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sanitary authority "to set up a second infirmary for the ’’

.chronic and practically hopeless cases that now find their 7

way into the union infirmary." Such cases should, he thinks, ’,be dealt with by the guardians. But apart from this there (does not seem to be a suitable building at the fever hospital ifor the purpose of treating consumptive patients, and Dr. aWilloughby thinks that even if there were a suitable buildingthe presence of consumptive patients might from a senti-mental standpoint injure the present popularity of the ’institution. The other objection which he raises seems to the ’’us to have even greater force-i.e., that the consumptive Jpatients would have a prejudice against the hospital from 1the fact that the acute exanthemata are treated there.

Plympton St. Mary Rural -Distq-ict.-Alr. S. Noy Scottspeaks appreciatively of the work of the Didworthy iSanatorium for Consumption which has recently been opened

’

near Brent for the consumptive poor of Devonshire. He 4does not, however, speak enthusiastically as to the results ofsanatoriums generally. As he observes, it is impossible tosegregate into these institutions even a small proportion of thelarge number of persons who are suffering from pulmonary 1tuberculosis and it seems, he thinks, " almost foolish to

expect that the isolation and treatment of a few of thesepeople for a few months will produce any marked effect uponthe prevalence of the disease or reduce the death-rate in anyway proportionate to the cost which such treatment in-volves." He sees, too, great difficulty in continuing to pro-vide the discharged patient with anything approaching theabundant food which has formed such an essential part ofthe sanatorium treatment.

The 3oroe<yla of To7,qva?f.-A very useful and encouragingmethod of inspecting the dairies, cowsheds, and milkshops inthis borough was introduced by the late Mr. P. Q. Karkeek,the former medical officer of health, and is continued by Dr.Thomas Dunlop, his successor. Twice yearly a systematicinspection is made, not only of the dairies and cowshedsin the borough, but also of all the dairy farms outsidethe borough limits which send their milk into the borough.As an outcome of these inspections a register is compiled’which is printed in the form of a bill and posted upthroughout the town, copies being forwarded to all the

- dairymen and farmers ,concerned. These bills, which may beregarded as a species of informal licence, are in force forsix months, when another inspection takes place. Thefarmers apparently welcome the inspections and endeavour tocarry out the suggestions made, and a very material improve-ment in the former .condition of affairs appears to have taken

,place. But Dr. Dunlop thinks that sufficient care is not

taken in the milking of the cows and he states that whensome of the milk is treated in a separator the sedimentbetrays signs of material of which the healthy udder isinnocent. Proper means for washing the hands of themilkers are rarely seen and the milkers do not wear

overalls. This is not satisfactorv and we should like tosee the facts stated on the bill. The cow’s udders and themilker’s hands should be washed before the operation, themilk should be strained immediately after milking, and itshould then be cooled. All the utensils should be sub-

sequently scalded or preferably steamed. The Torquaymethods are admirable so far as they go but we cannot helpthinking that the informal licences in vogue may provesomewhat a false security if, that is to say, the bills whichare posted are intended to imply freedom from the likelihoodof specific contamination. We hope that Dr. Dunlop will.continue to deal with this very important subject in hisfuture annual reports and that he will record annually thefurther progress which he has been able to make. TheTorquay example might be usefully followed in other places.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8896 births and 6639deaths were registered during the week ending August 20th.The annual rate of mortality in these towns, which hadbeen 16-4, 19-8, and 22 1 per 1000 in the three precedingweeks, further rose last week to 22’ 7 per 1000. In Londonthe death-rate was 21’6 per 1000, while it averaged23’2 in the 75 other large towns. The lowest death-rates in these towns were 7’ 8 in King’s Norton, 9’ 6 inHandsworth (Staffs.), 10- 5 in West Hartlepool, 10- 7 in Black-burn, 11’ 8 in Hastings and in Devonport, 12-0 0 in Burton-on-Trent, and 12 1 in Bournemouth ; while the highest rates

vere 31-0 0 in Hanley, 31-4 in Tynemouth, 31-8 8 in St.lelens, 32 1 in Salford, 32 3 in Tottenham, 33-4 in York,!4 - 0 in Wigan, 34-6 6 in Bootle, and 39’ 1 in Liverpool. Thei639 deaths in these towns last week included 2842 which wereeferred to the principal infectious diseases, against 1255,059, and 2710 in the three preceding weeks ; of these!842 deaths, 2538 resulted from diarrhoea, 130 from measles,’9 from whooping-cough, 39 from diphtheria, 30 from’ fever " (principally enteric), and 26 from scarlet fever, butiot any from small-pox. The lowest death-rates last weekrom these principal infectious diseases were recorded in

castings, Bournemouth, Devonport, Burton-on-Trent, King’sNorton, Stockton-on-Tees, West Hartlepool, and Southshields ; and the highest rates in Tottenham, East Ham,xrimsby, Birkenhead, Liverpool, Bootle, York, Hull, andhondda. The greatest proportional mortality from measles)ccurred in Blackburn, Huddersfield, Halifax, Bradford,md Rhondda; and from diarrhoea in Tottenham, West3am, East Ham, Leyton, Reading, Grimsby, Liverpool,3ootle, Wigan, York, and Hull. The mortality fromeach of the other principal infectious diseases showedio marked excess in any of the large towns; and nofatal case of small-pox was recorded either in London)r in any of the 75 large provincial towns. Thelumber of small-pox patients under treatment in the Metro-politan Asylums hospitals, which had been 46, 32, and 21 atthe end of the three preceding weeks, had further declinedj0 18 at the end of last week ; two new cases were admittedluring the week, against seven, two, and none in the threepreceding weeks. The number of scarlet fever cases in;hese hospitals and in the London Fever Hospital on Saturdaylast, August 20th, was 1745, against 1784, 1758, and 1763m the three preceding Saturdays ; 198 new cases wereadmitted during the week, against 243, 166, and 189 in thethree preceding weeks. The deaths in London referred topneumonia and diseases of the respiratory system, whichhad been 118, 112, and 121 in the three preceding weeks,declined again last week to 106, and were 14 below thenumber in the corresponding period of last year. The causesof 39, or 0’6 6 per cent., of the deaths in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in West Ham, Bristol, Salford, Bradford,Leeds, Newcastle-on-Tyne, and in 49 other smaller towns;while the largest proportions of uncertified deaths were

registered in Liverpool, St. Helens, Manchester, Halifax,South Shields, Gateshead, and Tynemouth.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principal Scotchtowns, which had been 14 1, 14 - 6, and 15’ per 1000 in thethree preceding weeks, further rose to 17’ per 1000during the week ending August 20th, but was 5’ 6 per 1000below the mean rate during the same period in the 76 largeEnglish towns. The rates in the eight Scotch towns

ranged from 7-8 8 in Leith and 12-3 in Perth, to 20 - 2 inGreenock, and 21-1 1 in Paisley. The 567 deaths in thesetowns included 66 which were referred to diarrhoea, 16 towhooping-cough, seven to measles, four to scarlet fever,and one to diphtheria, but not any to small-pox or to"fever." In all, 94 deaths resulted from these principalinfectious diseases last week, against 58, 85, and 109 in thethree preceding weeks. These 94 deaths were equal to anannual rate of 2 - 8 per 1000, which was 6 - 9 per 1000below the mean rate last week from the same diseasesin the 76 large English towns. The fatal cases of diar-rhoea, which had been 24, 48, and 68 in the three

preceding weeks, declined again last week to 66, ofwhich 44 were registered in Glasgow, five in Aberdeen, fivein Leith, four in Edinburgh, four in Dundee, and three inPaisley. The deaths from whooping-cough, which hadbeen 26 in each of the two preceding weeks, decreased to16 last week, and included 11 in Glasgow and two inDundee. The fatal cases of measles, which had been seven,five, and six in the three preceding weeks, rose againlast week to seven, of which three occurred in Glasgow.The deaths from scarlet fever, which had been two, one, andtwo in the three preceding weeks, further rose to four lastweek, and included two in Edinburgh. The deaths referredto diseases of the respiratory organs in these towns, whichhad been 55, 47, and 39 in the three preceding weeks, roseagain last week to 47, but were slightly below the numberin the corresponding period of last year. The causes of

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22, or nearly 4 per cent., of the deaths registered in theseeight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 17’ 9, 21’ 2,and 27’ 1 per 1000 in the three preceding weeks, declinedagain to 24’ 5 per 1000 during the week ending August 20th.During the past four weeks the death-rate has averaged 22 ’ 7per 1000, the rates during the same period being 19’ 7 inLondon and 14-2 in Edinburgh. The 178 deaths ofpersons belonging to Dublin registered during the weekunder notice showed a decline of 18 from the number in the

preceding week and included 43 which were referred tothe principal infectious diseases, against 13, 25, and 46in the three preceding weeks ; of these, 33 resultedfrom diarrhoea, four from measles, three from whooping-cough, two from "fever," and one from diphtheria,but not any from either small-pox or scarlet fever.These 43 deaths were equal to an annual rate of 5’9 9per 1000, the death-rates last week from the principalinfectious diseases being 8’ 8 in London and 1-4 in Edin-burgh. The 33 fatal cases of diarrhoea corresponded withthe number in the preceding week. The deaths frommeasles, which had been four, three, and five in the three

preceding weeks, declined again last week to four. Thefatal cases of whooping-cough, which had been four in eachof the two preceding weeks, decreased last week to three.The 178 deaths in Dublin last week included 60 amongchildren under one year of age and 27 among personsaged 60 years and upwards ; the deaths both of infantsand of elderly persons showed a decline from the number inthe preceding week. Seven inquest cases and four deathsfrom violence were registered; and 57, or nearly a third,of the deaths occurred in public institutions. The causesof nine, or more than 5 per cent., of the deaths in Dublinlast week were not certified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointment is notified :-Staff Surgeon

C. S. Facey to the President, for three months’ hospitalstudy.

ROYAL ARMY MEDICAL CORPS.

Captain J. H. Campbell, D.S.O., has arrived at theStation Hospital, Western Heights, Dover, and CaptainS. H. Fairrie has arrived at the Station Hospital, Canter-bury, both for duty.

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Major W. M. Roocroft to be Surgeon-Lieutenant-Colonel (dated August 2nd, 1904).

VOLUNTEER CORPS.

- Rt/?e.’ 2nd Volunteer Battalion the King’s (ShropshireLight Infantry) : Surgeon-Captain G. Hollies to be Surgeon-Major (dated August 20th, 1904). lst Volunteer Battalionthe Manchester Regiment: Surgeon-Major W. M. Roocroftto be Surgeon-Lieutenant-Colonel (dated August 20th, 1904).

DEATHS IN THE SERVICES.

Surgeon-Major-General Alfred Malpas Tippetts, A.M.D.(retired), recently at Southsea. He joined the army in 1854,became surgeon in 1864, surgeon-major in 1879, deputy sur-geon-general in 1880, and surgeon-general in 1891. Heserved in the Eastern Campaign, 1854-55, with the 7thFusiliers, including the affair of Bulganac, battles of Almaand Inkerman, and siege of Sebastopol (medal with threeclasps and Turkish medal); served in the Afghan war

of 1878-80, and took part in the expeditions into Bazar andHisarik Valleys (medal). He retired with the rank of sur-

geon-major-general in 1892. A Distinguished Service Rewardof .6100 a year falls vacant by the death of Surgeon-GeneralTippetts.

Inspector-General Dugald M’Ewan, H.P.K., R.N. (re-tired), on the 22nd inst., at Bedford. He reached the rankof inspector-general in 1887.

THE RETIREMENT OF LIEUTENANT-COLONEL A. F. S.CLARKE, A.M.S.

The retirement of Lieutenant-Colonel A. F. S. Clarke,Army Medical Staff, from the post of surgeon of the RoyalMilitary College, which he vacates on account of his having

reached the age limit, is a matter Hailing for some noticeon our part. During’ the time lie has held the appointmenthe has been devoted to his work and to the interest of the

college and all concerned therewith. The post is a difficultand responsible one to fill but Colonel Clarke is an officerof sound judgment with a knowledge of the work he had todo, as well as great kindliness and absolute honesty in thedoing of it.

THE WAR IN THE FAR EAST.

The news from the seat of war-such as there is-is of

military and not of a medical nature. Beyond the fact thata fierce conflict is raging round Port Arthur and that thegarrison of that strong fortress is being hardly pressed wereally know but little of what is actually taking place thereat the present time. As regards the progress of the war inManchuria the heavy rains have for the moment put an endto military operations. The rumour is that there is muchinefficiency from sickness among the Russian troops underthe command of General Kuropatkin.

Correspondence.

HOT WEATHER AND FOOD PRESER-VATIVES.

"Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-The wave of exceptionally hot weather that hasrecently visited this country has been followed by the usualepidemic of infantile diarrhcea and the mortality in all thegreat centres’ of population has risen in consequence,Liverpool heading the list with a death-rate of 37’ per1000. In the conditions under which multitudes of the

poor live it is not a matter for surprise that diarrhoeadue to the consumption of decomposing food shouldbe extremely prevalent. Even in the houses of thewell-to-do it has been difficult to keep milk, fresh

meat, and fresh butter in a condition fit for consump-tion for more than a few hours and some of it has oftenhad to be thrown away as not above suspicion. In theslum dwellings of our great cities the difficulty of keepingfresh food in a state fit for consumption must be well-nighinsurmountable. The air of the overcrowded rooms reekswith organic emanations from the bodies and clothes of theinhabitants; water has to be fetched from a standpipe out-side and is used sparingly ; there are no relays of dishes orother receptacles to hold the food, such receptacles as existare dirty ; there is nothing to keep off the flies, andwhen food goes bad the family must eat it or do with-out any. These conditions ’are not peculiar to Liverpoolbut are met with in all large cities, but there is one

circumstance about Liverpool which I think explains, in

part at least, their disastrous influence on the health of thechildren there during the last few weeks. For some yearspast the authorities in Liverpool have been carrying on acrusade against the use of boric acid and salicylic acid aspreservatives in food and I am of opinion that the successof the authorities in putting a stop to the use of preserva-tives has laid the public open to serious risks from poisoningfrom decomposing food. Some months ago, when dis-cussing the question of preservatives with an officialwho was strongly opposed to their use on the ground, as healleged, that by sterilisation the food could always bedelivered to the consumer in good condition, I asked himhow it was to be kept from going bad directly it was opened.His answer was that the officials had nothing to do with thefood after it had reached the hands of the consumer, thatthe only business of the officials was to see that the con-sumer got it pure, which meant in this connexion freefrom preservatives. This view may satisfy the officialmind but it is not sense. I have more than once

invited the opponents of the use of preservatives tobring forward a single instance in which any humanbeing has suffered from the reasonable use of boric acidor salicylic acid as preservatives in food, but they have notbrought forward a single case that would bear investigation.The objections to their use are purely hypothetical, chieflyresting upon feeding experiments on young animals whichhave been wrongly interpreted. On the other hand, no one