272

Greenwich, and Woolwich. The number of scarlet fever

patients under treatment in the Metropolitan Asylums Hos-pitals at the end of last month was 3498, against 3431,3776, and 3787 at the end of the three preceding months ;the weekly admissions averaged 371, against 506, 493, and477 in the three preceding months. The prevalence of

diphtheria showed a slight decline from that recorded in thetwo preceding months ; this disease was proportionally mostprevalent in Hammersmith, Fulham, Chelsea, Bethnal Green,Deptford, Greenwich, Lewisham, and Woolwich. There were1241 diphtheria patients under treatment in the Metro-

politan Asylums Hospitals at the end of last month, against953, 1118, and 1228 at the end of the three precedingmonths; the weekly admissions averaged 143, against158 in each of the two preceding months. Entericfever also was less prevalent in December than ineither of the two preceding months; the greatest propor-tional prevalence of this disease last month was recorded in

Hampstead, Holborn, Finsbury, Shoreditch, Bethnal Green,Poplar, Bermondsey, and Greenwich. The MetropolitanAsylums Hospitals contained 147 enteric fever patients at theend of last month, against 95, 145, and 184 at the end ofthe three preceding months ; the weekly admissions averaged16, against 18, 24, and 29 in the three preceding months.The 20 cases of puerperal fever notified during the monthincluded three which belonged to Islington, and two eachto Paddington, Hampstead, Stepney, Southwark, Camberwell,and Lewisham. Of the three cases notified as cerebro-spinalmeningitis one belonged to Fulham, one to Islington, andone to Battersea.The mortality statistics in the table relate to the deaths of

persons actually belonging to the various boroughs, the deathsoccurring in institutions having been distributed among theseveral boroughs in which the deceased persons had pre-viously resided. During the five weeks ending Jan. 2nd thedeaths of 6591 persons belonging to London were registered,equal to an annual rate of 14 . 3 per 1000 ; in the three pre-ceding months the rates had been 12 - 8, 12 3, and 14 6 6 per1000. Among the several boroughs the death-rates lastmonth ranged from 9’ 9 in Hampstead, 10 3 in Lewisham,11-3 in Greenwich, 11.8 8 in Paddington and in Woolwich,12 . 1 in Battersea, and 12 - 3 in Wandsworth and Deptford,to 17’2 in Shoreditch, 18.1 1 in Finsbury and in Bermondsey,18 2 in Stepney, 18’ 5 in Bethnal Green, and 19 - 1 inHolborn. The 6591 deaths from all causes included 566which were referred to the principal infectious diseases ; ofthese, 267 resulted from measles, 52 from scarlet fever,90 from diphtheria, 29 from whooping-cough, 39 fromenteric fever, and 89 from diarrhoea, but not any from

small-pox, from typhus fever, or from ill-defined pyrexia.No death from any of these diseases was recordedlast month in the City of London ; while among the

metropolitan boroughs they caused the lowest death-ratesin Paddington, Kensington, Hampstead, St. Pancras, StokeNewington, Holborn, Lambeth, and Deptford; and the

highest rates in St. Marylebone, Bethnal Green, Stepney,Islington, Poplar, Southwark, and Bermondsey. The 267 fatalcases of measles were 76 in excess of the corrected averagenumber for the corresponding period of the five precedingyears ; the greatest proportional mortality from this diseaselast month was recorded in St. Marylebone, Islington,Finsbury, Bethnal Green, Stepney, Southwark, and Bermond-sey. The 52 deaths from scarlet fever were slightly fewer Ithan the corrected average number ; this disease was pro-portionally most fatal in Hackney, Shoreditch, Stepney,Poplar, and Bermondsey. The 90 fatal cases of diphtheriawere equal to the average ; among the various metropolitanboroughs the highest death-rates from this disease were

recorded in Hammersmith, Chelsea, Shoreditch, BethnalGreen, Stepney, Camberwell, and Lewisham. The 29 deathsfrom whooping-cough were equal to less than one-fourthof the corrected average number for the correspondingperiod of the five preceding years ; the greatest propor-tional mortality from this disease last month was re-

corded in Chelsea, Shoreditch, Bethnal Green, Ber-

mondsey, and Battersea. The 39 fatal cases of enteric feverslightly exceeded the corrected average number; this diseasewas proportionally most fatal in St. Marylebone, Stoke

Newington, Finsbury, Shoreditch, Poplar, Bermondsey, andGreenwich. The 89 deaths from diarrhoea also showed a

slight excess over the corrected average ; the greatest pro-portional mortality from this cause was recorded in Hammer- ismith, Fulham, St. Marylebone, Islington, Finsbury, Stepney, i’

Southwark, Camberwell, and Lewisham. In conclusion, tmay be stated that the aggregate mortality in London lastmonth from these principal infectious diseases was 2’3 percent. below the average.

Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 117 per 1000. The lowest rates of infantmortality were recorded in St. Marylebone, Hampstead,Stoke Newington, Hackney, Lambeth, Camberwell, and

Lewisham ; and the highest rates in Kensington, Hammer-smith, Westminster, Bethnal Green, Stepney, and South-wark.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

THE following appointments are notified :—Fleet-Surgeon E. C. Lomas, D. S. 0., to the President, additional, for threemonths’ course at West London Hospital. Stafr-Surgeon :W. K. Hopkins, to the Royal Arthur, lent, for voyage.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel R. Jennings has been noted for the

appointment of Administrative Medical Officer at Devonport.Colonel H. R. Whitehead, Principal Medical Officer, 1st(Peshawur) Division at Cherat, has been selected for the

appointment of Principal Medical Officer, Southern Command.Colonel 0. E. P. Lloyd, V.C., from Ranikhet, has beenappointed Principal Medical Officer, Peshawur Division.Major R. J. Blackham, D.P.H., has been appointedDivisional Sanitary Officer, 1st (Peshawur) Division, India.

TERRITORIAL FORCE.

Royal Army Medical Corps.For attmalament to Units other than Medicai Units :-Sm-

geon-Lieutenant-Colonel Frederick William Gibbon, from TteTyne Division (Electrical Engineers) Royal Engineers (Volua-teers), to be Lieutenant-Colonel, with precedence as in theVolunteer Force (dated April lst, 1908). Edgar Reid (lateSurgeon-Captain, 3rd Glamorgan Volunteer Rifle Corps)to-be Captain (dated April 1st, 1908). The undermentionedSurgeon-Lieutenant-Colonels and Honorary Surgeon-Colonds,from the 6th Volunteer Battalion, The Manchester Regim61t,to be Lieutenant-Colonels with the honorary rank of SurgEon-Colonels, with precedence as in the Volunteer Force (dstedApril lst, 1908): Thomas Fort and Robert Lancelot Sparjow.Lieutenant Henry Arthur Clifton Harris, from the Sussexand Kent Bearer Company, Royal Army Medical Corps(Volunteers), to be Lieutenant, with precedence as it the

Volunteer Force (dated April lst, 1908). Surgeon-LieutEnant-Colonel and Honorary Surgeon-Colonel William MtehellRoocroft, from the 5th Battalion, The Manchester Reginent,to be Lieutenant-Colonel with the honorary rank of Sirgeon-Colonel, with precedence from August 20th, 1904 (datedApril 2nd, 1908). Lieutenant Alfred Harold Godwin,from the 2nd West Lancashire Field Ambulalce, tobe Lieutenant (dated August 13th, 1908). JohnWilfred Bird to be Captain (dated Sept. 14th 1908).Lieutenant Charles H. Sedgwick to be Captaii (datedSept. 25th, 1908). Surgeon-Captain John Robert A7illiams,from the 6th Battalion, The Royal Welsh Fusililrs, to beCaptain (dated Nov. 18th, 1908). Surgeon-Mjor HarryLegh de Legh, from the 4th Battalion, Alexanda, Princessof Wales’s Own (Yorkshire Regiment), to be Mfjor (datedNov. llth, 1908). Captain William R. Willis resigns hiscommission (dated Dec. 4th, 1908).

lst London Territorial Division: Surgeor-Lieutenant-Colonel and Honorary Surgeon-Colonel James Jantlie, fromthe Honorary Colonelcy of the Eastern Commaid, MaidstoneCompanies, and the London District, London CompaniesRoyal Army Medical Corps (Volunteers), is alpointed to theHonorary Colonelcy of the division, with prcedence as inthe Volunteer Force (dated April lst, 1908).The announcements in the London Gazde of Nov. 6th,

1908, regarding the transfer of Surgeon-Majr Hugh RansonBramwell and Surgeon-Captain John Comie from theTynemouth Royal Garrison Artillery Volunteers) are

cancelled.lst East Anglian Field Ambulance : Gptain Francis A.

Brooks to be Major (dated Nov. 30th, 190f).2nd Lowland Field Ambulance : Captah Peter F. Shaw to

be Major (dated Dec. 13th, 1908).

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2nd North Midland Field Ambulance: Captain and

Honorary Major Horace Walter Plant (Retired List, Volun-teers), to be Transport Officer, with the honorary rank ofMajor (dated June 28th, 1908).

lst Northumbrian Field Ambulance: Lieutenant FrankHawthorn to be Captain (dated Dec. 1st, 1908).2nd Northumbrian Field Ambulance : Quartermaster and

Honorary Lieutenant Alfred Johnson to be Transport Officer,with the honorary rank of Lieutenant (dated Dec. lst, 1908).

lst Welsh Field Ambulance: Surgeon-Major ThomasLewis Kenrick Davies, from the 6th Battalion. The RoyalWelsh Fusiliers, to be Major (dated Nov. 18th, 1908).

The undermentioned officers are appointed to the TerritorialForce, on the Unattached List, for service with the con-

tingents of the Senior Division of the Officers TrainingCorps as stated against their names in the ranks andin the precedence which they severally held as

officers in the Volunteer Force (dated July 17th, 1908) :-Surgeon-Captain Walter Tyrrell Brooks (lst (Oxford Uni-versity) Volunteer Battalion, The Oxfordshire and Bucking-hamshire Light Infantry), Oxford University, to be Captain ;Surgeon-Lieutenant William Duncan Sturrock (lst (OxfordUniversity) Volunteer Battalion, The Oxfordshire and Buck-inghamshire Light Infantry), Oxford University, to beLieutenant.

VOLUNTEER CORPS.

Royal Engineers (Volunteers): : The Tyne Division

(Electrical Engineers) : Surgeon-Major Frederick W. Gibbonto be Surgeon-Lieutenant-Colonel (dated March 31st, 1908).

Rifle : 1st Volunteer Battalion, The Highland Light tInfantry: Surgeon-Captain James Swanson resigns his com-mission (dated March 31st, 1908).DINNER OF THE MEDICAL OFFICERS OF THE ROYAL NAVY.On Jan. 8th between 70 and 80 medical officers of the

Ryal Navy, retired and active lists, dined at the CriterionRestaurant, Piccadilly, and it is hoped that this dinner willbecome an annual feature. The dinner was convened byFleet-Surgeon J. Lloyd Thomas, Fleet-Surgeon P. B.

Haadyside, and Fleet-Surgeon A. R. Bankart, M. V. O.

Correspondence.LORD LISTER ON SULPHO-CHROMIC

CATGUT.

"Audi alteram partem."

To the Editor of THE LANCET.SIR,-I desire with your permission to add in your columns 1

a few vords regarding sulpho-chromic catgut to what was 1stated inmy paper on the Preparation of Catgut for SurgicalPurposes published in THE LANCET of Jan. 18th, 1908, p. 148. 1It does mt begin to be absorbed for about ten days, and it isthen gradially eroded, retaining considerable firmness to thelast. It is thus well adapted not only for tying vessels inwounds bm also for the ligature of arterial trunks in theircontinuity aid for buried sutures. Its trustworthiness forthese purposes has been amply demonstrated by long experi-ence. I ma3 add that immersion of the catgut in 1 to 20solution of cu-bolic acid for about 20 minutes before thecommencement of an operation has afforded perfect securityof an aseptic state of the thread, while no disadvantagearises from its emaining in that solution for any length oftime which on ether grounds may be found convenient.

I am, Sir, yours, &c.,Jan. 14th, 1909. LISTER.

THE ABSORPTION OF PROTEINS.To’4e Editor of THE LANCET.

SIR,-Your issue of Jan. 2nd contains an article by Pro-fessor W.D.Hallibu-ton on "The Absorption of Proteins,"put forth as arejoindqo to remarks upon the subject containedin my lectures recentb delivered at the Royal College of Phy-sicians of London. ’lhe point dealt with is no less funda-mental a one than the manner in which protein food passeswithin the system from the seat of absorption in the wallsof the alimentary canal o that of utilisation in the tissues.

Professor Halliburton contends that protein at the seat ofabsorption becomes broken down into the amino-acidswhich, by virtue of their small molecular condition, passthrough the walls of the vessels into the blood stream andthus become distributed through the system and brought intorelation with the tissues by which they are in a directmanner taken for application to utilisation. Under such aproposition the blood, as far as protein food is concerned, issimply a medium for the conveyance of crude products ofdigestion within reach of the tissues.No matter what the condition existing with respect to

rest and exercise, the tissues are always to be ready to takethat which is presented to them from the seat of absorption.It is admitted that the amino-acids are capable of passinginto the urine and that they do pass into it if they reach theblood in excess of their removal by the tissues, but thetissues, apart from the consideration of whether they arewanted or not, and apart from the consideration of whethermuch or little in amount of them is entering the blood, areforced to take them to keep them from showing themselves,as is found under normal circumstances they fail to do, in theurine.What, under such circumstances, is the object of the

presence of the elaborated protein principles found in theblood 1 If re-synthesis of the products of digestion takesplace at the seat of absorption, their presence is intelligibleenough, but if the products of digestion are to traverse thecirculation as such for direct appropriation by the tissues,the protein constituents of the blood become needless as faras tissue nutrition is concerned, a view standing in

antagonism with that generally held.Undoubtedly, it may be considered, the protein constitu-

ents of the blood must have a function of importance todischarge. Professor Halliburton does not seem to regardthem as occupying an intermediate position between the foodand tissue appropriation. Definitely we know that in theincubating egg the chick is developed from products allied tothe protein constituents of the blood and not from productsallied to those derived from digestive action. Becauseanimals fed with the amino acids maintain nitrogenous equi-librium and health is no argument in support, as it is allegedby Professor Halliburton to be, of food protein passing asamino-acids to the tissues for their nutrient supply. Any-digestion product which can be taken on by the bioplasmicmolecules of the lymphocyte will serve the purpose for theoccurrence of re-synthetic action at the seat of absorptionand, with the amino-acids here synthesised into protein, acondition is supplied which equally well fits in with themaintenance of nitrogenous equilibrium and health in animalsfed on them as under the other mode of viewing the question.

Professor Halliburton says: "If the intestinal epithelium"- epithelium stands here in error for lymphocytes-’ werethe exclusive, or even the principal, seat of protein synthesis,the coagulable protein in the blood ought to be raised after aprotein meal. Recent analyses have shown that this is notthe case." ........ The sentence Dr. Pavy quotes from my’ Chemical Physiology’ states that chyle contains more

protein than does lymph from the limbs. The statement iscorrect, but the inference I drew from it in mv more youthfuldays is incorrect." Is Professor Halliburton viewing thismatter in a right way ? 2 I entered at some length into theincreased flow that takes place through the thoracic duct asa result of food ingestion, but he is altogether silent uponthis point. Surely an increased flow of a protein-containingfluid must count for something in relation to the entry ofprotein into the blood stream. Let me from this standpointgive consideration to the matter.Viewing the absorbent system and its contents through the

information that has been acquired with regard to them Iread the deductions to be drawn in the following way. Asystem of vessels exists, commencing in lacunas dispersedbetween the tissue elements and ending in junctions withveins at the lower part of the neck. From the capillary blood-vessels a transudation into the lacunae takes place from whichthe tissues draw their supply. The nature and amount ofthis transudation are dependent upon the existing collateralconditions related to state of blood and of blood pressure, butunder no circumstances, I conceive, can it be assumed thatthe blood plasma passes bodily into the lacunse. The

impediment offered by membranes to the transudation of pro-tein is well understood, and it is only under the influence ofpressure that a passage takes place. According to the amount t