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nersons showed a slight decline from the numbers recordedin the preceding week. Six inquest cases and 6 deaths fromçiolence were registered ; and 83, or more than a third, of thedeaths occurred in public institutions. The causes of 15,or nearly 7 per cent., of the deaths in the city last week wereact certified.

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THE SERVICES.

NAVAL MEDICAL SERVICE.STAFF-SURGEON HOWARD JAMES MCCHLEARY TODD has

been promoted to the rank of Fleet-Surgeon in Her

.Majesty’s Fleet. Staff-Surgeon Myles O’Connell McSwinyhas also been promoted to the same rank.

ARMY MEDICAL STAFF.

Surgeon - Lieutenant - Colonel William A. May to be

Brigade - Surgeon - Lieutenant - Colonel, vice A. L. Brown,retired. Surgeon-Major Henry E. W. Barrington retireson retired pay.Surgeon-Major Wyatt assumes medical charge of the e

Station Hospital and troops at Newbridge. Surgeon-Lieutenant E. W. W. Cochrane is held in readiness toembark for India about the end of February or the begin-ming of March. Surgeon-Captain Cockerill has proceededto the Station Hospital, Canterbury, for duty, and Surgeon-Major Webb has proceeded from Devonport to Exeter.

INDIA AND THE INDIAN MEDICAL SERVICES.

Surgeon-Lieutenant Perry has assumed charge of the CivilMedical duties of the Dera Ghazi Khan District, relievingSurgeon-Captain Graves.

VOLUNTEER CORPS.

Rifle : 1st (Hertfordshire) Volunteer Battalion the Bed-fordshire Regiment: Surgeon - Lieutenant R. Odell to beSurgeon-Captain. 2nd Volunteer Battalion the Royal ScotsFusiliers: Surgeon-Lieutenant-Colonel R. Girvan resigns hiscommission; also is permitted to retain his rank and tocontinue to wear the uniform of the battalion on his retire-ment. 6th Volunteer Battalion the Gordon Highlanders :Surgeon-Major R. S. Turner, M.D., to be Surgeon - Lieu-tenant-Colonel.

THE HEALTH OF THE RUSSIAN NAVY.

According to the most recent annual report the averagestrength of the Russian Navy in 1893 was 28,003 men.Among them 20,717 cases of sickness were treated and 338deaths took place, equal respectively to 739’8 and 12-07 per1000. The principal diseases are shown in the followingtable :-

Generally speaking this return may be said to be a recordof progress, but in some respects the sanitary condition ofthe Russian Navy still leaves much to be desired. The affec-tions classed as 11 typhic " consisted mainly of enteric fever,the balance including two cases of spotted typhus fever, oneof recurrent fever, and twelve of an ill-defined disorderpresenting vague febrile signs. In all the fatal " typhic " casesthe respiratory apparatus became involved for the most partin the form of capillary bronchitis. Although paludal diseaseis still a formidable item in the list its character is steadilyimproving. As a rule only six or seven days’ loss of service

resulted from its attacks. In some districts the poison hascompletely disappeared. The Caspian flotilla supplied 1515cases of ague in 1890, whereas in the year under report therewere barely 200. Amongst the civil population cholera in1893 caused great damage, but the men of the navy not onlyafloat but ashore almost entirely escaped. Their barracksand ships were disinfected and ventilated, the closets werethoroughly cleansed, iron bedsteads were issued in place ofthe old foul cots, as long as the epidemic lasted the sailorsreceived extra rations of superior quality, their drinking waterwas carefully passed through Pasteur. Chamberland filters andtempered with citric acid or red wine, all ordinary taps wereclosed and sealed, three times daily hot tea was served out,every man was compelled to wear a flannel belt, and allfatiguing duty was as far as possible interdicted. The resultof these precautions showed itself in almost perfect im-munity whilst all around thousands were dying. InKronstadt, for example, the general death-rate from cholerawas 4’0 per 1000, while among the sailors it was 0 2.During the year there were eleven cases only in theentire fleet with four deaths. It is worthy of note thatwhereas pneumonia was mainly destructive towards the south,other affections of the respiratory organs prevailed in therigorous north. In ice-bound Vladivostok there were buttwo cases of pneumonia during the year, while in snowyArchangel the disease remained conspicuous by its absence.The continuance of scurvy in the Russian Navy is a distinctsanitary blot. The compiler thinks that since the diseaseinvariably appears during the period from May to Septemberit cannot be due solely to defective hygiene. Season hasevidently something to do with its occurrence and perhaps,he adds, it may owe its spreading tendency to infection.Out of 4018 venereal cases 868 were syphilitic. Thesediseases are steadily gaining ground, especially in certainseaports, Sevastopol and Baku being among the worst.The cause of this sanitary retrogression is twofold-(1)clandestine prostitution and (2) perfunctory inspection of themen who are allowed to absent themselves from examinationon any trivial pretext.

THE CONDITION OF THE ARMY.The correspondence between Mr. H. O. Arnold-Forster,

Sir Arthur Haliburton, and others continues as lively as everand is likely to do so until the question of army reform isthrashed out in Parliament. It seems to us, as we havealready said, that on physiological and medical grounds weare, in order to create and maintain a reserve, losicg anumber of soldiers from the regular army just at the timethat they are best fitted for service abroad with the colours.No one wants to return to long service as it existed yearsago. What is wanted is that soldiers who desire to re-engageand continue in the service, instead of being relegated tothe reserve, or who desire to leave the reserve and join theranks, should have every opportunity of doing so if physi-cally fit and of good character. As it is at present the soldierwho cannot find employment in civil life and desires tore-enter the ranks of the army and go on for pension cannotdo so unless he refunds his deferred pay, which is a pro-hibitory condition. The army requires, or would at any ratebe benefited by the presence of, a certain proportion of suchmen, although their numbers might be limited by therequirements of the service and considerations of cost; inother words, the introduction of more elasticity into thepresent system is needed ; and if we have understood LordLansdowne’s remarks aright it is this that he is prepared tocarry out. The fact of the British army being a voluntaryone and the requirements of India and the colonies un-

questionably make the problem a very difficult one to solve.

THE INDIAN FRONTIER WAR.There is but little to chronicle regarding matters on the

Indian frontier. The wounded are reported to be doing well.The Zakka Khels are still irreconcilable and have not sub-mitted to the terms proffered them. The Khyber is still ina disturbed state, but the Indian authorities have decided topermit caravans under the protection of military escorts topass along the Khyber Pass, and we shall consequently soonlearn whether trade with the mountain tribes and Afghani-stan has been re-established.

PRINCESS HENRY OF BATTENBERG AT NETLEY.On Wednesday afternoon, Jan. 26th, Princess Henry of

Battenberg visited the Royal Victoria Hospital, Netley. Theobject of the visit was to convey a message of sympathy andadmiration from the Queen to the soldiers and particularly to

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those who have just returned from active service. Surgeon-Major-General Nash was among thoae who assembled atthe Hospital pier to meet her Royal Highness and party.

THE COMPOSITION OF REGIMENTS.The limes of the 25th inst. contained a communication

under the heading of "The Scottish Regiments" whichmay be read with interest at the present time in connexionwith the recruiting and constitution of the army and thechanges which have taken place in it during the presentcentury and especially during the latter part of it.The Broad Arrow states that" Some idea may be formed

of the serious effects which the Indian Frontier Campaignhas had on the strength and health of the European regi-ments engaged, judging from the latest returns of theGordon Highlanders. That corps went into the field 897strong of all ranks ; its loss from killed, wounded, and sickhas amounted to 377, leaving a present total strengthof 520."

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Correspondence.

MIGRAINE AND ARTHRITIS.

" Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-These notes of six cases of acute pain in the ankle-joint commencing in young adult life I have ventured toplace together, as they bear such a strong resemblance toeach other, and what would explain one would probablyexplain all. That there is some difficulty in forming anopinion on them I have good evidence, for the patient inCase 3 alone was variously diagnosed and treated by differentexperienced physicians as strnmous disease, rheumatoidarthritis, gout, and a sprain. Whatever the true pathologyof these attacks, the later history of two of them may besome guide to giving a correct prognosis in the others.CASE 1.-A bright, intelligent girl, very quick at learning,

at the age of fourteen years suddenly one afternoon had severepain and swelling of the right ankle. There was no history ofan accident. The veins around the joint were much enlargedand the "joint throbbed." The attack passed off the Eame

night and the joint was perfectly well for six months, whenshe had an exactly similar attack. Three attacks have sinceoccurred at irregular intervals. The medical man called it" rheumatism." She suffers severely from migraine.CASE 2.-An unmarried woman, aged fifty-two years,

has had similar attacks to the above since she was fifteenyears of age at very irregular intervals, but has had noattack since the catamenia ceased five years ago. Thepatient had been a martyr to migraine headaches until thelast few years, when they have entirely left her.CASE 3.-A strong, healthy man, aged forty-one years,

has had attacks of inflammation in the right ankle since theage of sixteen years. They seldom last more than twelvehours and he can play a hard game of lawn-tennis or ride abicycle on the second day. They are getting gradually lessfrequent and less severe. He has always been subject tomigraine attacks, but these are becoming less troublesome.CASE 4.-A strong, active man, a carpenter, aged twenty-

six years, was under observation for Bell’s paralysis whenhe had an attack in his right ankle. The pain was verysevere for a few hours and there was swelling of the veins;about the joint followed by a slight amount of synovitis.There were no gouty symptoms and a blister gave no urateof soda crystals. He had had similar attacks since he wasfifteen years of age and suffered much from migraine.CASE 5.-A bright, intelligent lad, aged eighteen year3. He

had had three similar attacks during the last two years. Healso suffered from headaches on one side of his head, &c.CASE 6.-A highly educated youth, aged twenty-two years,

who had taken a scholaiship and high honours, had his firstattack at fourteen years of age and did not know how manysince. They seldom laid him up for more than one day andhe played and won a "single" lawn-tennis match on thethird day after one attack. He dreaded his migraine farmore than his bad ankle.The attacks resemble gout, and that I confess may be the

true diagnosis, but they all present these ungout-hkesymptoms. They all feel "unusually well before an

attack and there are no premonitory dyspeptic symptoms>In none of the attacks that came under my notice was thereany marked rise of temperature and they do not tend toreturn on the following night. Recovery is rapid and com-plete, there is no tendency to spread to other joints, and theytend to get less frequent and less marked as age advances.until they cease at middle life. No urate of soda crystalscan be obtained from a blister.

I have seen several similar cases of which I have kept no,notes, and an aged medical friend, since dead, who saw thepatient in Case 3 with me in consultation told me that he him.self had had similar attacks in his youth, but that they hadceased for many years. He called them " rheumatic gout,"but did not pretend to understand their pathology. He gave.however, a good and true prognosis in Case 3, the onlytrue one he had received. All these cases had what may betermed "disjointed migraine "-i.e., they had the retina}projections with "escapement-wheel" " figures at one time,hemicrania at another, and numbness of lips, hand, &c., atanother. Is it not possible that these joint attacks are

another symptom of this obscure complaint ? The distension.of the temporal artery so common with the hemicraniaproves that migraine does cause vaso-motor effects, and theconjunctivitis that occasionally accompanies it shows thatthe smaller vessels may also be affected. In some migrainepatients the numbness is confined to one hand, and is it nottherefore possible that these cases of arthritis or arthriticcongestion are a concentration of the vaso-motor storm on asingle joint 7

It is difficult to believe that these attacks are due to a.deposit of urate of soda, for they are too transient and thereis no sign of such deposit elsewhere. There is such a totalabsence of constitutional symptoms that it seems impossiblethat they are due to rheumatism or any other form of blood.poisoning. The only remaining disease, therefore, withwhich they can be .classed is rheumatoid arthritis, which isplaced with the neuroses. I would venture to suggest, thea,that these ankle attacks are of neurotic origin and that theyare closely connected with that obscure nervous diseasecalled migraine.-I am, Sirs, yours faithfully,Jan. 15th, 1898. CLAYTON JONES, M.B. Oxon.

"LEGISLATION AS A REMEDY FORMEDICAL GRIEVANCES."

To the Editors of THE LANCET.

SIRS,-So large a portion of space is devoted in yourcurrent issue to the debate between Mr. Brudenell Carter andMr. Horsley and matters connected therewith that it is

hardly to be wondered at that the reply of the former shouldhave been crowded out. Yet there are one or two mattersin it of such importance to the profession that I venture toask you to afford me space to refer to them. Of theEe themost weighty is undoubtedly the estimate expressed by Mr.Carter, a typical member of the Council as constituted bythe Act of 1858, of the position and influence of theDirect Representatives granted to the profession by thelegislation of 1886. He thinks it within the boundsof possibility that in some other body not concernedofficially with either education, examination, or registration,not merely a small proportion, but even a majority, or

possibly the whole, of the members might be elective. He,however, just as evidently thinks that on the General MedicalCouncil they are entirely out of place ; in fact, he says inexpress terms (I quote from a tiaubeript of shorthand notes)that where questions of education and examination have tmbe discussed and settled in detail it must be by the repre-sentatives of the bodies that have to carry them out and thatthe latter woudd not accept dictation from other persons.Mr. Carter has evidently forgotten the very recent instancein which outsiders not only interfered but compelled theCouncil to bow humbly to and obey their mandate.Mr. Carter is clearly of opinion, this and other facts

notwithstanding, that "everything is for the best in thisbest of all possible " councils except the presence upon itof the Direct Representatives, of whom he says that whilsttheir presence might be useful if the Council were inclined tofalter in the path of duty, yet there being no evidence ofthis, the stimulation they supply is unnecessary, nor will theCouncil be much influenced by it. It remains to be seen howthe profession will regard this slur upon, this insult to, thosewhom it has chosen to represent it and who have an equalposition and voice in the Council with the nominees of