would havebeen interesting to learn what condition was found on postmortem if the animal died. I do not think we need be sur-prised to find the Klebs-Lof>3er organism in the dischargesfrom the horse’s head, nor can we claim that its presencesignifies in this case diphtheria because the organism may befound in throats free from any lesion whatsoever. In this casebhe lesions observed would be more valuable than the dis-overy of a particular organism. Then in cattle Dr.