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made by the staff in the course of this war and that things have notbeen foreseen which might have been. We have pointed out in dealingwith complaints in Part III. instances of such mistakes and over-sights. But taking their work as a whole and considering thedifficulties they have had to contend with we think that the principalmedical officer and his head staff have done excellent work. Theyhave never spared themselves and have shown a great devotion totheir duty and every desire to make due provision for the care of thesick and wounded, and when their conduct is fairly judged we thinkthat they deserve great praise. The organisation of the field andstationary and base hospitals for the colonial troops, the militia, andvolunteers fell upon the medical staff in South Africa, and in ourjudgment they met the difficulties presented to them with singularability and success.

CIVIL SURGEONS : COMPLAINTS AGAINST ORDERLIES.The Commissioners find that the work of the civil surgeons

was, as a whole, well done, and as for the orderlies the wayin which these men as a body discharged tbeir duties hasdeservedly been the subject of high praie from manywitnesses of experience. Some of the untrained orderlieswho had to be hastily obtained to sopplv deficiencies wereinattentive, rough, and occasionally brutal to patients. Butthese men were not the trained orderlies of the Royal ArmyMedical Corps. The report proceeds :- ’There are two other matters of importance to be mentioned. We

refer to the existence in places amongst the orderlies of the crimeof stealing the stimulants and comforts-and even the money andother property-of patients, and also of the practice of takingbribes from the patients for the supply of comforts or for ren-

dering the assistance due to them. There have been too manycomplaints on these heads brought to our notice for us to considerthe cases in which the ill-practices in question have occurred as so

exceptional as not to demand serious consideration, though we have nosufficient reason to justify us in concluding that they prevailed to anyvery large extent. The medical officers do not appear to have beensufficiently awa’ e of their existence. This is to be regretted, for other-wise steps no doubt would have been taken to remedy the evils inquestion. We think it advisable thar, the attention of the medicalofficers of the various hospitals should be specially and speedily calledto these matters, with a view to their instituting searching inquiry andstamping out the ill-practices so far as they exist in their hospitals.

PRIVATE HOSPITALS AND CHARITABLE SOCIETIES.The various private hospitals did excellent work, as well

as the Red Cross Society and sundry charitable persons.But there must have been some waste owing to the overlapping of

the various charities and charitable gifts, and to the difficulty of

properly distributing the same amongst those who needed them. Infuture wars it would be advisable, if possible. that some provisionshould be made by which all charitable gifts should be received anddealt with by one organised body.

RAILWAY TRANSPORT.

Considering that the railways were, as a rule, only singleline, of a small gauge, ani had only a small rolling-stock,the difficulties of transport were overcome in a most

creditable manner.

ADMINISTRATIVE DUTIES OF THE ROYAL ARMY MEDICALCORPS AND "RED TAPE."

The Commissioners do not think that the admiristrativeduties of the Royal Army Medical Corps could be lightenedby the employment of civil administrators, and with regardto " Red Tape" the Commissioners state :-We believe, shortly speaking, that what is meant from a practical

point of view by the use of the term as applied to the Royal ArmyMedical Corps is : (1) that there are numerous unnecessary returns andrecords to be filled up and kept by the principal medical officer ; and(2) that difficulties and delays ensue from the necessity cast upon theofficers of hospitals by the military regulations in respect of therequisitioning of necessaries.With regard to the first point, no doubt the returns and other docu-

ments are numerous. To a certain extent they cannot be avoided. Forinstance, records of admissions to the hospital, and discharges from it,and also of complaints of the patients, must be kept.So long as the medical officers are expected and required to answer

promptly all inquiries concerning wounded or sick soldiers, the necessityfor several full returns and records being kept must be admitted.We do not ourselves feel justified in attempting to point outwhat returns or records could in time of war be dispensed with ;except that in the case of general hospitals we cannot see thenecessity for three records being kept. as is ordinarily the ease--namely, one by the principal medical officer of the surgical division,one by the principal medical officer of the medical division, and the thirdby the chief principal medical officer of the hospital. It is possible,however, that the documents might properly be shortened in severalrespects, and the question as to how this could be effected might alsousefully form one of the subjects to be inquired into by the Committeewe have already mentioned. We should, perhaps, add that in this cam-paign civil surgeons were, as a rule, only required to fill up the dietsheets, which, in our opinion, of necessity should be kept by them. Asto a complaint that has been made against the c’assification of diseasesin the returns we cannot think that this is well founded. The classifi-cation in question is that of the Royal College of Physicians, the RoyalCollege of Surgeons, and is that adopted by th Registrar-General ofMortality in England.With regard to the second point, it is true that the medical officers

have to get supplies for their hospitals, including medical comforts,from the Army Service Corps, and such things as beds, mattresses, &c.,from the Ordnance officers. This no doubt does on some occasions

cause delav. Whether this can to any and what extent be avoidedwith practical advantage by permitting the Royal Army Medical Corpsto have sole possession of and control over all hospital necessaries (otherthan ordinary foort and ordinary clothing’, including such things asbeds, mattresses, and hospital clothing, is a question which should beconsidered by the Committee which we have already mentioned.Except in respect of special drugs or medical comforts not ordinarily

used, and in cases of urgency, the hospital should and in ordinarycases would be properly provided with all requisites, and the medicalofficers in charge as they fell short of any requisite would requisitionfor a supply in time, and we believe that apart from special casesthose requisitions would be complied with without any unreasonabledelay. But in cases of special medicines or instruments, or in casesof urgency, undoubtedly there might be delay, and the difficultycould only be met by giving the medical officers in command of thehospitals full powsr to order and buy on their own responsibility atthe expense of the State. Naturally, such a power is one liable to beabused, and ought to be exercised with great care, but there certainlyshould be such a power given to the officers, and it should be freelyused without liability on their part to censure, except in case of abuse.As a matter of fact, in this war such a power has been exercised

to a large extent by many of the medical officers. There is a GeneralRegulation of the Hoyal Army Medical Corps which points in thisdirection, but it is limited in scope and not quite explicit enough.Some of the medical officers in South Africa apparently did notknow that they had this power, and accordingly did not exercise it.In Natal Colonel Gallwey expressly issued a circular which dealt

with the buying by officers in cases of necessity, and that notice wasvery efficacious and was promptly acted upon by the medical officersthere. In others parts of South Africa an express circular of thekind was not issued, and it would have been better if it had been.Surgeon-General Wilson did send a circular pointing out generallythat medical officers in cases of emergency should take the initiative inprocuring what was necessary, and stated that he would support themin their acts, but he did not specially refer to the question of buying.It appears from his evidence, however, that he did speak to theprincipal medical officers on the subject, and told them to exercisethe power of buying freely.

TRANSPORT OF THE ROYAL ARMY MEDICAL CORPS.With regard to the suggestion of the Royal Army Medical

Corps having its own transport, the Commissioners considerthat there are difficulties in the way of this suggestion beingcarried out. But they think that general and stationaryhospitals should have their own transport which should notbe taken away from them.

SANITATION.In an ordinary hospital the Commissioners consider that the

principal medical officer should look after its sanitation.But when there is a question of the sanitation of a town, or of a large

camp, where hospitals exist, we think it is advisable that there should bea special sanitary officer who should be charged with the various larger-duties appertaining to sanitation, such as the lccation of proper campinggrounds for the various regiments, fixing sites for hospitals, providingsuitable sites for hospitals for sick horses, making arrangements for theremoval of refuse and the discharge of the latrines of the hospitals, andso forth. Occasionallv in this war special sanitary officers have beenappointed in large centres, as, for example in Bloemfontein and inPretoria, cases which are specially referred to in Part III. Butdifficulty has been experienced in finding suitable men for such posts.We think that it is preferable that the men to be appointed should heofficers of the Royal Armv Medical Corf’s, and that it is advisable, inorder that duly qualified special sanitary officers should be forthcomingin future wars when required, that. as part of the organisation andworking of the Royal Army Medical Corps, certain members of thatbody should be specially selected to undertake sanitary duties.

(To be continued.)

THE WAR IN SOUTH AFRICA.

SOUTH AFRICA has been the graveyard of many reputa-tions and the war bas given rise to no end of contentiouscriticism. The public can now read the South African

despatches covering the whole period and giving in effect ahistorical and, in a sense, official outline of the events of thecampaign. The study of them is of general interest anddoes not concern military readers only. They serve toclear up many points which unquestionably needed ex-

planation and to set forth the nature and difficulties ofan expedition which has so severely strained and tested,not only the medical, but every branch of the service.The medical service had, of course. in common with the retof the army, to take its full share of those difficultieswhich were brought about by the exceptional nature of thecampaign and the untoward occurrences which arose in thecourse of it. How far, however, these could and shouldhave been foreseen or guarded against and provided for bytimely and adequate hospital arrangements is a questic.nwhich is bound to be threshed out in Parliament during thepresent session.

Cases of plague still continue to make their appearat ceat Cape Town, but the disease has not happily sho" nany signs of rapid extension. The cases have been few

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so far and the disease is stated to be of a much lesssevere type than that which prevailed in Bombay, but thelocal authorities fear that some cases are being concealed.Be this as it may, the outbreak is very embarrassing in tl:1<1.tit seriously interferes with the employment of nativelabourers and with the work at the Cape Town docks, inaddition to causing a certain amount of anxiety inseparablefrom the mere fact of its presence.

The war news from South Africa is, on the whole,satisfactory. There is great activity on the part of theBritish in pursuit of the Boer forces. The sweeping methodadopted by Lord Kitchener’s policy is being systematicallypursnei. The object is apparently, as we have said, to drivethe Boars into certain positions and localities where, deprivedof cattle, horses, forage, ammunition, and supplies gene-rally, they will have to fight in order to live,instead of, as has been hitherto the case, livingin order to fight. It appears at the moment of writingthat both Botha’s and De Wet’s forces are in tighter situa-tions than they have hitherto been. Those of the Britishand colonial troops who have been for a long time in thefield are all more or less fatigued and getting what is termedstale. We may feel confident of their determination, how-ever, to spare no effort to bring the war to an end. All thisdesultory fighting in various directions on a small scaleadds to the number of wounded who are admitted to thesurgical side of hospitals, but it is on the medical side andchiefly from enteric fever and other forms of disease that the- sick lists are maintained.

"RETURN" CASES OF SCARLET FEVERAND DIPHTHERIA.

IN February, 1900, the Metropolitan Asylums Board askedthe Royal College of Physicians of London for an expressionof opinion as to certain cases of scarlet fever and diphtheriawhich had been discharged from the Board’s hospitals asrecovered but had nevertheless -been alleged to prove sourcesof infection on returning home.1 The reply of the Collegewas considered by the Board at its meeting held on Feb. 2nd ;it contained the three following recommendations, which themedical superintendents of the Board’s hospitals have beenauthorised to carry into effect :-

1. That in each hospital a couple of wards identical in respect tocubic space per bed, &c, should be set aside and administered on adifferent principle, the sex of the children being the same, and the ageas far as possible ; that in one ward the cases subject to mucous dis-charges from nose or ear be rigorously excluded ; that immediately onthe appearance of any such discharge the patient should be removed,and that all nozzles of syringes should be kept in antiseptic solutions.Jn the other ward no special attention should be paid to these dis-charges other than that hitherto adopted. The incidence of eitherrhinorrhoea. or otorrhcea should be compared. Cases of "septic scarletfever " should be excluded from both.

2. That, if possible, in certain hospitals, with the approval of themedical superintendent, two or more rooms previously disinfectedbe reserved for the isolation after six or eight weeks’ detention of single,patients who are suffering from rhinorrhcea or otorrhcea, but whosedesquamation is completed. Each patient so secluded should be keptfor 10 days or a fortnight before returning home. During this periodof detention the affected parts should be regularly irrigated or

syringed with some reliable antiseptic, and great care should be takenthat the nozzle of the apparatus be kept in a germicidal solution. Onthe expiration of the quarantine the patient should be sent homewhether the discharge has ceased or not. and the room should be dis-infected prior to the reception of another patient. The subsequenthistory of the case should be investigated.

3. That the inquiry into the facts connected with the incidence of thereturn cases at the managers’ hospitals should be continued for a periodof 12 months, and that the scope of the inquiry should include the,history of the cases discharged under the conditions mentioned.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6853 births and 4408deaths were registered during the week ending Feb. 16th.The annual rate of mortality in these towns, which hadbeen 16 4 and 19.8 per 1000 in the two precedingweeks, declined again last week to 19’5. In London the-death-rate was 19-3 per 1000, while it averaged 19 in

1 THE LANCET, April 21st, 1900, p. 1162.

the 32 provincial towns. The lowest death-rates inthese towns were 11’7 in Burnley, 13 3 in Bradford and inHuddersfield, 13 in Cardiff, and 14 3 in Preston ; the

highest rates were 22 in Birkenhead, 22 8 in Birming-ham, 251 in Plymouth. 273 in Norwich, and 28-8in Liverpool. The 4408 deaths in these towns in-cluded 348 which were referred to the principal zymoticdiseases, against 323 ana 397 in the two prece-ding weeks ; of these 105 resulted from whqoping-cough, 78 from measles, 71 from diphtheria, 35 fromdiarrhoeal diseases, 32 from "fever" (principally enteric),and 27 from scarlet fever. No death from any of thesediseases occurred in Huddersfield ; in the other towns ’theycaused the lowest death-rates in Croydon, Norwich, Bradford,and Newcastle, and the highest rates in Bristol, Birkenhead,Liverpool, Manchester, and Salford. The greatest pro-portional mortality from measles occurred in Liverpooland Bolton ; and from whooping-cough in Plymouth, Bristol,Birkenhead, and Salford. The mortality from scarlet feverand that from "fever" showed no marked excess in any ofthe large towns. The 71 deaths from diphtheria included20 in London, six in Salford, five in Manchester, five inLeicester, and four in Leeds. No fatal case of small-poxwas registered last week in any of the 33 towns,and ly one small-pox patient remained under treat-ment on Saturday last, Feb. 16th, in the MetropolitanAsylums hospitals. The number of scarlet fever patients inthese hospitals and in the London Fever Hospital at theend of the week was 1876, against numbers declining from2535 to 1963 on the seven preceding Saturdays; 142 newcases were admitted during the week, against 172, 178, and145 in the three preceding weeks. Influenza was certifiedas the primary cause of 16 deaths in London last week.The deaths referred to diseases of the respiratory organsin London, which had been 323 and 397 in the two precedingweeks, further rose last week to 420, but were 68 belowthe corrected average. The causes of 62, or 1-4 per cent.,of the deaths in the 33 towns last week were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in Cardiff,Salford, Bradford, Leeds, and in nine other smaller towns;the largest proportions of uncertified deaths were registeredin Liverpool, Blackburn, Sheffield, Gateshead, and Newcastle.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 21-1, 22-2, and 23-2 per 1000 in the threepreceding weeks, declined again to 22’6 during the weekending Feb. 16th, but showed an excess of 3’1 per 1000 overthe mean rate during the same period in the 33 large Englishtowns. The rates in the eight Scotch towns ranged from18 in Aberdeen and 19-7 in Dundee to 25’2 in Glasgowand 26-9 in Perth. The 710 deaths in these towns in-cluded 33 from whooping-cough, 25 from measles, 20 fromsmall-pox, 10 from diphtheria, 8 from diarrhoea, six fromscarlet fever, and four from "fever." In all, 106deaths resulted from these principal zymotic diseases,against 126 and 103 in the two preceding weeks. These106 deaths were equal to an annual rate of 3’4 per 1000,which was 1’9 per 1000 above the mean rate last week fromthe same diseases in the 33 large English towns. The fatalcases of whooping-cough, which had been 43 and 37 inthe two preceding weeks, further declined last week to 33,of which 25 occurred in Glasgow, six in Dundee, and twoin Paisley. The deaths from measles, which had declinedfrom 23 to 14 in the four preceding weeks, rose again to 25last week, and included 15 in Edinburgh and seven inAberdeen. The fatal cases of small-pox, which hadbeen 11, 24, and 11 in the three preceding weeks, rose

again last week to 20, and were all registered in Glasgow.The deaths from diphtheria, which had been seven in eachof the two preceding weeks, increased to 10 last week,and included six in Glasgow. The fatal cases of diarrhoea,which had been 27 and 18 in the two preceding weeks,further declined last week to eight, of which six occurred inGlasgow. The six deaths from scarlet fever correspondedwith the number in the preceding week, and included fourin Glasgow, where three of the four deaths from "fever,"were also registered The deaths referred to diseases of therespiratory organs in these towns, which had been 123 and148 in the two preceding weeks, declined again last weekto 153, and were 172 below the number in the correspondingperiod of last year. The causes of 29, or more than 4 per