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VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5166 birthsand 3348 deaths were registered during the week endingSeptember 3rd. The annual rate of mortality in these towns,which had declined from 23-7 to 23-3 per 1000 in the pre-ceding three weeks, further fell last week to 18 9. Duringthe first nine weeks of the current quarter the death-ratein these towns averaged 21’7 per 1000, and was 0’5 abovethe mean rate in the corresponding periods of the ten years1877-86. The lowest rates in these towns last week were13-3 in Huddersfield, 15’6 in Bristol, 16-6 in London, and172 in Derby. The rates in the other towns rangedupwards to 250 in Manchester, 258 in Wolverhampton,25 9 in Blackburn, and 29’1 in Preston. The deaths referredto the principal zymotic diseases in the twenty-eighttowns, which had declined in the preceding five weeksfrom 1301 to 925, further fell last week to 792; they in-cluded 500 from diarrhoea, 84 from scarlet fever, 76 fromwhooping-cough, 49 from measles, 47 from " fever "

(principally enteric), 31 from diphtheria, and 5 from

small-pox. These diseases caused the lowest death-rateslast week in Bristol and Huddersfield, and the highestin Plymouth, Wolverhampton, and Oldham. Diarrhoeacaused the greatest mortality in Brighton, Plymouth,Bolton, and Wolverhampton; measles in Birkenhead andOldham; scarlet fever in Blackburn, Bolton,and Oldham; and"fever" in Leicester, Oldham, and Portsmouth. Of the 31deaths from diphtheria in the twenty-eight towns,20 occurredin London, 3 in Newcastle-upon-Tyne, and 2 in Hull. Small-pox caused 5 deathsin Sheffield, but not one in Greater Londonor in any of the twenty-six otherlarge provincial towns. Only:3 cases of small-pox were under treatment on Saturday lastin the Metropolitan Asylum hospitals receiving cases of thisdisease, of which one was admitted during the week. Thedeaths referred to diseases of the respiratory organs inLondon, which had been 178 and 160 in the preceding twoweeks, rose again last week to 169, and were within 1 of thecorrected average. The causes of 62, or 1’9 per cent., of thedeaths in the twenty-eight towns last week were not

certified, either by a registered medical practitioner or bya coroner. All the causes of death were duly certified inBrighton, Portsmouth, Wolverhampton, Bradford, Sunder-land, and in four other smaller towns. The largest pro-portions of uncertified deaths were recorded in Preston,Halifax, and Oldham.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 18 6 and 187 per 1000 in the precedingtwo weeks, declined again to 185 in the week endingSeptember 3rd; this rate was slightly below the meanrate during the same week in the twenty-eight largeEnglish towns. The rates in the Scotch towns last weekranged from 15’1 and 16’2 in Leith and Perth, to 21’4 inDundee and 26’5 in Paisley. The 463 deaths in the eighttowns last week were within 3 of the number in the pre-ceding week, and included 39 which were referred to

diarrhoea, 31 to whooping-cough, 18 to scarlet fever, 12 to"fever," 2 to diphtheria, and not one either to measles orsmall-pox; in all, 102 deaths resulted from these principalzymotic diseases, against 87 and 111 in the preceding twoweeks. These 102 deaths were equal to an annual rateof 4’1 per 1000, which was 0 4 below the mean rate fromthe same diseases last week in the twenty-eight Englishtowns. The fatal cases of diarrhoea, which had increasedfrom 28 to 53 in the previous four weeks, declined to 39 lastweek, of which 9 occurred in Glasgow, 8 in Edinburgh,and 6 in Paisley. The deaths referred to whooping-cough, which had been 24 and 26 in the preceding twoweeks, further rose last week to 31, and included 10 inGlasgow, 8 in Dundee, and 4 in Edinburgh. The 18 fatalcases of scarlet fever showed a f uither increase upon recentweekly numbers; 8 occurred in Glasgow, 4 in Dundee, and3 in Edinburgh. The 12 deaths referred to "fever," exceededby 8 the number in the preceding week, and included 5 inGlasgow and in Dundee. Of the 2 fatal cases of diphtheria,1 occurred in Greenock and 1 in Dundee. The deathsreferred to acute diseases of the respiratory organs in theeight towns, which had been 69 and 73 in the precedingtwo weeks, were 71 last week, and exceeded by 8 the number

returned in the corresponding week of last year. Thecauses of 67, or more than 14 per cent., of the deathsregistered in the eight towns during the week were actcertified. ___

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 35’5 and29 3 per 1000 in the preceding two weeks, rose again to

, 37.5 in the week ending September 3rd, and exceeded therate recorded in any week of the present year. During thefirst nine weeks of the current quarter the death-rate inthe city averaged 31’0 per 1000, the mean rate during thesame period being but 21’4 in London and 18 6 in Edin-burgh. * The 254 deaths in Dublin last week showed anincrease of 56 upon the number returned in the precedingweek; they included 31 which were referred to diarrhoea,23 to measles, 5 to "fever" (typhus, enteric, or simple),4 to whooping-cough, 2 to scarlet fever, and not one eitherto small-pox or diphtheria. Thus the deaths resultingfrom these principal zymotic diseases, which had been78 and 48 in the preceding two weeks, rose again last weekto 65; they were equal to an annual rate of 9’6 per 1000,the rate from the same diseases being 3’4 both in Londonand in Edinburgh. The fatal cases of diarrhoea, which hadbeen 27 and 13 in the previous two weeks, rose again to23 last week. The deaths referred to measles, which hadbeen 39 and 30 in the preceding two weeks, were 31last week. The fatal cases of "fever" exceeded thoserecorded in any recent week, and the deaths referred towhooping-cough and to scarlet fever also showed an in-crease. The deaths of infants and of elderly personsexceeded those returned in the preceding week. Two inquestcases and 3 deaths from violence were registered ; and 57,or nearly one-fourth, of the deaths occurred in publicinstitutions. The causes of 43, or nearly 17 per cent., ofthe deaths registered during the week were uncertified.

THE SERVICES.

WAR OFFICE.—Army Medical Staff: The undermentionedSurgeons-Major retire on retired pay with the honoraryrank of Brigade Surgeon (dated August 31st, 1887) :-JamesO’Reilly, M.B., and Jerome William Morgan. The under-mentioned Surgeons on probation to be Surgeons (datedJuly 27tb, 1887):-Henry Ernest Hill Smith, Wm. PercevalGore Graham, M.B., George Forbes Alexander, M.B., CharlesStuart Spong, William Boog Leishman, M.B., EdmundMcNeill Woods, M.B., James Thomson, M.B., Gerald Thos.Rawnsley, Charles William Reilly, Ernest Carrick Freeman,John Ernest Trask, William Jones Crofton, M.B., NormanHay Forbes, Alfred Percy Blenkinsop, John Paterson, M.B.,Vesey Henry William Davoren, Alfred Wright, Robert Jas.Copeland, M.B., John Girvin, Anthony John Luther, HaroldSamuel Peeke, Alfred Latour Borradaile, M.B., Rich. HenrySmyth, M.B., Thomas Birt, and William Hallaran, M.P.ADMIRALTY.-The following qualified candidates for the

Naval Medical Service have been appointed to be Surgeonsin Her Majesty’s Fleet :-James Bradley. M,D., Geo. Hewlett,M.B., George Alexander Waters, M.D., William Gordon Stott,M.B., Charles Sharman Woodwright, Michael O’Brien, M.D.,Jonathan Shand, M.B., and William Arthur Whitelegge, B,A.,M.D. (dated Aug. 17th, 1887).

The following appointments have been made :-Fleet Sur-geon N. Connolly, to the Turquoise (dated Aug. 16th, 1887) ;Staff Surgeon A. R. Joyce, to the Hercules (dated Aug. 16tb,1887); Surgeon J. A. Beattie, to the Turquoise; SurgeonH. F. Kiewitz, to the Ranger; Surgeon J. E. Penn, to theVernon; Surgeon G. D. Treu-Roper, to the Jackal : SurgeonA. W. M’Leod, to the Duncan; and Surgeon W. G. K. Barnes,to the Orontes (all dated Aug. 16th, 1887).ARTILLERY VOLUNTEERS.—1st Volunteer (Sussex) Brigade,

Cinque Ports Division, Royal Artillery: Henry AlgernonHod son, Gent., to be Acting Surgeon (dated Aug. 27th, 1887)1st Volunteer (Hampshire) Brigade, Southern Division,Royal Artillery: Ernest Frederic Eliot, Gent., to be ActingSurgeon (dated Sept. 3rd, 1887).-2nd Northumberland (thePercy): Acting Surgeon J. H. Davidson, M.B, resigns hisappointment (dated Sept. 3rd, 1887).RIFLE VOLUNTEERS.-1st Volunteer Battalion, the King’s

Own (Royal Lancaster Regiment) : Acting Surgeon J.Murray, M.B., is appointed Surgeon (dated Aug. 27th, 1887).

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1st Dorsetshire: Honorary Assistant Surgeon A. Emsonresigns his commission (dated Aug. 27th, 1887).—2nd Volun-teer Battalion, the Lincolnshire Regiment: Acting SurgeonJ. P. Stewart, M.B., resigns his appointment (dated Sept. 3rd,1887).THE VOLUNTEER MEDICAL STAFF CORPS.—The Maid-

stone Division: The transfer of Surgeon and Honorary Sur-geon-Major D. H. Monckton, which was notified in our issueof May 7th, 1887, to bear date April lst, 1887, and not astherein stated.

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Correspondence.PAIN AND ITS INTERPRETATION.

To the Editors of THE LANCET.

"Audi alteram partem."

SIRS,—May I presume on your courtesy and space for abrief retort ? 1 can assure Mr. Gillies I was not thinking ofpanegyrics in provincial " weeklies" when I said " universalexperience and common sense" were against his contentions,and I am content to appeal from his to the more impartialjudgment of the readers of THE LANCET as to our respective"methods." I have re-read Mr. Gillies’ original article, andI adhere to my statement that he had not therein exceptedcancer from his sweeping assertions as to the " eminentlymerciful" character of pain. It would be interesting totake the case of the travails of childbirth, and see how therival theories supported respectively by Mr. Gillies andmyself would meet that difficulty. Is pain " eminentlymerciful" there? Why, the theory of individual compensa-tion-or, as Mr. Gillies finds such consolation in the DailyNems phraseology, shall I say the " blessing in disguisetheory"?-will not hold water. Evolution, on the otherhand, is ready with an explanation. Man has not gainedthe upright posture and his cerebral development withoutpaying heavily for these distinctions. These two factors areresponsible for most, if not all, of the obstetric difficultieswhich woman experiences over and above the normal painsof parturition (if such there be). Evolution tells us we arebut parts of a plan, and individual suffering is lost in thegrandeur of the whole. If "pain never comes where it canserve no good purpose," what daring presumption it must beto attempt to abolish that much-disguised blessing by theuse of anaesthetics ! But Mr. Gillies is satisfied that all iswell, every seeming exception can be disposed of, and he isnot afraid that anything determined right for the individualshall be found wrong for the whole. Such optimism isrefreshing, but in logic such reasoning is known as petitioprincipii, and in philosophy such assertions imply a fami-liarity with the intentions of Omniscience to which I darenot pretend. Glorying in teleological implications, Mr. Gilliespays me the greatest compliment he can when he says " hedid not understand my rendering of the matter."

r am. Sirs. vours fftithfllllv.I am, Sirs,yoursfaithfully,

W. J. COLLINS, M.S., M.D., B.Sc. Lond.Albert-terrace, Gloucester-gate, Aug. 28th, 1887.

To the Editors of THE LANCET.

SIRS,—I have read Mr. Gillies’ " Interpretation of Pain "

and Dr. Collins’s criticism thereon very greedily, for " pain "

is an all-engrossing subject. No one familiar with thedoctrine of evolution and the rudiments of mental philo-sophy can fail, if he have thought the matter out for him-self, to agree with Dr. Collins’ critical remarks. Mr. Gilliesargues for the universal beneficence of pain, but, by hisacknowledged inability to follow Dr. Collins when the lattergentleman points out that the capacity for pain has verylargely evolved by a survival of the fittest, Mr. Gilliesforegoes what is perhaps the strongest argument in favourof his view. It is possible that pain is no necessary in-gredient of mind, any more, for instance, than sight is; butwhether or not (and the matter is too involved to be herediscussed), there is no doubt that the capacity for pain haslargely evolved by natural selection. For instance, an

animal which is very painfully affected by the operation ofan injurious agent is more likely to shun the same andto survive than one that is less painfully affected byit; and thus we see how by accumulation the capacity

for pain has grown, and how, moreover, it has come

to be a most potent weapon against evil. If bygrasping with his hand a burning object a child ex-perienced a sensation akin to that obtained, by suck-ing a sweetmeat, a host of children would be lured onto destruction; and, indeed, we have only to look aroundto see how capable is pain to ward off evil. It is a commonobservation that delicate, hyperæsthetic people otten reacha very ripe age, so carefully does their hyperaesthetieiamlead them to avoid injurious influences; while, on the otherhand, strong and vigorous individuals are frequently pre-maturely cut off owing to their callousness of pain. Now,whatever evolves in an individual on the principle ofnatural selection must be beneficial to that individual..Therefore pain must be beneficial. But I fear we cannotsay of it that it is an unmixed blessing. Viewed from a.

utilitarian point of view, it is decidedly imperfect, and itbehoves us, as practical medical men, to know in whatrespect. Were pain perfect in the above sense it wouldhave to fulfil the following conditions: It should alwaysoccur upon the first operation of an injurious agent,.and should cease immediately upon its removal, or whensome other useful purpose-e.g., rest-has been effected.Now, pain does not universally fulfil these conditions. Iterrs both by defect and by excess: for, oa. the one hand, itdoes not always occur when it can be of use, either notoccurring at all or too late ; and on the other hand, it ariseswhen it can be of no use—nay, very often when it ispositively harmful. It is impossible to develop thesetwo propositions adequately in this place, for I am com-pelled to be very brief. Concerning the first kind ofimperfection: Pain is not present in noma, nor (veryoften) in hydatid and several other disorders. In manydiseases, though of use when it does come, it would haveserved a better purpose had it appeared earlier, during thefirst operation of the pathogenic agent, as in rheumatism,gout, syphilis, and the specific fevers. Finally, it may cometoo late, as in perforating ulcer, which may be unattendedby pain till the fatal paroxysm of agony occurs. It is truethat many diseases, and amongst them some of the above,are due to imprudence, the erring individual knowing well.that pain will be the outcome of his conduct. But prudencedepends, as Bain points out, upon the vividness of idealpain, and if the latter is not stronger than the anticipatedpleasure, so as to overcome it, it fails to deter, and the faultmust be laid at the door of pain, which does not adequatelypersist in the memory. As regards the imperfection byexcess, too many examples, alas, could be quoted ; the factcan be established by asking two questions: In how manyhomes are good and loving people at the present momentpraying for the happy release? How many doctors are therenow struggling, might and main, against pain, not only byremoving the cause, which, pushing Mr. Gillies’s remarks to apractical issue, would be the only justifiable method ofdealing with it, but by every means in their power, and that,too, not solely for the purpose of giving ease for a time, butvery often because the pain is distinctly harmful, because.if it cannot be overcome, it may turn the scales in thefavour of death ? The subject of pain is an awful one, andit is one with which medical men have especially to do;,but, for these very reasons, it behoves us, if we write uponthe philosophy of it, to be most careful that we approach.the subject from a strictly scientific point of view.

T 11m Cira yours faithfully

Guilford-street, W.C., Aug. 28th. HARRY CAMPBELL, M.D.

To the Editors of THE LANCET.

SIRS,—Mr. H. Cameron Gillies, in his reply to Dr. Collins’s,letter, makes a candid but surprising confession. He

says: "As to Dr. Collins’s own rendering of the matter,.which I honestly confess I did not understand......" Surelythere was nothing at all incomprehensible in Dr. Collins’s"rendering." It would, then, appear that Mr. Gilliesdoes not understand what every believer in the greattruths of evolution must admit to be the real meaningof pain. Does, or does not, Mr. Gillies close his eyesto the fact that with the steady onward march ofdevelopment and natural selection, the nervous systembecomes more and more appreciative of all sensations?’Can he deny that the greater the capacity for enjoymentbecomes, the greater must also be the capacity forsuffering ? If Mr. Gillies deny this, it would be difficult