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ligature of the hypogastric and ovarian veins after Tren-

delenburg’s plan, as an easy and innocent procedure and wellworthy of trial.

Dr. SPINELLI of Naples and Dr. MAZZUCCHI of Florencewere opposed to hysterectomy because of the present in-ability to distinguish the cases calling for it and becausethe measures now in use could accomplish as much as theoperation.

Dr. MoRISANI of Naples also recognised the difficulty ofselecting cases, since he did not think it possible to ascertainwith certainty in ’any given case that the infection ha notextended beyond the uterus. Of four patients operated uponin his clinic two had recovered, but this only proved that acertain proportion of women might be saved by the opera-tion who would otherwise die. The whole attention ofclinicians and pathologists should therefore be turned to

searching for the precise indications for performing hyster-ectomy. He believed the abdominal method to be the best.

Dr. FARG1S of Barcelona related two cases where hysterec-tomy seemed clearly indicated. In one of them it was

performed, in the other not. The termination was the samein both cases-namely, death.

Dr. PINARD of Paris said that he had hoped for enlighten-ment from the Congress on the question of the indicationsfor hysterectomy in puerperal cases, but that in so doing hehad experienced the only illusion which’ he had had sincecoming to Italy. He divided those who had spoken or. thesubject into two categories. The first of these consistedchiefly of obstetricians who regarded the indications withtimidity and hesitation and believed them to be turnishedonly by exceptional cases. In the other category were

the surgical gynaecologists, mostly younger men, who

thought that the operation should be performed frequentlyand at an early stage. All were agreed that it was

necessary where a putrefying placenta could not be removedin any other way (an extremely rare occurrence), wherethere was a sloughing fibroma, or where perforation of theuterus had taken place, especially in cases of abortion or

attempts at criminal abortion. But he confessed that hecould not understand the other two indications spoken of-namely, the existence of intoxication without infectionand the condition in which from the whole characterof the symptoms the case was judged to be desperate. As

long as clinical criteria were wanting and even bacterio-logical assistance failed he would counsel the young gynae-cologist to reserve the bistoury for cases of localised puerperalinfection and to stay his hand until further orders in theacute forms of puerperal cli4eae.

- Dr. DUDLEY of New York was even more emphatic, statingthat he believed the majority of United States obstetriciansto be with him in a radical opposition to hysterectomy inpuerperal infection. He had himself operated in a certainnumber of his cases, and had lost them, whilst he had savedall the others by the measures which he adopted by pre-ference-namely, ice on the abdomen, drainage of thefornices, and antiseptic irrigations.. He therefore consideredhysterectomy to be an unjustifiable procedure in puerperalfever.

Dr. LA ToRRF of Rome opposed the operation, placing hisfaith above all in curetting the uterus repeatedly in order toclean it out completely. He would resort to hysterectomyonly as ultima ratio when the woman was practicallycondemned to death.

Dr. LEOPOLD and Professor TREUB, replying to the variousspeakers, were satisfied with the discussion, which theythought had been useful, since it showed that the generalfeeling was in favour of operating only in exceptional case,and because it emphasised the continued need of prudence indealing surgically with puerperal fever.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8765 births and 4923deaths were registered during the week ending Nov. 8th.The annual rate of mortality in these towns, which hadbeen 17-4, 16-9, and 16 - 6 per 1000 in the three precedingweeks, rose again last week to 17’3 per 1000. In Londonthe death-rate was 17’1 per 1000, while it averaged 17’4per 1000 in the 75 other large towns. The lowest death-ratesin these towns were 62 in Hornsey, 7-6 in Leyton, 8’0in Aston Manor, 8’ 5 in Bournemouth, 9’ 0 in Willesden,

9-4 in Handsworth, 95 in East Ham, and 9.8 in New-port (Mon.) ; the highest rates were 22’2 in Sunderland,22’3 in Nottingham and in Barrow-in-Furne8s, 22.4 imNewcastle-on-Tyne, 22-5 in Preston, 22-8 in Cardiff, 23-1 1in Liverpool, and 36 6 in Bootle. The 4923 deaths inthese towns last week included 558 which were referred tothe principal infectious diseases, against 682. 604, and 576in the three preceding weeks; of these 558 deaths, 198resulted from measles, 113 from diarrhoea, 76 from diph-theria, 67 from scarlet fever, 54 from "fever" (princi-pally enteric), 48 from whooping-cough, and two from

small-pox. No death from any of these diseases was

registered last week in Hornsey, Tottenham, Brighton,Bournemouth, Reading, Ipswich, Coventry, Derby, Birken-head, Wallasey, Rochdale, Halifax, Rotherham, or West

Hartlepool; in the other towns they caused the highestdeath-rates in Hanley, Grimsby, Bootle, Salford, Hull, Gates-head, and Cardiff. The greatest proportional mortality frommeasles occurred in Bristol, Hanley, Bootle, Salford, Hull,South Shields, and Cardiff ; from scarlet fever in Bootle,St. Helens, Bolton, Burnley, and Newcastle-on-Tyne ; from

diphtheria in Rhondda ; from whooping-cough in Hanleyand Grimsby ; and from diarrhoea in Hanley, Bootle,Blackburn, Preston, Sunderland, and Tynemouth. The mor-tality from fever" showed no marked excess in any of thelarge towns. Two fatal cases of small-pox were registeredlast week in Merthyr Tydfil, but not one in any other of the76 large towns. The number of small-pox patients undertreatment in the Metropolitan Asylums hospitals, which hadbeen 28, 23, and 19 at the end of the three preceding weeks,had further declined to 14 at the end of last week ; no newcase of small-pox was admitted during the week, thenumbers having been four, one, and six in the threepreceding weeks. The number of scarlet fever cases inthese hospitals and in the London Fever Hospital atthe end of the week was 2900, against 2871, 2904,and 2869 at the end of the three preceding weeks;346 new cases were admitted during the week, against362, 362, and 349 in the three preceding weeks. Thedeaths referred to diseases of the respiratory organsin London, which had been 251, 291. and 298 in thethree preceding weeks, further rose last week to 332,but were 45 below the corrected average. Influenza wasreturned as the primary caue of 23 deaths in London lastweek, against 13. six, and 10 in the three preceding weeks.The causes of 54, or 1-1 per cent., of the deaths in the76 large towns last week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in West Ham, Bristol,Bolton, Salford, Hull, Cardiff, and in 45 other smallertowns ; the largest proportions of uncertified deaths were

registered in Liverpool, Rochdale, Preston, Rotherham, andSouth Shields.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the r’rincirtalScotch towns, which had been 18-0, 16-8, and 18-9per 1000, decreased again to 17’1 per 1000 during theweek ending Nov. 8th, and was slightly below themean rate during the same period in the 76 largeEnglish towns. The rates in the eight Scotch towns

ranged from 9 3 in Leith and 13’2 in Aberdeen to 19 - 3 inGlasgow and 28’ 1 in Perth. The 553 deaths in these townsincluded 21 which resulted from diarrhoea, 18 from whooping-cough, five from "fever," four from scarlet fever, three frommeasles, and three from diphtheria. In all, 54 deaths werereferred to these principal infectious diseases last week,against 56, 46, and 55 in the three preceding weeks. These54 deaths were equal to an annual rate of 1.7 per 1000,which was 0’3 per 1000 below the mean rate last weekfrom the same diseases in the 76 large English towns.The fatal cases of diarrhoea, which had been 24, 21, and18 in the three preceding weeks, rose again last week to 21,of which 11 were recorded in Glasgow, three in Edinburgh,three in Dundee, and three in Aberdeen. The deaths from

whooping-cough, which had been seven and 16 in the twopreceding weeks, further increased to 18 last week and in-cluded nine in Glasgow, four in Edinburgh, and three inPerth. The fatal cases of "fever," which had beemone and three in the two preceding weeks, further rose lastweek to five, of which four were registered in Glasgow.The deaths from measles, which had been two and five inthe two preceding weeks, declined again to three last week,and all occurred in Edinburgh. The deaths referred t<

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diseases of the respiratory organs in these towns, which hadbeen 116 and 146 in the two preceding weeks, further roselast week to 150, but were 12 below the number in the

corresponding period of last year. The causes of 24, or

more than 4 per cent., of the deaths registered in these

eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 30-0 and 23 - 9per 1000 in the two preceding weeks, rose again to 30’3

per 1000 during the week ending Nov. 8th. During the

past four weeks the death-rate has averaged 27’8 per 1000,the rates during the same period being 16’ 6 in London and15-8 in Edinburgh. The 220 deaths of persons belongingto Dublin registered during the week under notice were 46t.n excess of the number in the preceding week, and in-cluded 30 which were referred to the principal infectiousdiseases, against 35, 40, and 27 in the three preceding weeks ;of these, 16 resulted from measles, five from " fever," fourfrom scarlet fever, three from diphtheria, and two from Idiarrhoea, but not one from either small-pox or whooping-cough. These 30 deaths were equal to an annual rate of 4 - 1per 1000. the death-rates last week from the same diseasesbeing 1’5 in London and 1- 9 in Edinburgh. The fatal casesof whooping-cough, which had been 19. 20, and 16 in thethree preceding weeks, were again 16 last week. Thedeaths from "fever," which had been one and three in thetwo preceding weeks, further rose last week to five. Thefatal cases of diphtheria, which had been two and three inthe two preceding weeks, further increased to four last week.The deaths from diarrhoea, which had been 11, 14, and threein the three preceding weeks, further declined last week totwo. The 220 deaths in Dublin last week included 45 ofchildren under one year of age and 44 of persons agedupwards of 60 years ; the deaths of infants correspondedwith the number in the preceding week, while the deaths ofelderly persons showed a marked increase. Four deathsfrom violence and seven inquest cases were registered ;and 84, or more than 38 per cent., of the deaths occurred inpublic institutions. The causes of seven, or more than 3per cent" of the deaths registered in Dublin last week werenot certified.

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VITAL STATISTICS OF LONDON DURING OCTOBER, 1902.IN the accompanying table will be found summarised

complete statistics relating to sickness and mortality in theCity of London and in each of the metropolitan boroughs.With regard to the notified cases of infectious diseases it

appears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 10’ 0 per 1000 ofthe population, estimated at 4,579,107 persons in themiddle of the year. In the three preceding months the rateshad been 10’0, 8-5, and 9-1 per 1000 respectively. Therates were considerably below the average in Paddington,Kensington, Chelsea, City of Westminster, Hampstead,Holborn, and Woolwich, while they showed the largestexcess in Fulham, St. Pancras, Southwark, Battersea,Wands worth, and Deptford. The prevalence of small-

pox last month showed a further considerable declinefrom that recorded in recent months ; among the variousmetropolitan boroughs this disease was proportionallymost prevalent in Hammersmith, Hackney, Stepney, andCamberwell. The Metropolitan Asylums hospitals con-

tained 19 small-pox patients at the end of last month,against 305, 109, and 42 at the end of the three pre-ceding months ; the weekly admissions averaged three,against 45, 19, and seven in the three preceding months.The prevalence of scarlet fever during October showed amarked increase over that recorded in the precedingmonth ; the greatest proportional prevalence of this diseaseoccurred in St. Pancras, Southwark, Lambeth, Battersea,Wandsworth, and Deptford. The number of scarlet feverpatients under treatment in the Metropolitan Asylumshospitals, which had been 2515, 2615, and 2656 at theend of the three preceding months, had further increasedto 2820 at the end of last month ; the weekly admissionsaveraged 358, against 322, 292, and 330 in the three pre-ceding months. The prevalence of diphtheria also showed aconsiderable increase over that recorded in the precedingmonth ; among the various metropolitan boroughs this diseasewas proportionally most prevalent in Fulham, Hackney,Bethnal Green, Wandsworth, Camberwell, and Deptford.

There were 941 diphtheria patients under treatment in theMetropolitan Asylums hospitals at the end of October,against 1008, 1013, and 981 at the end of the three

preceding months ; the weekly admissions averaged 149,against 165, 145, and 142 in the three preceding months.Enteric fever showed a slightly decreased prevalencelast month, as compared with that recorded in the

preceding month ; the greatest proportional prevalenceof this disease occurred in Hackney, Finsbury, Shore-ditch, Bethnal Green, Stepney, Bermondsey, and Green-wich. The number of enteric fever patients in the

Metropolitan Asylums hospitals, which had been 289,281, and 359 at the end of the three precedingmonths, had further risen to 401 at the end of last month ;the weekly admissions averaged 59, against 49, 38, and 63in the three preceding months. Eryipetas was propor-tionally most prevalent in Stoke Newington, Hackney,Finsbury, Shoreditch, Bethnal Green, Southwark, and Ber-mondsey. The 39 cases of puerperal fever notified duringthe month included seven in Stepney, five in Shoreditch, andtwo each in Paddington, St. Marylebone, Islington, Fins-

bury, Camberwell, Deptford, and Lewisham.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various metropolitanboroughs, the deaths occurring in public institutions

having been distributed among the various boroughsin which the deceased persons had previously resided.

During the four weeks ending Nov. 1st the deaths of7025 persons belonging to London were registered, equalto an annual rate of 16’0 per 1000, against 13’8, 14’3,and 16’4 per 1000 in the three preceding months. Thelowest death-rates in the various metropolitan boroughslast month were 10’2 in Hampstead, 10’8 in Wands-worth, 12 4 in Battersea, 12-5 in Stoke Newington, 12’7in Paddington, and 13 3 in Kensington and in Hackney;and the highest rates 19 3 in Bethnal Green and in Stepney,19-5 in Poplar, 20’0 0 in Southwark, 21 9 in Finsbury, 22-7 inBermondsey, and 22-9 in Shoreditch. The 7025 deathsfrom all causes included 876 which were referred to theprincipal infectious diseases ; of these one resulted fromsmall-pox, 139 from measles, 51 from scarlet fever, 110 fromdiphtheria, 111 from whooping-cough, 90 from enteric fever,and 374 from diarrhoea. The lowest death-rates from thesediseases were recorded in Paddington, City of Westminster,Hampstead, Stoke Newington, City of London, andGreenwich; and the highest rates in Shoreditch, Poplar,Southwark, Bermondsey, Camberwell, and Deptford. Thefatal case of small-pox belonged to Camberwell. The139 deaths from measles were 20 in excess of the

average number ; among the various metropolitan boroughsthis disease was proportionally most fatal in Fulham,Shoreditch, Poplar, Southwark, Bermondsey, Camberwell,and Deptford. The 51 fatal cases of scarlet fever showeda decline of 44 from the average number in the corres-

ponding periods of the 10 preceding years ; this diseaseshowed the highest proportional mortality in Fulham, St.

Marylebone, Finhbury, Poplar, Battersea, and Camberwell.The 110 deaths from diphtheria were 161 below thecorrected average number ; among the various metropolitanboroughs this disease was proportionally most fatal inHammersmith, Fulham, St. Pancras, Bethnal Green,Bermondsey, Camberwell, and Woolwich. The 111 fatalcases of whooping-cough were 34 in excess of the averagenumber in the corresponding periods of the 10 precedingyears ; this disease showed the highest proportional mortalityin Hammersmith, St. Pancras, Finsbury, Shoreditch, Stepney,Poplar, and Southwark. The 90 fatal cases of enteric feverwere slightly above the corrected average number ; amongthe various metropolitan boroughs this disease was propor-tionally most fatal in Chelsea, St. Pancras, Shoreditch,Poplar, and Deptford. The 374 deaths from diarrhoea wereconsiderably in excess of the average number in the cor-responding periods of the 10 preceding years ; this diseaseshowed the highest proportional mortality in Hammersmith,Shoreditch, Bermondsey, Deptford, Lewisham, and Wool-wich. In conclusion, it may be stated that the aggregatemortality in London last month from these principal infec-tious diseases was 1’ 4 per cent. above the average.

Infant mortality in London during October, measured

by the proportion of deaths of children under one year ofage to registered births, was equal to 154 per 1000. Thelowest rates of infant mortality were recorded in Fulham,Chelsea, the City of Westminster, Hampstead, StokeNewington, and Wandsworth ; and the highest rateo im

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Kensington, the City of London, Shoreditch, Bethnal Green,Poplar, and Southwark.

THE SERVICES.

ROYAL Navy MEDICAL SERVICE.

SURGEON ARTHUR GASKELL has been specially promotedto the rank of Staff Surgeon in His Majesty’s Fleet for con-spicuous professional merit. Dated Oct. 31st, 1902.

Staff Surgeon Gaskell entered the service as Surgeon onNov. 14th, 1893.The following appointments are notified :-Fleet Sur-

geon E. J. Biden to the Vernon. Staff Surgeon J. Sugrue tothe Venerable. Surgeons : 0. Mills to the Venerable andE. A. Penfold to the Apollo.

ROYAL HORSE GUARDS.

Captain John H. Power, from Royal Army Medical Corps,to be Surgeon-Captain. Dated Oct. 15th, 1902.

ROYAL ARMY MEDICAL CORPS.Lieutenant--Colonel A. Ashby, retired pay, has arrived at

Strensall for duty. Major W. H. Pinches has arrived in theHome District for duty. Captain K. M. Cameron joinsshortly at Woolwich for duty. Captain L. N. Lloyd, D.S.O.is appointed to the Irish Guards as an attached medicalofficer. The following tour-expired officers will return to

England during the trooping season of 1902-03, and will bedetailed for duty with troops on the homeward voyages : Lieu-tenant-Colonel Swayne, D.S.O., Lieutenant-Colonel Wolseley,Lieutenant-Colonel - Rainsford, C. 1. E , Lieutenant-ColonelKirkpatrick, Lieutenant-Colonel Routh, Lieutenant-ColonelFlanagan, Lieutenant-Colonel Watson, Lieutenant-ColonelO’Sullivan, Lieutenant-Colonel Kay, Lieutenant-ColonelHeffernan, Lieutenant-Colonel Laffan, Lieutenant-ColonelNoding, Lieutenant-Colonel Jencken, and Lieutenant-Colonel Morris ; Major Bartlett, Major Deane, MajorV. E. Hunter, Major Riordan, Major Donnet, MajorHaines, Major Rowan, Major Marks, and Major Trotter ;Captain Jackson, Captain Thomson, Captain Taylor,Captain Keble, Captain Killery, Captain Master, CaptainDansey-Browning, Captain Clark, Captain Barnet, CaptainBoyle, Captain Fleury, Captain Fox, Captain Green,Captain Morgan, Captain Silver, Captain Buist, CaptainDove, Captain Howell, Captain Lawson, Captain Steel,and Captain Staddon.

IMPERIAL YEOMANRY.Herts : Surgeon-Captain L. Drage to be Surgeon-Major.

Dated Nov. 8th, 1902. Suffolk (The Duke of York’s OwnLoyal Suffolk Hussars) : Surgeon-Lieutenant-Colonel A.

Cooper resigns his commission, with permission to retainhis rank and to wear the uniform of the regiment on Iretirement. Dated Nov. 8th, 1902.

HONOURABLE ARTILLERY COMPANY OF LONDON.

Surgeon-Captain P. E. F. McGeagh to be Surgeon-Major.Dated Oct. 28th, 1902

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Major G. Middlemiss to be Surgeon-Lieutenant-Colonel. Dated Nov. 12th, 1902.

VOLUNTEER CORPS.

Rifle: lst Volunteer Battalion the King’s (LiverpoulRegiment) : George Burton Robinson to be Surgeon-Lieu-tenant. Dated Nov. 8th, 1902. 2nd (Earl of Chester’s)Volunteer Battalion the Cheshire Regiment : The appoint-ment of Andrew MacLennan to be Surgeon-Lieutenant,which was announced in the London Gazette of July25th,1902, bears date July 19th, 1902. 3rd Volunteer Battalionthe Manchester Regiment: Surgeon-Lieutenant A. Hiltonto be Surgeon-Captain Dated Nov. 8th, 1902 7th (Clack-mannan and Kinross) Volunteer Battalion Princess Louise’s(Argyll and .Sutherland Highlanders) ; Surgeon-Lieutenant-Colonel J. H. Hay resigns his commission. Dated Oct. 18th,1902.

THE NATIONAL HEALTH AND THE ARMY. I

Major-General Sir Frederick Maurice’s recent address at z’

the Civic Society of Glasgow (vide THE LANCET, Nov. 1st,1902, p. 1220), affords a fitting opportunity for callingattention to a matter which, as it seems to us, is of

some importance. From a national defence and armypoint of view it is obviously important that our re-

cruiting system should entail as little wastage as

possible and that as many of our would-be soldiersshould be secured as practicable. Among the numberof young men offering themselves for enlistment itis well known that there are many who are found on

medical examination to be suffering from such physicalbut remediable disabilities as varicose veins, varicoceles,and hernias. Assuming these men to be in other respectseligible recruits, it is important that they should be

kept under the eye of the military authorities with a

view to their future enlistment, subject to their givingconsent in the meantime to the necessary operationsbeing performed for their cure. And this view is,we believe, to some extent already recognised andacted upon, but instead of the necessary work inthis respect being thrown upon the military institutions ofthe Government it largely falls, we believe, upon civilgeneral hospitals and their overworked surgical staffs to

carry it out. If so, it certainly seems to us thatcivil institutions should be relieved of work of thiskind and for many reasons. In the first place, itwas never intended by the charitable that any part oftheir donations to hospitals should be expended on behalfof the Government and possibly to the disadvantage ofthe ordinary hospital patient. The professional work ofa large civil hospital is now so laborious that the sur-

gical staff have to struggle manfully with it in orderto accomplish it. Calls upon their time and energyin one direction can only be made at the expenseof some other direction, such as that of the clinical

teaching of the hospital students, for example. Moreover,beds have to be occupied by this class of cases to the

possible disadvantage of ordinary patients and with a

limitation of the teaching usefulness of the hospital. Theremedy for all this is to be found in the provision and estab-lishment of hospital accommodation by the Government forthis and other purposes. Such a provision on its part would,while relieving the surgical staffs of civil hospitals, at thesame time also secure practical opportunities for surgicalwork on the part of officers of the army medical service. We

suggest, too, that a hospital of this kind might possiblyenable accommodation to be extended to other branches ofthe Government services and might embrace the metropolitanpolice, for example. The War Office has started a MedicalStaff College in London and it now remains for the Govern-ment, in order to complete its scheme, to add to it a

hospital.HEALTH OF THE JAPANESE NAVY.

Baron Saneyoshi, F. R. C. S. Eng., chief of the Bureau ofMedical Affairs of the Japanese Navy, in his report on thesanitary conditions of the Imperial navy of Japan for theyear 1899, states that the mean daily force in the service forthat year was 19,540 persons, an increase of 1114 as com-

pared with the preceding year. The number of cases

of disease and injury reported shows a decrease of 76, inspite of there being, in comparison with the precedingyear, some increase of force as a result of the ex-

pansion of the Japanese navy. On the other hand, thenumber of days’ sickness exhibits an increase of 44,497 dayswhen contrasted with the preceding year. This increase isattributable to the appearance of many ca’-es of granularconjunctivitis and venereal diseases. The ratio per 1000 ofcases, deaths, and invalidings of force shows a decrease,probably the result of the general improvement of sanitaryconditions. The number cf ca-es of venereal diseases

reported was 4894. the ratio being 250- 46 per 1000 of force,I which exhibits an increase of 24’10 per 1000 as compared

with the preceding year. There was no case of death butfour men were invalided. The cases in this group of diseaseshave increased year by year and the total number during the

L year under notice was more than one-fourth of that over allL the other diseases and injuries. The principal diseases of. this class were 1464 cases of gonorrhoea and its sequelse,. 1412 cases of soft chancre, 1039 cases of bubo, 678 cases

of secondary and tertiary syphilis, and 301 cases of hardchancre.

QUEEN ALEXANDRA’S S IMPERIAL MILITARY NURSINGSERVICE.

; The regulations for admission to the Queen Alexandra’s, Imperial Military Nursing Service have been issued by ther War Office in the form of a pamphlet of 12 pages. Can-E didates for appointments, who must be of British parentage