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was, however, remedied later on by private charity, a trained nurse rendering help that was valuable and muchappreciated. It is not often that so severe and sudden anoccurrence of enteric fever ensues apart from pollution ofwater or milk ; but in this case the amount of air pollutionand the resulting specific contamination appear to havebeen quite exceptional. Indeed, Mr. Spear suggests thathad not the neighbours become too terror-stricken to comenear the infected locality, the mischief induced wouldprobably have been far greater than it was. Amongstthe circumstances that favoured both the spread andthe fatality which marked this outbreak were the condi-tions inside as well as outside the homes of the people.In one house Mr. Spear found six children lying illof fever. Separate beds for each patient were out ofthe question, and the tossing and raving of bed-fellowswas singularly distressing. One child was covered withbruises, the result of lack of attendance and frequent fallsout of bed in a state of delirium. Had a hospital beenavailable these painful circumstances and the spread ofthe disease would doubtless have been largely avoided ; andit is to be hoped that the present intention of the authorityto make such provision will come to be actually accom-plished. The disgraceful sanitary circumstances affectingthis small community also call for immediate action. Aftersuch an experience as this fever outbreak has afforded, theresponsibility resting upon the authority to adopt theneeded sanitary measures is by no means a small one.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Birminghana -The death-rate of this borough rose

slightly during 1889, being 18’4: per 1000 living, and theincrease was largely due to zymotic diseases, and especiallyto scarlet fever and diarrhoea. But it is satisfactory to findthat Dr. Alfred Hill is able to record the lowest knowndeath-rate from enteric fever, and at the same time thelowest in any of the twenty large towns and cities ofEngland, a result which he holds to be due to the work thathas been done in removing the conditions favourable to thespread of this infection. Indeed, the outcome of sanitarywork in the borough is stated to be already a very sub-stantial one. But there is still much to do ; and Dr. Hill’sreference to the "acres of middens and similar privies,"which still tend to foul the atmosphere of Birmingham,reminds us of the astonishment which some foreigners whovisited the city on the occasion of the recent British MedicalAssociation meeting expressed as to this in so advanced acentre of our midland district. The infant death-rate was174 per 1000 births, which is unquestionably high, anddoubtless is connected, as is also the diarrhoea mortality,with the excremental tainting of air and soil due to middenprivies. But, for all this, only three of the large Englishtowns-namely, London, Norwich, and Bristol-stand higherthan Birmingham in the zymotic mortality for 1889. Scarletfever was very prevalent during the year ; more so, indeed,than in any year since 1883. The total deaths from thiscause were 156, and when it is remembered that in previousepidemic years the annual number of deaths has rangedfrom 326 to 995, it is easy to understand that much is nowclaimed for the influence of the isolation measures adoptedin the sanitary hospitals of the borough. During 1875-78the number of scarlet fever cases admitted to hospital was525, and the deaths were 1701; during 1879-83 the admissionsgrew to 1952, and the deaths were 1175 ; but during 1884-89the admissions rose to 3759, and the deaths were only 434.It remains, however, to be seen how far the improvedresults of the last period were due to the marked absence ofscarlet fever during five years of that period, rather than tooperations mainly limited to a single year. Certain it isthat the time of the greatest aggregation of scarlet fever inhospital has not been, as some have contended, a period ofdanger to the borough ; and, so far as the charting of thedeaths shows, this aggregation did no particular injury tothe hospital neighbourhood. We cannot further followDr. Hill in the interesting and complete report which lie hasprepared, and which tells the sanitary history of the yearfrom a scientific as well as from a practical point of view.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5483 birthsand 3550 deaths were registered during the week ending

Sept. 20th. The annual rate of mortality in these townswhich had declined in the preceding four weeks from 21’0to 18’6 per 1000, rose again last week to 19-1. Therate was 16.2 in London and 21’4 in the twenty-sevenprovincial towns. During the first twelve weeks of the currentquarter the death-rate in the twenty-eight towns averaged19’1 per 1000, and was 1-2 below the mean rate in the corre-sponding periods of the ten years 1880-89. The lowest ratesin these towns last week were 12’9 in Derby, 14’1 inBradford, 14’4 in Bristol, and 15’3 in Norwich ; the highestrates were 27 9 in Sunderland, 30 0 in Blackburn, 31 -6 inManchester, and 35’7 in Preston. The deaths referred tothe principal zymotic diseases, which had declined in thepreceding four weeks from 999 to 599, rose again last weekto 680 ; they included 373 from diarrhoea, 76 from measles,72 from whooping-cough, 63 from diphtheria, 49 from"fever" (principally enteric), 47 from scarlet fever, and notone from small-pox, The lowest death-rates from thesediseases were recorded in Bristol, Derby, Halifax, andBirkenhead, and the highest in Manchester, Plymouth,Sunderland, and Preston. The greatest mortality frommeasles occurred in Plymouth, Wolverhampton, and Man-chester ; from scarlet fever in Liverpool ; from whooping-cough in Huddersfield, Sunderland, and Norwich; from"fever" in Blackburn, Halifax, and Plymouth; and fromdiarrhoea in Sheffield, Hull, Sunderland, and Preston. The63 deaths from diphtheria included 35 in London, 8 in Salford,4 in Manchester, 4 in Cardiff, and 3 in Liverpool. No deathfrom small-pox was registered in any of the twenty-eighttowns. No small-pox patients were under treatment at theend of the week either in the Metropolitan Asylum Hos-pitals or in the Highgate Small-pox Hospital. The numberof scarlet fever patients in the Metropolitan Asylum Hos-pitals and in the London Fever Hospital at the end oflast week was 1596, against numbers increasing from 1427to 1539 on the preceding four Saturdays; the new casesadmitted during the week were 211, against numbers in-creasing from 118 to 210 in the previous six weeks. Thedeaths referred to diseases of the respiratory organs inLondon, which had been 180 and 210 in the preceding twoweeks, declined again last week to 187, and were 3 belowthe corrected average. The causes of 58, or 1’6 per cent.,of the deaths in the twenty-eight towns were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in Portsmouth,Norwich, Salford, Hull, Sunderland, and in six othersmaller towns. The largest proportions of uncertifieddeaths were recorded in Preston, Liverpool, and Bristol.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 18 2 and 17’8 per 1000 in the precedingtwo weeks, rose again to 19’6 in the week endingSept. 20th, and was 0 5 above the rate that prevailed duringthe same period in the twenty-eight large English towns.The rates in the eight Scotch towns ranged from 10’9 inPertli and 14’3 in Aberdeen to 18’8 in Paisley and23 9 in Glasgow. The 506 deaths in the eight towns showedan increase of 43 upon the number in the previous week,and included 41 which were referred to diarrhoea, 25 to

whooping-cough, 7 to scarlet fever, 6 to measles, 6 to diph-theria, 4 to " fever," and not one to small-pox. In all,89 deaths resulted from these principal zymotic diseases,against numbers increasing from 65 to 80 in the precedingthree weeks. These 89 deaths were equal to an annualrate of 3’4 per 1000, which was slightly below the meanrate last week from the same diseases in the twenty-eightEnglish towns. The fatal cases of diarrhoea, which hadbeen 18 and 26 in the preceding two weeks, further roselast week to 41, of which 18 occurred in Glasgow, 8 inDundee, and 6 in Edinburgh. The deaths referred to

whooping.cough, which had increased from 14 to 25 in theprevious three weeks, were again 25 last week, and in-cluded 15 in Glasgow and 4 in Edinburgh. The 7 fatalcases of scarlet fever exceeded by two the number in thepreceding week ; 3 occurred in Glasgow and 3 in Paisley.The 6 deaths from diphtheria were within 2 of the numberin the previous week, and included 3 in Glasgow and 2 inDundee. The 6 fatal cases of measles showed a furtherdecline from recent weekly numbers, and included 3 inGlasgow and 2 in Greenock. The deaths referred todiseases of the respiratory organs in the eight towns,which had risen in the preceding three weeks from 56

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to 84, declined last week to 74, but exceeded the numberin the corresponding week of last year by 8. The causes of44, or nearly 9 per cent., of the deaths in the eight townslast week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had declined in the pre-ceding three weeks from 23’8 to 17’3 per 1000, rose againto 19’4 during the week ending Sept. 20th. During the pasteleven weeks of the current quarter the death-rate in thecity averaged 20’2 per 1000, the rate for the same periodbeing 18 ’2 in London and 16 ’6 in Edinburgh. The 131 deathsin Dublin showed an increase of 14 upon the number in theprevious week; they included 4 which resulted from diarrhoea,4 from "fever," 2 from measles, 2 from whooping-cough, 1from diphtheria, and not one either from small-pox or scarletfever. Thus the deaths referred to the principal zymoticdiseases, which had been 11 and 15 in the preceding twoweeks, declined again last week to 13 ; they were equal toan annual rate of 1’9 per 1000, the rate from the same dis-eases being 2’8 in London and 1’9 in Edinburgh. Thedeaths from diarrhœa, which had been 6 and 11 in the pre-vious two weeks, declined last week to 4. The fatal casesof "fever," of measles, and of whooping-cough showed aslight increase upon those recorded in the preceding week.The 131 deaths in Dublin included 26 of infants under oneyear of age, and 32 of persons aged upwards of sixty years ;the deaths of infants showed a slight decline, while thoseof elderly persons exceeded those recorded in the previousweek. Four inquest cases and 5 deaths from violence wereregistered during the week; and 41, or nearly a third, of thedeaths occurred in public institutions. The causes of 18,or nearly 14 per cent., of the deaths were not certified.

Correspondence.

TENACITY OF VITALITY IN LARVÆ ANDLOW FORMS OF ORGANIC LIFE.

"Audi alteram partem."

1’0 the La2tors of THE LANCET.

SIRS,—In perusing Dr. Broadbent’s able address atBirmingham my attention has been directed to some of theinteresting if not novel facts and statements which he hassubmitted for our consideration. That " strychnine actsalike on all animals that have a spinal cord" is well known.But we have not been equally conversant with the statementthat "when we leave the vertebrate series strychnine ceasesto be deadly." We are told that blackbeetles consume itwith impunity. Equally remarkable is the fact that "whendilute hydrocyanic acid is injected under the skin of a frogit hops about as if nothing had happened," while we knowthat a very minute quantity of strychnine-the thousandthpart of a grain-will produce tetanic convulsions in a frog, andotherwise affect it in such adecided manner that the manifesta-tions produced are justly regarded as a delicate physiologicaltest of the presence of the poison. While engaged in verify-ing these experiments I have found that dipterous larvæwhich feed on putrescent animal matter, more particularlythe larvas of the musca vomitoria and the sarcophagacarnaria, swim about freely for about one hour in dilutehydrocyanic acid, when gradually their movements ceaseand they die. They live actively and apparently unaffectedfor fully four hours in the liquor hydrargyri perchloridi ofthe Pharmacopoeia, thus shaking our faith to a considerableextent in the prompt and universally deadly effect of oneof the foremost of antiseptics. I should mention, how-ever, that some of the larvæ, the more mature and fullydeveloped, cease their more active movements in the per-chloride solution in three hours; while others-the smaller,less developed, and more thread-like in appearance-possessthe enormous power of resisting the destructive effect of thesolution for more than five hours. This circumstanceaccords with our knowledge of the spores of bacteria, whichresist the influence of agents destructive to their vitalityfor a very much longer period than the fully formed bacteria.My purpose, however, is not to try to establish any analogybetween bacteria and larvae, but to describe the experimentsas they occurred, in the hope that they may be more or lessinteresting to at least a few of the readers of THE LANCET.

The larvæ of muscidæ have frequently been found in theear and other parts of the human body, and have naturallybeen washed out with weak solutions of the perchloride ofmercury as the best antiseptic, which lotions, I need hardlysay, are as nearly as possible inert for such a purpose. Itis of course as fu tile as it is customary in several parts ofthe country to apply lotions of corrosive sublimate to sheepinfested with larvæ, and this is by no means an unimportantquestion, in consequence of the worry, mischief, anddestruc-tion they cause to llocks of sheep during the warlll season ofthe year. Several agents kill the parasites very promptly;but for general use by farmers and sheep graziers, if chloro-form is too dangerous an agent to place in their hands, thechloroform water of the Pharmacopœia, strength recom-mends itself as being inexpensive, promptly effective, andinnocuous. The larvas are not only made torpid, they areactually killed by it.The appended tabular statement shows approximately the

destructive effect of different agents on the larvae ; but allthe experiments as already noticed clearly prove that someof the larvæ, depending on their different degrees of develop.ment, are more resistant than others to the agents used fordestroying them :-

Larvæ immersed in chloroform killed instantly." chloroform Nvater P.B. killed in 5 minutes." ess. anisi ........ )$8 8 minutes." acid. carbolic liq..... " 8 minutes." ol. rusci ........ 12 minutes." acid. liydrocyanic dil. P.B. " 1 hour." liq. carbonis deterg..... " 1 hour." ol. month. pip ...... " 1 hour." ol. carbolic (1 in 16 olive} 75 minutes.oil) ..... "

" ol. eucalypti ...... " 2 hours." huile de cade ...... " 3 hours." tinct. iodi ........ 3 hours." sal. alembroth (1 grain} 4 hours.in 2 oz. distilled water) / " " hours.

(Some of the larvæwere dead in three

" liq. hydrarg. perchlor.P.B. hours, others wereI quite active afterfive hours.

I am, Sirs, your obedient servant,Alexander-sq., S.W., Sept. 22nd, 1890. D. MACKINTOSH, M.D.

"THE LEUCOCYTE AS THE SURGEON’SFRIEND."

To the Editors of THE LANCET.. SIRS,—Dr. W. J. Collins, in an eloquent letter (vide THELANCET, Sept. 13th), requests us to make an amendehonorable to the leucocyte, insinuating that the latter hasbeen unwittingly injured or despised through ignorance.The leucocyte is at present in a sad plight. Its proudposition of an organiser and regenerator of new tissue whichit had arrogantly occupied for many years has been rudelyshaken by the savants of the Tenth International Congress.It now holds, as far as inflammation is concerned, themodest position which Virchow years ago assigned to it.Messrs. Ballance and Sherrington removed all the charmwhich hovered around the leucocyte, and Professor Ziegler,who once raised it to the greatest power and dignity, andwas its truest friend, gave it the coup de grâce. Theleucocyte now clings to the title of " phagocyte," whichMetchnikoff conferred on it, and which others since havealways been ready to defend. In this capacity "it shouldbe welcomed as the surgeon’s friend," so Dr. Collinspleads; however, he wisely adds-"if Metchnikoff’s re-

searches are unambiguous." Therein the difficulty lies.A priori, especially atter a careful study of Virchow’s cel-lular pathology and the recent researches of Messrs.Ballance and Sherrington, we should be inclined to denythis phagocytic action. Again, good authorities believethat in claiming the above title the" lowly leucocyte " isdemanding more than is due to it. This is not theplace to discuss all the points for and against this matter,but a few suggestions will show that it is by no

means unambiguous. Professor Robert Koch, versed in allmatters appertaining to bacillary life, is a strong opponentto Metchnikoff’s theory, and maintains that the livingbacillus attacks the leucocyte, and then destroys it.lAgain, Flügge and Baumgarten 3 showed that the "phago-

1 Cf. his researches on the bacillus of mouse septicæmia.2 Zeitschr. fur Hygiene, 1888, iv.

3 Centralbl. fur Klin. Med., 1888, 29.