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DRY heat should be applied by surrounding the patient’sbody with hot blankets, sand-bags, &c.The treatment of the second stage will be very different.

During the first there is vital power, and high spasmodicaction, but in the second the patient is in a state of realexhaustion, and would sink under the measures adopted forthe first. Even the warm-bath is dangerous to life now, andmust be avoided.

In the second stage there are two indications, 1st, toremove deadly coldness ; 2nd, to remove the great debility.For the first, recourse must be had to DRY heat; for thesecond, to stimulants, such as ether, ammonia, brandy.The rapid type now comes to be considered, as in many

instances the attack is desperate, the patient suddenlyfalling down, perhaps insensible. There is little visible

attempt at reaction. The pulse disappears at the wrist, theheat declines. In these cases, cramps, vomiting, and

purging, are either completely absent, or exceedingly slightin their existence. Two stages may still be formed;1. That of apparent debility ; 2. That of real debility. Forthe treatment of these varieties, we must adopt the author’sown words:-"The chief remedial measure is blood-letting, and here its use is

founded upon the fact, that, for a certain space of time after thecommencement of the attack, the resources of the constitution are notto be measured by the external symptoms."

(At the end of the remainder of the quotation, which wecannot here transcribe for lack of space, the Editor states,"We shall quote no further. To the work itself we referthe anxious practitioner.")

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 7785 births and 3786 deaths were registered during the week ending Oct. 30th. The annual rate of mortality in these towns, which had been equal to 12-9, 12 . 2, and 12. 0 per 1000 in the threepreceding weeks, were again equal to 12 - 0 in the week undernotice. During the first four weeks of the current quarterthe annual death-rate in these towns averaged only 12’ 3 per1000, and in London during the same period the rate did notexceed 11 - 9 per 1000. The lowest annual rates of mortalityrecorded in the 76 towns last week were 6’ 7 in Cardiff,6’9 in Walthamstow, 7’ 0 in Wolverhampton and in Bury,and 7’1 in Hornsey ; the rates in the other towns rangedupwards, however, to 17’ 5 in Oldham, 17.6 in GreatYarmouth, and 18-0 in Newport (Mon.). In London therecorded death-rate last week did not exceed 11’9 per1000. The 3786 deaths in the 76 towns last weekexceeded by but 14 the low number in the previousweek, and included 293 which were referred to the principalepidemic diseases, against numbers declining steadily from849 to 311 in the nine preceding weeks ; of these 293deaths, 110 resulted from diarrhoea, 57 from diphtheria, 42from whooping-cough, 38 from measles, 30 from scarlet fever,and 16 from "fever" (principally enteric), but not. one fromsmall-pox. The 293 deaths from these epidemic diseaseslast week were equal to an annual rate of 0 - 9 per 1000,which was lower than the rate from these diseases in anyprevious week of this year. No death from any of these

epidemic diseases was registered last week in Norwich,Rochdale, Reading, York, or in five other smaller towns;the annual death-rates therefrom ranged upwards, how-ever, to 3’4 in Burnley, 3’7 in West Bromwich, 4’ 0in Merthyr Tydfil, and 7 - 6 in Hanley. The deaths attributedto diarrhoea in the 76 towns, which had declined in thenine preceding weeks from 675 to 141, further fell last weekto 110, and were fewer than in any week since the end ofJuly ; the highest death-rates from this cause in these townslast week were 1. 5 in Burnley, 2’ 2 in West Bromwich, and2.3 in Hanley. The deaths referred to diphtheria, whichhad been 51 and 46 in the two previous weeks, rose lastweek to 57, and caused death-rates equal to 1 1 in Hudders-field, 1 - 3 in Merthyr Tydfil, and 1. 7 in Barrow-in-Furness ;this disease also caused 18 deaths in London and its suburbandistricts, and 6 in Manchester and Salford. The 38 fatalcases of measles showed a slight increase, and causeddeath-rates equal to 1-5 in West Bromwich, Wallasey,and Burnley, and to 3.8 in Hanley. The deaths fromwhooping-cough, which had been 27 and 28 in the two

preceding weeks, rose to 42 last week, and were propor-tionally most fatal in Swansea. The 30 fatal cases ofscarlet fever showed a further decline from recent weeklynumbers ; and the 16 deaths referred to ’’ fever " showed aconsiderable decline from the numbers in recent weeks, butincluded 2 each in Portsmouth, Leeds, and Newcastle-on-Tyne. The number of scarlet fever patients under treatmentin the Metropolitan Asylums and London Fever Hospitals,which had been 2810 and 2799 at the end of the two pre-ceding weeks, had further declined to 2743 on Saturday last;284 new cases of this disease were admitted to these hospitalsduring last week, against 371 and 345 in the two pre-ceding weeks. The Metropolitan Asylums Hospitals con-

tained 2 small-pox patients on Saturday last. Of the 1107deaths registered in London last week, 193 were referred topneumonia and other diseases of the respiratory system,against 167 and 174 in the two preceding weeks, but were 36below the corrected average number in the correspondingweek of the five years 1904-08. The causes of 27, or

0’ 7 per cent. of the deaths registered in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death regis-tered during last week were duly certified in Leeds,Bristol, West Ham, Bradford, Newcastle-on-Tyne, Salford,Leicester, and in 56 smaller towns; the 27 uncertifiedcauses of death in the 76 towns last week included 8 in

Liverpool and 6 in Birmingham.

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns 787 births and 462deaths were registered during the week ending Oct. 30th.The annual rate of mortality in these towns, which had been12 - 8 and 13 - 1 per 1000 in the two preceding weeks, de-clined again to 12.9 in the week under notice. Duringthe first four weeks of the current quarter the annualdeath-rate in these Scotch towns averaged 12 - 7 per 1000,and exceeded by 0 - 4 the mean rate during the same periodin the 76 large English towns. The annual death-rates lastweek in these Scotch towns ranged from 8 - 0 in Aberdeenand 11 4 in Paisley, to 18 4 in Perth and 18-8 8 in Greenock.The 462 deaths from all causes in the eight towns last weekshowed a decline of 8 from the number in the previous week,and included 34 which were referred to the principalepidemic diseases, against 45 and 54 in the two precedingweeks. These 34 deaths were equal to an annual rate of1’ 0 per 1000, against a mean rate of 0 - 9 from thesame diseases last week in the 76 English towns.The 34 deaths from these diseases in the Scotch townslast week included 10 from diarrhoea, 9 from measles, 6from scarlet fever, 4 from diphtheria, 4 from whooping-cough, and 1 from "fever," but not one from small-

pox. The deaths attributed to diarrhoea, which had been15 and 28 in the two preceding weeks, declined last weekto 10, and were fewer than in any week since the end ofMarch last ; 4 were returned in Glasgow and 2 in Leith.The 9 fatal cases of measles exceeded the number in anyrecent week, and included 8 in Glasgow. Of the 6 deathsfrom scarlet fever, 5 occurred in Glasgow. The fatal cases ofdiphtheria, which had been 12 and 11 in the two precedingweeks, declined last week to 4, of which 2 were returnedin Edinburgh. The 4 deaths from whooping-cough included2 both in Glasgow and in Edinburgh ; and the fatal case of" fever " occurred in Glasgow. The deaths referred to diseasesof the respiratory system in the eight towns, which had been57 and 84 in the two preceding weeks, declined again to 68last week, and were 19 below the number in the correspond-ing week of last year. The causes of 9, or l’ 9 percent., of the deaths in the eight towns last week were notcertified or not stated; in the 76 English towns the propor-tion of uncertified causes of death last week did not exceed0’7 7 per cent.

-

HEALTH OF IRISH TOWNS.

In 22 town districts of Ireland, having an estimatedpopulation of rather more than a million, 614 births and 359deaths were registered during the week ending Oct. 30th.The mean annual rate of mortality in these towns, which hadbeen equal to 15 2 and 14’ 8 per 1000 in the two precedingweeks, rose to 16 4 in the week under notice. During thefirst four weeks of the current quarter the annual death-ratein these Irish towns averaged 15’ 4 per 1000, whereas the

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mean death-rate during the same period did not exceed 12’ 3 inthe 76 largest English towns, and 12 ’ 7 in the eight principalScotch towns. The annual death-rate, during last weekwas equal to 18. 6 in Dublin, 19 .in Limerick, 19-2in Cork, 15.6 in Belfast, and 15.7 in Londonderry ; themean rate in the 16 smallest Irish town districts last weekwas equal to 13.9 per 1000. The 359 deaths from allcauses in the 22 town districts last week showed anincrease of 34 upon the number in the previous week,and included 26 which were referred to the principalepidemic diseases, against numbers declining from 42 to 22in the four preceding weeks ; these 26 deaths were equalto an annual rate of 1.2 per 1000, against 1’ 0 in theprevious week ; in the 76 English towns the ratefrom the same diseases last week did not exceed0’ 9 per 1000. The 26 deaths from these epidemicdiseases in the Irish towns last week included 12from diarrhoea, 10 from whooping - cough, 2 from"fever," and 1 each from measles and diphtheria,but not one either from scarlet fever or small-pox. The 12deaths from diarrhoea in the 22 towns last week corre-

sponded with the number in the previous week, andincluded 3 in Dublin, 3 in Belfast, and 2 in Waterford.The 10 fatal cases of whooping-cough showed an increaseof five upon the number in the previous week ; 5 occurredin Belfast, 3 in Limerick, and 1 each in Dublin andWaterford. Of the 2 deaths referred to enteric fever 1 eachwas returned in Dublin and in Lisburn. The 60 deathsreferred to pneumonia and other diseases of the respira-tory system last week in the 22 towns showed an

increase of 10 upon the number in each of the three pre-ceding weeks. The causes of 19, or 5-3 per cent.,of the deaths in these Irish towns last week were not certifiedby a registered medical practitioner or by a coroner ; in the76 English towns the proportion of uncertified causes ofdeath last week did not exceed 0 - 7 per cent., and in theeight Scotch towns the proportion was 1 .9 per cent.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Staff-Surgeons :

F. H. Nimmo for three months’ study at West London

Hospital, lent, to reside at Greenwich College ; P. T.Nicholls to the rictory. Surgeons: J. R. A. Clark-Hall tothe Excellent; and G. G. Vickery to the Victory, additional,for disposal.

ROYAL ARMY MEDICAL CORPS.Lieutenant William E. Marshall is seconded for service

with the Egyptian Army (dated Oct. 14th, 1909).Major M. P. C. Holt, D.S.O., has been appointed specialist

in advanced operative surgery, 3rd (Lahore) Division. MajorR. F. E. Austin, from Chatham, has been appointed to India.

THE ROYAL ARMY MEDICAL CORPS COLLEGE.

The course for Captains on promotion to Major has begunat the Royal Army Medical College, Millbank, S. W. Thecourse of instruction will be extended over a period of ninemonths and some 50 officers will attend. It is understoodthat the first three months will be devoted to lectures andlaboratory instruction in military hygiene and tropicalmedicine at the College, the second three months to post-graduate courses in the London hospitals, and the last threemonths to specialist’s work connected with either hygiene,bacteriology, advanced operative surgery, ophthalmology,midwifery and diseases of women and children, dentistry, orvenereal diseases and dermatology. Examinations will beheld at the end of each three months.

INDIAN MEDICAL SERVICE.Lieutenant-Colonel Harris has been appointed an Honorary

Surgeon to H.E. the Viceroy, vice Lieutenant-Colonel Perry.Major Heard, on his return to India from leave, has beenappointed Professor of Midwifery in the Lahore MedicalCollege. Major Hugh Ainsworth, at present OfficiatingMedical Adviser, Patiala State, has been appointed Professorof Ophthalmic Surgery in the Lahore Medical College. Theservices of Colonel Carruthers and Captain Cazalay arereplaced at the disposal of the Commander-in-Chief. Theservices of Captain Roberts are replaced at the disposal of

the Army Department, and those of Captain Young are

placed temporarily at the disposal of the Eastern Bengal andAssam Government for employment in the Sanitary Depart-ment. Captain Holmes has been appointed Civil Surgeonat Quetta. Major E. C. Macleod, Agency Surgeon, is grantedone year’s leave. Lieutenant Zorab is permitted to resignthe service from Sept. 26th, 1909.

SPECIAL RESERVE OF OFFICERS.

Royal Army Medical Corps.Supplementary List : The undermentioned to be Lieu-

tenants (on probation) :-Edward Andrew Gregg (datedJuly 30th, 1909), and Arthur Henry Habgood (datedSept. 22nd, 1909).

TERRITORIAL FORCE.

.Royal Army Medical Corps.London Mounted Brigade Field Ambulance: Captain

William Peart Thomas, from the 2nd London (City of

London) Field Ambulance, Royal Army Medical Corps, to beCaptain (dated Sept. 27th, 1909).

lst London (City of London) General Hospital : BrigadeSurgeon-Lieutenant-Colonel and Brevet Colonel CharlesEdward Harrison, C.V.O., retired pay (late Grenadier

Guards) to be Lieutenant-Colonel (dated Oct. 19th, 1909).Attccehed to Units other than Medical Units.-Lieutenant

Ashley Bird to be Captain (dated April lst, 1908).For Attachment to Units other than Medical Units.-John

Walter Pridmore to be Lieutenant (dated Sept. 21st, 1909).

Correspondence.

THE ROYAL HOSPITAL OF ST.BARTHOLOMEW.

" Audi alteram partem."

To the Editor of THE LANCET.

SIR,-A few months since public attention was directed tothe needs of St. Bartholomew’s Hospital by a conference atthe Mansion House between the Lord Mayor, the treasurer ofthe hospital, and the masters of the leading City guilds, withreference to the financial position of the institution. At that

meeting Lord Sandhurst, the treasurer, explained the exactstate of affairs, and the Lord Mayor read the following letterwhich he had received from Colonel Sir Arthur Bigge :-

Marlboroueh House, Pall Mall. S.W..April 6th, 1909.

My Dear Lord Mayor,-I am directed by the Prince of Wales toinform you that, as President of St. Bartholomew’s Hospital, he haslately had an opportunity of learning from Lord Sandhurst, thetreasurer, that there is now an annual deficit of about £12,000 in theworking of the hospital, due in a large measure to payment of intereston a capital debt of approximately .8170,000. His Royal Highnessdesires me to say that he has received this information with muchregret, as he would view with grave concern the necessity for in anydegree curtailing the work of what is the only general hospital in theCity boundaries. His Royal Highness sincerely trusts that funds maybe raised to prevent the possibility of such an unfortunate contingency.

Yours verv trulv.The Right Hon. the Lord Mayor. ARTHUR BIGGE.

For various reasons, but in particular as it was desired notto clash in any way with the annual collection of the Hos-

pital Sunday Fund, it was decided to postpone making ageneral appeal until the autumn. The time has now arrivedwhen it has become necessary to take steps to meet the

grave situation with which St. Bartholomew’s is faced, andwe desire to urge its unique claims to public sympathy andsupport.For nearly 800 years St. Bartholomew’s Hospital has

carried on, on its present site, a great work: firstly, inthe alleviation of the sufferings of the sick, maimed, anddiseased poor; and secondly, in the training of medicalpractitioners whose services in after life are of incalculablebenefit to humanity, rich and poor alike, all over the world.From time to time the accommodation of the hospital hasbeen increased to meet the demands upon it, and there arenow 680 beds. On an average 8000 patients are admitted toits wards in each year, while some 130,000 persons aretreated in the out-patients’ department. The hospital alsomaintains a convalescent home (7U beds), to which over

1000 patients are admitted annually. To carry on this great