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41 in Barrow-in-Furness. The deaths attributed todiarrbcea in the 77 towns, which had been 68 and 103 inthe two preceding weeks, further rose last week to 120 ; thehighest annual rates from this cause during the weekwere 1 5 in Rhondda, 1-7 in Wigan, 2-1 in Birkenhead,2-6 in Walsall, and 3’0 in Bootle. The fatal cases of

whooping-cough, which had been 88 and 106 in the two

previous weeks, declined again last week to 87 ; they causedthe highest rates, 1-7 in Salford and 1-9 in Burnley. The85 deaths from measles showed a further decline from thenumbers in recent weeks, and were fewer than in any previousweek of this year ; this disease showed last week the highestproportional mortality in Nottingham, Liverpool, MerthyrTydfil, and Barrow-in-Furness. The 31 deaths referred todiphtheria showed an increase upon recent weekly numbers,and included 6 in London and its suburban districts, 3 inLiverpool, and 2 each in Portsmouth, Birkenhead, Leeds,and Hull. The 18 fatal cases of scarlet fever were fewerthan in any previous week of this year; 3 occurred inStoke-on-Trent, and 2 both in London and Leeds.The deaths referred to enteric fever, which had been

7, 14, and 11 in the three preceding weeks, were 12 last

week, of which 4 were returned in London. The number ofscarlet fever patients under treatment in the MetropolitanAsylums and in the London Fever Hospital, which hadincreased in the four preceding weeks from 1353 to 1548,had further risen to 1562 on Saturday last ; 179 new casesof this disease were admitted to these hospitals during lastweek, against 249 and 173 in the two preceding weeks.Only 1 case of small-pox was under treatment in the Metro-politan Asylums at the end of last week. The 957 deathsregistered in London during last week included 111 whichwere referred to pneumonia and other diseases of the

respiratory system, showing a decline of 20 from the numberin the previous week; they were 8 below the correctedaverage number in the corresponding week of the five years1905-09. The causes of 30, or 0.8 per cent., of the deathsregistered during the week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death registered during the week were dulycertified in London, Leeds, Bristol, West Ham, Bradford,Newcastle-on-Tyne, Leicester, Salford, and in 52 othersmaller towns ; the 30 uncertified causes of death in the77 towns last week included 4 in Liverpool, 4 in Sheffield,and 2 each in Preston, Hull, and Gateshead.

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns 854 births and 460deaths were registered during the week ending July 30th.The annual rate of mortality in these towns, which hadbeen equal to 12.4 and 12 - 0 per 1000 in the two precedingweeks, rose again to 12-7 in the week under notice.During the first four weeks of the current quarter thedeath-rate in these towns averaged 12 - 3 per 1000, andexceeded by 1’1 the mean rate during the same period inthe 77 largest English towns. The annual death-rateslast week in these eight Scotch towns ranged from8-4 and 9-8 8 in Leith and Aberdeen to 13-8 8 in Dundeeand 13-9 in Glasgow. The 460 deaths from all causesin the eight towns last week showed an increase of 26on the number in the previous week, and included 46which were referred to the principal epidemic diseases,against 33 and 58 in the two preceding weeks; of these 46deaths, 20 resulted from diarrhoea, 11 from whooping-cough,4from measles, 4 from diphtheria, 4 from " fever," and 3 fromscarlet fever, but not one from small pox. Themeanannual rateof mortality from these epidemic diseases in the eighttowns last week was equal to 1’3 per 1000, against 1’1 1from the same diseases in the 77 English towns ; the

highest rate from these diseases in the Scotch townsiast week was 2-2 in Glasgow. The 20 deaths attributedto diarrhoea in the eight towns last week were withinone of the number in the previous week, and included 17 inGlasgow. The fatal cases of whooping-cough, which hadbeen 2, 3, and 12 in the three preceding weeks, were 11 lastweek, of which 9 occurred in Glasgow. Three of the 4 deathsfrom measles were returned in Glasgow ; and one each fromscarlet fever in Glasgow, Dundee, and Paisley. The fatalcases of diphtheria, which had been 5 and 8 in the two pre-ceding weeks, declined last week to 4. of which 3 occurredin Glasgow and 1 in Edinburgh All the 4 deaths referredto -’fever" were returned in Glasgow ; 3 were certified as

enteric and 1 as cerebro-spinal meningitis. The deathsreferred to diseases of the respiratory system in the eighttowns, which had been 49 and 50 in the two precedingweeks, further rose to 61 last week, and exceeded by 18 thenumber in the corresponding week of last year. The causesof 16, or 3 5 per cent., of the deaths in the eight townslast week were not certified or not stated; in the 77English towns the proportion of uncertified causes of deathlast week did not exceed 0 - 8 per cent.

HEALTH OF IRISH TOWNS.

In the city of Dublin 243 births and 120 deaths wereregistered during the week ending July 30th. The annualrate of mortality in the city, which had been equal to16-8, 14 - 8, and 17-2 per 1000 in the three precedingweeks, declined again to 15-5 5 in the week under notice.

During the first four weeks of the current quarter theannual death-rate in the city averaged 16 ’1 1 per1000 ; the mean rate during the same period did notexceed 10 - 6 in London and 11.9 in Edinburgh. The 120deaths in the city last week from all causes showed a declineof 13 from the number in the previous week, and included8 which were referred to the principal epidemic diseases,against 7 and 12 in the two previous weeks; of these 8deaths, 4 resulted from diphtheria, 3 from scarlet fever, 1from enteric fever, but not one from measles, whooping-cough, diarrhoea, or small-pox. The annual death-rate fromthese epidemic diseases in the city last week was equal to1.0 per 1000, against 0 - 6 in London and O. 4 in Edinburgh.The 4 fatal cases of diphtheria in the city last week showeda marked increase upon recent weekly numbers ; the 3deaths from scarlet fever corresponded with the number inthe previous week. The 120 deaths included 52, or

43-3 per cent., which were recorded in public in-stitutions. The causes of 7, or 5-1 per cent., of thedeaths in the city last week was not certified either by aregistered medical practitioner or by a coroner. In Belfast 214births and 135 deaths were registered during last week. Theannual rate of mortality in this town, which had been equalto 19-3, 18-1, and 15-6 per 1000 in the three precedingweeks, rose again laGt week to 18-0. During the first fourweeks of the current quarter the annual death-rate in Belfastaveraged 17-8 per 1000, and exceeded the rate during thesame period in Dublin by 1-7 per 1000. The 135 deathsfrom all causes last week in Belfast showed an increase of18 upon the number in the previous week, and included17 which were referred to the principal epidemic diseases,against 24 and 29 in the two previous weeks ; of these17 deaths, 8 resulted from measles, 6 from diarrhoea,2 from enteric fever, and 1 from diphtheria, but notone from scarlet fever, whooping-cough, or small-pox. Theannual death-rate from these epidemic diseases in Belfastlast week was equal to 2.3 per 1000, against 1.0 inDublin. The fatal cases of measles in Belfast, which hadramred between 19 and 49 in the 13 preceding weeks,declined to 8 last week ; the 6 deaths from diarrhoea, and thetwo from enteric fever exceeded the numbers in recentweeks. All but one of the causes of death in Belfast lastweek were duly certified.

THE SERVICES.

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

H. W. A. Burke to the Collingwood. S7irgc-ons : J. H. B.Martin to the St. Vincent, and F. L. Smith to the KingAlfred.

ARMY MEDICAL SERVICE.

Colonel Edward North retires on retired pay (datedAugust 3rd, 1910).

Lieutenant-Colonel Richard H. S. Sawyer, from the RoyalArmy Medical Corps, to be Colonel, vice E. North (datedAugust 3rid,1910).

ROYAL ARMY MEDICAL CORPS.

The undermentioned Majors are placed on retired pay(dated July 29th, 1910): Henry J. Parry, D.S 0., and RobertW. H. Jackson.

Captain George H. Richard, from the Half-pay List, is

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restored to tfje establishment with 1).cce(tei,ce litxt belovCaptain C. W. O’Biien (dated July 25th, 1910).

Colonel T. J. R. Lucas, C.B., has been appointed PrincipaMedical Officer of the First (Peshawar) Division in place oColonel C. H. Beatson, C.B., who has vacated the appointment. Lieutenant-Colonel W. A. Morris, commanding th,station hospital at Cawnpore, has been selected to ofliciat4as Principal Medical Officer of the Allahabad and Fyzaba(Brigades during the absence on leave of Colonel L. EAnderson. Lieutenant-Colonel J. M. Irwin, from the Wa:Office, has been posted to the Eastern Command for duty aWoolwich. Lieutenant-Colonel M. L. Hearn has beer

appointed Medical Inspector of Recruits for the Irish Command, vice Major C. Dalton appointed Staff Officer to th(Principal Medical Officer in Ireland. Lieutenant-ColonelT. H. F. Clarkson has been warned for service abroad for the

coming trooping season. Lieutenant-Colonel J. S. Greerhas arrived home on leave from India. Major E. M.Hassard has been appointed to command the statior

hospital, Lahore Cantonments. Major A. J. Luther, or

return from a tour of service at Thayetmyo, Burma, has beerposted to Cahir. Major A. W. N. Bowen, from Jersey, hasjoined at Poona. Major C. W. R. Healey has been trans.ferred from Kamptee to Nasirabad. Major J. Grech, fromMeerut, has been posted to Warrington. Major W. A. Ward,specialist in dermatology and venereal diseases at RochesterRow, has joined at Bulford Camp, Salisbury Plain. MajorH. J. Parry, D.S.O., on return from a tour of service atPietermaritzburg, has been posted to Cosham. MajorH. J. M. Buist, D.S 0., on completion of the tenure of hisappointment as Deputy Assistant-Director at the MedicalDivision of the War Office, has been appointed to Pirbright.Major E. M. Williams has been appointed Specialist in Mid-wifery and Diseases of Women and Children to the 8tb(Lucknow) Division. Major H. C. French has arrived homeon leave from Malta. Captain T. E. Fielding has been trans-ferred from London District to Woolwich. Captain C. W.Bowle, specialist in dental surgery, has joined at Dalhousiefrom Multan. Captain D. P. Johnstone, on completionof at our of service in Burma, has been posted to Preston.On completion of the promotion course at the Royal ArmyMedical College, Caotain W. C. Croly, Captain A. W.

Sampey, Captain W. W. Browne, and Captain F. W. Rowan-Robinson have been appointed to the Eastern Command andposted to Colchester for duty. Captain A. H. Davidson.from Buttevant, has joined the Curragh Camp. Captain A. S.Littlejohns has been transferred from Potchefstroom toPretoria. Captain J. S. Pascoe, from Cyprus, has been

posted to Pretoria. Captain R. Rutherford, from the RoyalArmy Medical College, has been ordered for service in theStraits Settlements, embarking in September. Captain D. T.McCarthy, on return from leave, has been transferred fromMeerut to the station hospital at Agra for general duty.Captain G. W. G. Hughes and Captain W. Byam have arrivedhome on leave from Egypt. Lieutenant L. C. Hayes and Lieu-tenant E. M. Parsons-Smith have joined the London Districtand have been appointed to Queen Alexandra’s MilitaryHospital, Alillbank, for duty. Lieutenant A. L. Stevenson,from the Curragh, has been posted to Bangalore to undergoa course of Indian sanitation. Lieutenant J. E. Ellcome,from Tregantle, has joined the station hospital at Kamptee.Lieutenant G. P. Taylor has been transferred from Glasgow toIrvine Camp.

INDIAN MEDICAL SERVICE.

Colonel W. A. Quayle has been appointed Principal MedicalOfficer of the Abbottabad and Sialkot Brigades. Lieutenant-Colonel C. M. Thompson has been permanently transferredfrom military to civil employment. Lieutenant-Colonel A. L.Duke has been appointed Administrative Medical Officer ofthe North-West Frontier Province, vice Lieutenant-ColonelG. W. P. Dennys. Lieutenant-Colonel E. Hall, civilsurgeon of Dacca, Eastern Bengal, has been granted threemonths’ privilege leave. Lieutenant-Colonel R. E. S. Davishas arrived home on leave from India. Major D. Graves hasbeen reverted from civil to military employment. MajorR. G. Turner, civil surgeon of Cawnpore, has been appointedCivil Surgeon of Sharanpur, United Provinces, in place ofLieutenant-Colonel W. Vost, who has been granted leave.Major F. O’Kinealy, civil surgeon of Simla, has been selectedas surgeon on the staff of the Viceroy-Elect of India (SirCharles Hardinge). Major T. W. Irvine has been grantedsix months’leave from India. Major C. H. Bensley and MajorJ. Mulvaney have arrived home on leave from India. Captain

v W. H. A. K CLitlen has been appointed to the substantivemedical charge of the 61.-t Prince of Wales’s Own Pioneers,

1 vice Lieutenant-Colonel C. M. Thompson. Captain R. A.f Chambers has been posted temporarily to the Jail Department- of the Punjab. Captain E. W. C. Bradfield, in medical chargee of the 31st Duke of Connaught’s Own Lancers, has beene appointed a Specialist in Ophthalmology to the 7th1 (Meerut) Division. Captain J. M. A. Macmillan has been. selected to officiate as Civil Surgeon of Pachmarhi. Captainr J. Husband has been posted to the Civil Medical Charge oft the Kobat district in place of Captain G. Browse. Captaini C. F. Marr has been appointed to the Civil Medical Charge- of Bhamo, vice Lieutenant-Colonel K. Prasad who has been

granted leave. Captain S. A. Razzak has been posted to1 South Canara as District Medical Officer. Captain W. D.

Wright has been selected to officiate as Civil Surgeon ofi Ahmadnagar. Captain R. A. Chambers has taken over

. charge of the Lahore District Jail and the female jails. Theservices of Captain J. Morison have been placed temporarilyat the disposal of the Government of Eastern Bengal and

i Assam. Captain P. K. Tarapore has been posted to the’ Rangoon Central Jail. Captain H. Emslie-Smith has been- appointed Civil Surgeon of Murshidabad. Captain P. S.t Mills has been appointed a Specialist in Radiography and, Electrical Science to the 5th (Mhow) Division. Captain’ A. W. Greig, superintendent ot the Mandalay Central Jail,’ has been granted two years’ combined leave from India.: Captain T. W. Harley, Captain H. Hay-Thorburn, and

Captain J. W. McCoy, Bombay, have arrived home on leave’ from India.

SPECIAL RESERVE OF OFFICERS.

Royal Army Medical Cor_ps.Lieutenant Morton W. Ruthven is confirmed in his rank.John Henry Bell to be Lieutenant (on probation) (dated

’ June 21st, 1910).

TERRITORIAL FORCE.

Royal Army Medical Corps.3rd East Anglian Field Ambulance : Major and Honorary

Surgeon-Lieutenant-Colonel Harry T. Challis to be Lieu-tenart-Colonel (dated June 20th, 1910).

3rd Lowland Field Ambulance : Lieutenant James W.Keay to be Captain (dated June lst, 1910).

Attached to Units other than Medical Units.—LieutenantColonel Frederick H. Appleby resigns his commission, andis granted permission to retain his rank and to wear the

prescribed uniform (dated July 30th, 1910). Lieutenant-Colonel John F. Tabb resigns his commission, and is grantedpermission to retain his rank and to wear the prescribeduniform (dated July 30th, 1910).For attacthment to Units other than Medical Units.-

William Thomas Blackledge (late Captain, 3rd WestLancashire Brigade, Royal Field Artillery) to be Captain(dated Jan. 24th, 1910). Nod Wallace Kidston to be Lieu-tenant (dated May lqt, 1910). Charles Douglas to be Lieu-tenant (dated May 19th, 1910).

THE ROYAL VICTORIAN ORDER.

Fleet-Surgeon George Trevor Collingwood, R.N., of theRoyal Naval College, Osborne, has been appointed a memberof the Fourth Class of the R3yal Victorian Order. The

appointment is dated July 24th, 1910.ROYAL ARMY MEDICAL CORPS EXAMINATIONS.

The following is a list of successful candidates for com-missions in the Royal Army Medical Corps at the examina-tion held in London last month, for which 29 candidatesentered :-

INDIAN MEDICAL SERVICE EXAMINATIONS.The following is the result of the examination for 15 com-

missions in His Majesty’s Indian Medical Service, which washeld in London last month:-

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THE FUTURE OF THE INDIAN MEDICAL SERVICE.The Broad rirrorv of July 29th gives a long report of the

recent lndian Medical Service dinner at Simla. Surgeon-General C. P. Lukis, Director-General of the Indian MedicalService, in proposing the toast of the evening, said that

nowadays it was the fashion to say that the palmy days ofthe Indian Medical Service were past, and many of the

younger generation were depressed by fears that it would nolonger offer a career to men who were really keen on theirprofession. He had no hesitation whatever in saying thatthose fears were groundless, and after more than a year’sexperience in his present office he honestly assured them thatit was his firm conviction that the Indian Medical Servicewould flourish even more vigorously in the future than ithad in the past. Changes would undoubtedly come ere long,but those changes would be for the better and not for theworse, and would place them in a stronger position than theyever occupied before. Pointing out the defects of the service,he said that every thinking man must be struck by themarvellous improvement in military medical organisationthat had been made by the sister service since the Boer War,but could the same be said of the Indian Medical Service ?He feared not. It seemed to him that so far as the militarybranch was concerned it was very much where it was whenhe came to India 30 years ago. Wherever he went he found

square men in round holes, and he saw lieutenant-colonels incharge of regiments performing precisely the same dutiesthat they did as lieutenants, and with no greater responsi-bilities or opportunities of acquiring administrative abilitythan they had in the days of their griffinhood. This appearedto him to be a grave defect, and, therefore, as the head ofthe service and as being chiefly responsible for the selectionof officers for promotion to the administrative grade, he hadfelt it his duty to place his views on this subject before theGovernment, who would, he hoped, give them their earnestconsideration.

BRITISH RED CROSS AND TERRITORIAL NURSING NOTES.

On July 29th, by invitation of Colonel the Hon. H. G. L.Crichton many people assembled at Netley Castle to witnessa display by the Hampshire branch of the British Red CrossSociety. The lady members of the various voluntary aidassociations in connexion with the county branch gave apractical demonstration in looking after the wounded.The Mayor of Derby presided over a public meeting on

July 28th which was convened with the object of forming alocal branch of the British Red Cross Society. The Duke ofDevonshire strongly deprecated the friction between the RedCross Society and the St. John Ambulance Association incertain quarters, remarking that there must be no frictionin Derby. If he and the leaders of the St. John AmbulanceAssociation in Derbyshire could not devise some reasonableand practicable scheme for coordinate working after a

quarter of an hour’s consultation he would retire, he said,from public life altogether.At a lancheon given by Mr. Arthur Stanley, M.P., at the

Carlton Hotel on July 29th in honour of the delegates of theJapanese Red Cross Society now in England, Mr. S.

Hirayama, one of the delegates, said that the Japanesesociety was now devoting all its energy to the development ofa perfect system of relief which could be instantly put intooperation in time of war. In this way they were contri-

butirg to the great international work of the Red Crosswhich endeavoured to ameliorate the condition of the soldierwounded in war.A branch of the British Red Cross Society for the Repton

division has been formed at Ticknall.

MEDICAL BRANCH OF THE NAVY LEAGUE.

At a meeting held under the presidency of Dr. W. P.Herringham at the Imperial Institute on July 29th, a

medical branch of the Navv League was formally constituted.Sir Richard Douglas Powell, Bart., K.C.V.0., was appointedPresident.

DURING the past few days His Majesty theKing has graciously consented to become the patron ofKing’s College Hospital, of the Royal Meteorological Society,of the Royal Sea-Bathing Hospital, Margate, and the RoyalSanitary Institute, and the King and Queen have been

gracionsly pleased to become patrons of the Royal DentalHospital of London, Leicester-square.

Correspondence.

A CASE OF ENLARGED FRONTALSINUSES.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,—The following is an account of greatly enlargedfrontal sinuses in an imbecile, aged 24 years, physically welldeveloped but with a rather small cranium. The cavitiesformed projections into the floor of the anterior fossa of theskull equalling each the size of a small hen’s egg, and

occupying the whole extent of the orbital plate. The caseillustrates, I believe, certain of the changes in the skull boneswhich are apt to develop consequent on changes in the brain,and indeed it may be also taken to exemplify the theories oftissue-tension (Ribbert) and boundary-struggle (Thierschand Boll).

The cranium, though somewhat small (namely, ant. post.7 inches, trans. at the frontal ext. ang. proc. 4 inches, andat the parietal eminences 5 inches), seemed sufficient insize, nevertheless, to warrant the presence of a brain con-siderably over 38 ounces in weight. This organ, which wasuniformly abnormally firm, was decidedly ill-developed inthe frontal regions. As to the frontal sinuses, these measured3 inches across combinedly ; the right cavity was 141 inchesant. post. and the left 2 inches ; while the depth of each was1 inches. In each case the opening of communication withthe nose was near the midline on the floor of the cavity t ofan inch from the ant. side. The sinuses were separatedby a thin bony partition ; their walls were regular, exceptabove, where a multilocular tendency was present. Behindand internally they communicated by wide mouths with alarge ethmoidal sinus on each side.

I am, Sir, vours faithfully,

July 26th, 1910.

HORATIO MATTHEWS, M.B., Ch.B. Glasg.,Acting A.M.O., Three Counties Asylum, Hitchin.

GRAIN ITCH.To the Editor of THE LANCET.

SIR,—Under this heading Dr. H. J. Fardon mentions inTHE LANCET of July 30th a case of skin eruption after thehandling of straw. I think the cause of the eruption to bethe fostid chamomile (Anthemis cotula). This plant is a

frequent cause of skin irritation in the hands and arms ofthose reaping corn by hand. I recently had under my carea brother and sister who developed a vesicular eruptionafter playing in a hay-field. This eruption I attributed tosome plant in the hay, but I was unable to identify it.

I am, Sir, yours faithfully,Knightwick, Worcester, August lst, 1910. P. G. FOULKES.

A SLUR ON ENGLISH PATHOLOGISTS.To the Editor of THE LANCET.

SIR,—In Dr. Hertz’s book on "Constipation and AlliedIntestinal Disorders " there occurs a statement which I thinkshould not be allowed to pass unchallenged. On p. 107 wefind the following :-Virchow, writing in 1853, expressed his astonishment that such a

common condition as localised chronic peritonitis had up to that timearoused so little attention; it is also remarkable that until quiterecently very few further observations of any value were made on thesubject. This is due to the fact that, at any rate in England, thepathologist generally examines the viscera after they have beenremoved from the abdomen by an attendant, so that the peritonealrelations are destroyed and most of the adhesions are divided.

Now not only peritoneal adhesions but many other importantpat,hological conditions would be overlooked if the patho-logist only examined the viscera after they had been removedfrom the body by an attendant, and no pathologist worthy ofthe name would consider that he had made a satisfactoryexamination if he had not himself done the dissection or

supervised it. It is possible, indeed, Dr. Hertz’s statementwould lead one to believe that in the hospital withwhich he is connected the sections are conducted in

this fashion. If so it is rather surprising, for, so far