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Thomas Hepplewhite, Ernest James Maxwell, JohnOwnsworth Garland, and temporary Honorary LieutenantFrederick William Watkyn-Thomas.Dated Oct. 16th: Francis James Browne, Thomas Muir

Crawford, George Stevenson Gordon. Stevenson PlumbeMoore, and William Beatson Drummond.Dated Oct. 17th: John Charsley Mackwood and James

Joseph Reynolds.Dated Nov. 10th : Alexander Waugh.

The undermentioned to be temporary Honorary Lieu-tenants :-

Dated July 24th : James Reid Dick, whilst employedwith No. 1 British Red Cross (Duchess of Westminster’s)Hospital.Dated Oct. 21st: James Stuart Leslie.

Robert Joel Cazalet Donty to be temporary HonoraryLieutenant whilst serving with No. 2 British Red CrossHospital (dated Oct. 24th).Temporary Honorary Captain Mark C. Gardner relin-

quishes his commission on ceasing to be employed with theAustralian Voluntary Hospital (dated Oct. 3rd).Temporary Honorary Lieutenant Andrew F. H. Rabagliati

relinquishes his commission on ceasing to be employed withNo. 4 British Red Cross Hospital (dated Oct. 24th)..Temporary Lieutenant Albert Turner relinquishes his

<commission (dated Sept. 19th).The appointment to a temporary Lieutenancy of Fraser B.

Gurd is antedated to May 25th.OVERSEA CONTINGENTS : CANADIAN ARMY MEDICAL CORPS.

B. A. Sandwith to be temporary Captain, R.A.M.C. (datedOct.14th).The undermentioned Lieutenants to be temporary

Lieutenants, R.A.M.C.:-Dated Oct. 4th: Thomas John Simpson, John George

Moore Sloane, Cecil John Sparrow, Michael JosephCasserley, and Arthur Clifford Johnston.

SPECIAL RESERVE OF OFFICERS.

Royal Army Medical Corps.The undermentioned Lieutenants to be Captains : Gavin

Young, Peter MacCallum, James S. Robinson, RobertForgan, James O’Brien, Forster H. B. Norrie, Robert B..Myles, Gilbert W. Rose, Douglas Cran, Robert McKinlay,William B. Postlethwaite, John 0. Reid, Patrick C. MacRae,John McC. Orme, Ian C. Mackay, Henry P. Crow, WilliamB. Cathcart, Frederick E. Feilden, Neville H. Linzee, RobertP. S. Mason, Austin A. Clarke, Thomas Young, John F.Lyons, James G. Wilson, Alfred T. Logan, Raymond F.Pinson, and Robert Taylor.

TERRITORIAL FORCE.

Royal Army Medical Corps.Highland Mounted Brigade Field Ambulance: Ronald

William Cadell Macdonald (late Surgeon-Lieutenant, 8thVolunteer Battalion, The Royal Scots) to be Captain.South Midland Field Ambulance: Lieutenant Edmund

Whichello to be Captain.Wessex Field Ambulance : Captain Harold C. Adams to be

temporary Major.’

Eastern General Hospital: Captain Charles H. Benham isseconded for duty with a general hospital.Northern General Hospital: Captain Wilfred E. Alderson,

from Attached to Units other than Medical Units, to beCaptain, whose services will be available on mobilisation.Captain Arthur A. Pratt is seconded for duty with a CasualtyClearing Station.London Sanitary Company: John Inglis to be Lieutenant.East Lancashire Casualty Clearing Station: Captain

Thomas B. Wolstenholme to be temporary Major.Northumbrian Casualty Clearing Station: The under-

mentioned Lieutenants to be Captains: Fred Phillips andStanley McCoull.East Lancashire Field Ambulance: Frederic William

Marsden (late Major, East Lancashire Brigade, Royal FieldArtillery) to be Major.London Field Ambulance: Captain Edward P. Minett is

restored to the establishment. Lieutenant Robert W. Baronresigns his commission on account of ill-health.Southern General Hospital: To be Captains, whose

services will be available on mobilisation: Eric DanversMacnamara and Gathorne R. Girdlestone.

. London Casualty Clearing Station: Lieutenant Cecil A.Robinson to be Captain.Lowland Field Ambulance: Lieutenants to be Captains :

Frank M. Robertson and William J. Scade.Highland Casualty Clearing Station: Alexander Fraser

MacBean to be Lieutenant.Welsh Border Mounted Brigade Field Ambulance: William

Morgan to be Lieutenant.London (City of London) Field Ambulance: Captain

Arthur D. J. B. Williams relinquishes his commission. ’

Attached to Units other than Medical Units.-LieutenantLeonard H. H. Boys to be Captain.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns with populationsexceeding 50,000 persons at the last Census, 7609 birthsand 4945 deaths were registered during the week endedSaturday, Nov. 6th. The annual rate of mortality inthese towns, which had been 139, 133, and 13’8 per 1000 inthe three preceding weeks, rose in the week under notice to14-2 per 1000 of their aggregate population, estimated at18,136,180 persons at the middle of last year. During the firstfive weeks of the current quarter the mean annual death-ratein these towns averaged 14-0, against 14-6 per 1000 in London.The annual death-rate last week ranged from 4-0 in Ilford,5-2 in Wimbledon, 7-0 in Walthamstow, 7’2 in Wallasey, and8-1 in Southend-on-Sea, to 19-0 in Middlesbrough, 20-1 inBlackpool, 23-3 in Walsall, 24-5 in Barrow-in-Furness, and26-1 in Barnsley.The 4945 deaths from all causes were 135 in excess of the

number in the previous week, and included 444 which werereferred to the principal epidemic diseases, against numbersdeclining from 973 to 451 in the five preceding weeks. Ofthese 444 deaths, 226 resulted from infantile diarrhoealdiseases, 71 from diphtheria, 57 from measles, 44 fromwhooping-cough, and 23 each from scarlet fever and entericfever, but not one from small-pox. The mean annual death-rate from these diseases was equal to 1-3 per 1000, andcoincided with that recorded in the previous week. Thedeaths of infants (under 2 years) from diarrhoea andenteritis, which had steadily declined from 808 to 255 inthe five preceding weeks, further fell to 226 and included 56in London, 20 in Liverpool, 10 in Birmingham, 9 in Man-chester, and 7 each in West Ham and Walsall. The deathsreferred to diphtheria, which had been 61, 50, and 73 in thethree preceding weeks, fell to 71, of which 19 occurred inLondon, 6 in Stoke-on-Trent, and 3 each in Plymouth,Barrow-in-Furness, Sheffield, and Hull. The fatal cases ofmeasles, which had been 23, 40, and 37 in the three pre-ceding weeks, rose to 57 last week; 7 deaths were registeredin Gloucester, 5 each in Nottingham and Sheffield, and4 each in Birmingham and Barnsley. The deaths attributedto whooping-cough, which had been 35, 31, and 36 in thethree preceding weeks, further rose to 44, and included 10in London, 7 in Liverpool, and 3 each in East Ham andBirmingham. The deaths referred to scarlet fever, whichhad been 21, 26, and 25 in the three preceding weeks, fellto 23, of which 9 occurred in London, 3 in Liverpool, and2 in Birmingham. The fatal cases of enteric fever, whichhad been 12, 11, and 25 in the three preceding weeks, fell to23, and included 2 each in London and Southampton.The number of scarlet fever patients under treatment in

the Metropolitan Asylums Hospitals and the London FeverHospital, which had been 3014, 3110, and 3110 at the end ofthe three preceding weeks, fell to 3066 on Saturday last; 344new cases were admitted during the week, against 453,462, and 378 in the three preceding weeks. These hospitalsalso contained on Saturday last 1624 cases of diphtheria, 72of measles, 52 of enteric fever, and 6 of whooping-cough,but not one of small-pox. The 1244 deaths from all causesin London were 18 in excess of the number in the previousweek and corresponded to an annual death-rate of 14’4per 1000. The deaths referred to diseases of the respiratorysystem, which had been 169, 187, and 216 in the three pre-ceding weeks, further rose to 265 in the week under notice,and were 72 above the number recorded in the correspondingweek of last year.Of the 4945 deaths from all causes in the 96 towns, 209

resulted from different forms of violence and 396 were thesubject of coroners’ inquests, while 1436 occurred in publicinstitutions. The causes of 49, or 1-0 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest. All the causes ofdeath were duly certified in London and in its 14 suburbandistricts, in Manchester, Leeds, Bristol, Bradford, Newcastle-on-Tyne, and in 56 other smaller towns. Of the 49 uncertifiedcauses of death, 10 were registered in Birmingham, 8 inLiverpool, 5 in Gateshead, 3 each in Southport and SouthShields, and 2 each in Stoke-on-Trent, Blackpool, Sheffield,Hull, and Darlington.

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HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns with an aggregate popu-lation estimated at 2,345,500 persons at the-’ middle ofthis year, 1022 births and 726 deaths were registeredduring the week ended Saturday, Nov. 6th. The annualrate of mortality in these towns, which had been 15’5,15’7, and 16’2 per 1000 in the three preceding weeks,fell to 16-1 per 1000 in the week under notice. Duringthe first five weeks of the current quarter the meanannual death-rate in these towns averaged 16-0, against

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14-0 per 1000 in the large English towns. The annualdeath-rate last week ranged from 6’1 in Falkirk, 10’3 inPerth, and 11’3 in Kilmarnock, to 17’8 in Paisley, 18’0 inGreenock, and 22-0 in Leith.The 726 deaths from all causes were 1 fewer than the

number in the previous week, and included 61 which werereferred to the principal epidemic diseases, against numbersdecreasing from 102 to77 in the four preceding weeks. Ofthese 61 deaths, 18 resulted from infantile diarrhoealdiseases, 15 from measles, 12 from scarlet fever, 9 fromdiphtheria, 4 from whooping-cough, and 3 from entericfever, but not one from small-pox. The mean annualdeath-rate from these diseases was equal to 1’4, against 1’3per 1000 in the large English towns. The deaths of infants(under 2 years) from diarrhoea and enteritis, which haddeclined from 54 to 25 in the four preceding weeks, furtherfell to 18, and included 6 in Dundee, 4 in Glasgow, and2 each in Edinburgh, Aberdeen, and Clydebank. The deathsreferred to measles, which had increased from 6 to 20in the six preceding weeks, fell to 15, of which 6 occurredin Glasgow, 3 in Greenock, and 2 each in Edinburghand Ayr. The fatal cases of scarlet fever, which had been16, 18, and 14 in the three preceding weeks, fell to 12 lastweek, and comprised 9 in Glasgow, 2 in Aberdeen, and 1 inEdinburgh. The deaths attributed to diphtheria, whichhad been 8, 9, and 14 in the three preceding weeks, fellto 9, of which 5 were registered in Glasgow and 2 each inEdinburgh and Aberdeen. The 4 deaths referred towhooping-cough, of which 2 were registered in Aberdeen,were slightly in excess of the average in recent weeks. The3 fatal cases of enteric fever occurred in Glasgow.The deaths referred to diseases of the respiratory system,

which had steadily increased from 56 to 158 in the ninepreceding weeks, fell to 150 in the week under notice,but were 46 above the number registered in the corre-

sponding week of last year. The deaths from violencenumbered 32, against 24 and 33 in the two preceding weeks.

HEALTH OF IRISH TOWNS.

In the 27 town districts of Ireland, with an aggregatepopulation estimated at 1,212,380 persons at the middleof this year, 540 births and 367 deaths were registeredduring the week ended Saturday, Nov. 6th. Theannual rate of mortality in these towns, which hadbeen 14-8, 16-0, and 16-9 per 1000 in the three precedingweeks, fell to 15-8 per 1000 in the week under notice.During the first five weeks of the current quarter themean annual death-rate in these towns averaged 15-9,against corresponding rates of 14-0 and 16-0 per 1000 in theEnglish and Scotch towns respectively. The annual death-rate last week was equal to 15-6 in Dublin (against 14-4 inLondon and 17-1 in Glasgow), 15-8 in Belfast, 16’3 in Cork,24-0 in Londonderry, 6-8 in Limerick, and 11-4 in Waterford,while in the 21 smaller towns the mean death-rate was 16-6per 1000.The 367 deaths from all causes were 26 fewer than the

number in the previous week, and included 27 which werereferred to the principal epidemic diseases, against 53 and51 in the two preceding weeks. Of these 27 deaths, 15resulted from infantile diarrhoeal diseases, 4 from scarletfever, 3 from diphtheria, 2 each from measles and whooping-cough, and 1 from enteric fever, but not one from small-pox. The mean annual death-rate from these diseaseswas equal to 1-2, against corresponding rates of 1-3 and1-4 per 1000 in the English and Scotch towns respec-tively. The deaths of infants (under 2 years) fromdiarrhoea and enteritis, which had been 29. 36, and 23in the three preceding weeks, further fell to 15, andincluded 4 each in Dublin and Belfast and 2 each in Traleeand Queenstown. The deaths referred to scarlet fever,which had been 3, 3, and 8 in the three preceding weeks,fell to 4 last week, and comprised 3 in Belfast and 1 inCork. The 3 fatal cases of diphtheria were registered inDublin, Belfast, and Lisburn respectively ; those ofwhooping-cough in Ballymena; those of measles in Dublinand Londonderry; and that of enteric fever in Dundalk.The deaths referred to diseases of the respiratory system,

which had been 42, 60, and 53 in the three precedingweeks, rose to 65 in the week under notice. Of the 367deaths from all causes, 124, or 34 per cent., occurred inpublic institutions, and 9 resulted from violence. Thecauses of 15, or 4-1 per cent., of the total deaths were notsertined either by a registered medical practitioner or

by a coroner after inquest; in the large English townsthe proportion of uncertified causes did not exceed1-0 per cent.

i

CORNISH CENTENARIANS.-Mrs. E. H. Selley, ofGloucester, born at Lawhitton, Cornwall, and Mrs. Page, ofRochester, born at Launceston, Cornwall, both celebratedlast week the 100th anniversary of their birthday.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Artet’ial Intubation.WOUNDS of large arteries require ligature, which

implies immediate suppression of the circulationin the whole limb or organ supplied by the vessel.Such sudden suppression may give rise to gangreneof the limb requiring secondary amputation or tograve functional disturbance-e.g., of the brain.To avoid these accidents M. Tuffier has devised amethod which he calls " arterial intubation." Itconsists in uniting the divided ends of the vesselby a special tube which allows the circulation tocontinue for some days; the suppression beinggradual, trouble is avoided. The difficulty lies inpreventing the blood from clotting in the tube soplaced, and to this end M. Tuffier employs instru-ments of approved value in transfusion. It isknown that very thin-walled silver tubes, dippedin boiling paraffin wax so that a thin layer adheres,permit the circulation of blood through them with.out clotting at all or only very slowly. In Carrel’smethod of end-to-end anastomosis of blood-vessels’liquid vaseline is used for a similar purpose. In sup-port of this new method, which may have abundantapplication in war surgery, M. Tuffier reported tothe Academy of Medicine the case of a man with atransverse wound of the elbow in whom the distalsegment of the limb was cold and livid withouttrace of circulation. Eight and a half hoursafter the injury, a relatively long time, circula-tion was re-established by means of a verynarrow paraffin tube, 2 mm. in diameter, unitingthe brachial with the radial artery. The radial

pulse was perceptible for ten hours and the forearmand hand recovered their warmth. Three dayslater the tube was removed. Success in this casewas only partial on account of the narrowness ofthe tube employed and the relatively long timebetween the injury and the intubation, but only apart of the hand became gangrenous.

Intensive Treatment of Infectious S,yphibides inthe Army.

M. Bernheim drew attention in the Paris MedicalSociety to the necessity of reducing the time ofstay in hospital in the case of infectious syphiliticaffections. M. Bernheim’s technique is as follows.Each day an injection is given of mercuricbenzoate (in 1 per cent. solution) or of biniodidein a dose of 3 centigrammes. To aid the action ofthe mercury and hasten its elimination the patientdrinks daily a glass of sulphur water and takes asulphur bath every third day. He is allowed anextra ration of a litre of milk. During each mealhe takes a pilule containing 1 milligramme each ofarsenious acid and sulphate of strychnine. Heuses a toothbrush with powder of mentholatedchalk, and the gums are painted daily with chromicacid 1 : 50. During this intensive cure the patientis carefully watched and the urine examined everysixth day. The local lesions are submitted toactive treatment. The chancres are exposed todry heat by approaching a flat thermo-cautery andthen powdered with calomel. Mucous patches arepainted successively with silver nitrate 1 : 10 andchromic acid 1 : 15, and papular syphilides coveredwith Vigo plaster.Nov. 8th.

1 See THE LANCET, Oct. 3rd, 1914, p. 836.