752

the hands of a purchaser, owing to the existence of no legallimitation as to the frequency or continuance of its use.

General Praotitione’l’s and their LOO1l1n-tenents.

A case of considerable interest to general practitioners,arising out of the engagement of a locum- tenent, was heard atthe Cerkenwell county court on March 5th. The actionwas brought by Mr. Henry Bazett against Dr. Thomas G.Hockridge of Lloyd-square, W.C., for Z26 8s. in respect ofdamages arising out of an alleged breach of contract. Thematerial question at issue was that of the length of noticewhich a locum-tenent was entitled to receive in termination ofhis engagement. The plaintiff stated that the defendant hadmade a contract with him to act as locum-tenent fromNov. 30th, 1911, to Jan. 16tb, 1912, at the rate of 4 guineasper week, and board and lodging. On Dec. 15th, theplaintiff, through illness, had to leave the defendant’shouse for temporary rest and on his recovery he wasrefused permission to continue his duties. The claimwas for .BI9 4s., salary for four weeks and four days, and<S7 4. as an equivalent to board and lodging for the sameperiod. The defendant called evidence of a custom in the Iprofession of 48 hours’ notice to terminate such an engage-ment. The plaintiff denied this, and contended that eachmedical man had his own rules, and that these varied. Inthe case of illness of a doctor a locum-tenent was engaged foran indefinite period ; if the engagement was by the day pay-ment was at the rate of 1 guinea per day. The defence wasthat a principal could dismiss a lccum-tenent at practically amoment’s notice. It was only a temporary engagement, thoughpayment was usually made weekly for the sake of convenience.The defendant cited 38 years’ experience of such engage-ments which were always subject to 48 hours’ notice. The

plaintiff, in addressing the bench, submitted that the rela-tion between principal and locum-tenent was that of masterand servant, and that it would be an exceedingly hard andserious thing for the locum-tenent to be placed outside thatlaw and, because of illness, have to bear the brunt of it all.In giving judgment his honour said that the plaintiff fell illand had to be replaced by another locum-tenent. The plaintifftook up the position that although you have to pay some-body else you must pay me as well." It seemed to him

impossible to accept that conclusion. The principal of thelaw of master and servant did not apply in this instance andjudgment must be for defendant with costs. The plaintiffasked whether he had the right to appeal, to which his honourreplied in the affirmative.

An Interesting Case under the Workmen’s Compensation Act.

Recently at the Weston-super-Mare county court, before. his Honour Judge Austen, the widow of a chef at a local

hotel claimed .B300 under the Workmen’s Compensation Actfor the death of her husband. The deceased man, whilst

dressing in his room in the hotel, slipped over a mat, andcomplaining of great pain went home and sent for a medicalman. The medical attendant stated that deceased had abdo-minal pains, and a post-mortem examination showed’ thatdeath was caused by haemorrhage from a ruptured right renalartery. He added that although he had never known or read I,of a renal artery being ruptured by a violent twist, he con-sidered in this case that that had occurred and caused death.The medical man was not allowed to state what the deceasedhad told him of the accident-viz., that he had slipped whilstdressing and violently twisted himself-his Honour holdingthat the statement would not be evidence. Judge Austen, indeciding against the claim, said he was not satisfied that anaccident had taken place, or that it arose out of, and in thecourse, of the deceased man’s employment.

Libel Action brought by a Dentist.A most righteous verdict was given on Tuesday last by

a King’s Bench jury, when Mr. F. R. Moser was awarded.B600 damages for libel, the defendants, Mr. George Smith, aCamberwell builder, and his wife having accused him ofimproper behaviour towards the female defendant while shewas his patient. The accusations were obviously and utterlyuntruthful.

THE Princess Henry of Battenberg has con-sented to become a vice-patron of the Chelsea Hospital forWomen.

’

Public Health.REPORTS OF INSPECTORS IN THE MEDICAL DEPARTMENT OF

THE LOCAL GOVERNMENT BOARD.

On an Outbreak of Enteric Fever at Oakenshaw, in, theUrban District of Willington, by Dr. T. CARNWATH.-Oakenshaw is a mining village with a population of some1280 persons, about seven miles to the south-west of thecity of Durham. It is included in the urban district ofWillington, in which enteric fever has been endemic formany years. Before 1909 Oakenshaw itself was relativelyfree from the disease, but in that year sporadic cases beganto occur in the village with unusual frequency, and thiscontinued on into 1910, finally culminating in a severe

outbreak in April and May, which was practically confinedto the village, and did not extend to other parts of theWillington district. Systematic application of the Widaltest at the time of Dr. Carnwath’s inquiry suggested thatmany cases of illness had occurred which were to be attributedto enteric fever infection, although for one reason or anotherthey had not been notified. Dr. Carnwath concludes thatthere were altogether 74 cases, 11 of which occurred in 1909and the remainder in 1910 ; of these 74 cases 7 were fatal.As many as 33 occurred in the last week of April and in thefirst week in May, and special attention was directed to theexplanation of this striking feature of the outbreak. Thelatter appeared almost certainly to be due to a milkinfection. The milk-supply of the village was obtainedmainly from three farms, of which one farm, X, supplied85 households, or 35. 1 per cent. of the total houses inOakenshaw. Of the 57 invaded households as many as 49obtained milk from farm X, and there was evidence that theattack of the few persons who were customers of the otherfarms might be attributed to those farms having had dealingsin milk with the X farm. The amount of milk delivereddaily to each household was on an average from halfa pint to a pint; it was generally found that the memberof the family who fell ill was the one who " drankmost milk," but even so the quantity consumedin the majority of cases was exceedingly small. A

heavy proportional incidence of the disease on females andchildren gave confirmatory evidence of the infection havingbeen milk-borne. At the farm X only two persons, motherand son, had anything to do with the handling of the milkfrom the time it left the udder until it was delivered to thecustomer, and this had been so for 12 years. No history ofenteric fever could be obtained in either case, although theson had suffered from a "bad cold " with some affection ofthe lungs and bowels in 1908. The mother had no history ofany sickness save a liability to bilious attacks. Samples ofurine and fasces obtained from the son were examined by Dr.J. C. G. Ledingham at the Lister Institute for typhoid bacilliwith negative results, but those obtained from the motherin August, 1910, and again in December, contained largenumbers of typhoid bacilli. It may reasonably be concluded,therefore, that Mrs. X somehow caused the infection of themilk at intervals during 1909 and 1910, and did so with

particular intensity in April of the latter year. The questionwhy this infective ability was not shown, at any rate to anyconspicuous extent, before 1909 did not admit of anysatisfactory answer.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 94 largest English towns having an estimatedpopulation of 17,559,219 persons in the middle of this year,8603 births and 4846 deaths were registered during the weekending March 9th. The annual rate of mortality in thesetowns, which had steadily decreased from 21’ 6 to 15 - 4 per1000 in the four preceding weeks, further declined to 14.4per 1000 in the week under notice. During the first tenweeks of the current quarter the mean annual death-ratein these large towns averaged 16’7 per 1000, while inLondon during the same period the average death-rate didnot exceed 15’9 per 1000. The annual death-rates lastweek in the several towns ranged from 6’0 in Hornsey,6-3 in Enfield, 6- in Gillingham, 7-3 in Walthamstow, and

753

7. 5 in Ilford, to 20 - 3 in Great Yarmouth, 20’7 in ,Oldham,21-0 in Stockton-on-Tees, 24-2 in Salford, and 25-8 inBarrow-in-Furness.The 4846 deaths from all causes were 348 fewer than

the number in the previous week, and included 378 whichwere referred to the principal epidemic diseases, against353 and 394 in the two preceding weeks. These 378deaths from the principal epidemic diseases included136 from whooping-cough. 101 from measles, 53 frominfantile diarrhceal diseases, 49 from diphtheria, 25from scarlet fever, and 14 from enteric fever, butnot one from small-pox. The mean annual death-ratefrom these diseases last week was equal to 1-1 per1000, against 1-0 and 1-2 in the two precedingweeks. The deaths attributed to whooping-cough, whichhad decreased from 186 to 142 in the four precedingweeks, further declined to 136 last week, and caused thehighest annual death-rates of 1-7 in Southampton and inWalsall, 1-8 in Great Yarmouth, 2’4 in Barrow-in-Furness,and 2’5 5 in Merthyr Tydfil. The deaths referred to measles,which had increased from 69 to 109 in the three previousweeks, slightly declined to 101 last week ; the highestannual death-rates from this disease were 1- 3 in Swansea,1-4 in Oldham, 1-9 in York, 2-0 in Southport, 3.6 inWarrington, and 4.3 in Salford. The fatal cases of infantilediarrhoea, which had been 58, 39, and 49 in the three

preceding weeks, were 53 last week, and included 17 inLondon, 7 in Liverpool, 4 in Stoke-on-Trent, 4 in Sheffield,and 3 in Birmingham. The deaths attributed to diphtheria,which had increased from 43 to 53 in the three previousweeks, were 49 last week ; 14 deaths were recordedin London and its suburban districts, 4 in Portsmouth,4 in Manchester, and 3 in Leeds. The deaths referred toscarlet fever, which had been 28, 17, and 21 in the threepreceding weeks, rose to 25 last week, and included 5 inLondon, 4 in Manchester, and 3 in Leeds. Of the 14 fatalcases of enteric fever, which were 5 less than the average in the three preceding weeks, 3 were registered in London,2 in Manchester, and 2 in Rotherham.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and in the London Fever Hospital,which had decreased from 1512 to 1392 during the four pre-ceding weeks, had further declined to 1358 on Saturday last ;161 new cases of this disease were admitted to these hos-

pitals during the week, against 154, 181, and 160 in thethree previous weeks. These hospitals also containedon Saturday last 1113 cases of diphtheria, 478 of whooping-cough, 231 of measles, and 58 of enteric fever, but not oneof small-pox. The 1152 deaths from all causes recorded inLondon were 76 fewer than the number in the previousweek, and were equal to an annual death-rate of 13 - 3 per1000. The deaths referred to diseases of the respiratorysystem, which had steadily declined from 545 to 295 duringthe four preceding weeks, further fell to 259 last week, andwere 69 below the number registered in the correspondingweek of last year.

Of the 4846 deaths from all causes in the 94 large towns,169 resulted from different forms of violence, and 358 werethe subject of coroners’ inquests. The causes of 39, or 0 - 8 8per cent., of the deaths registered last week were notcertified either by a registered medical practitioner or by acoroner after inquest. All the causes of death were dulycertified in Leeds, Bristol, West Ham, Bradford, Hull,Newcastle-on-Tyne, Nottingham, Portsmouth, and in 66other smaller towns. The 39 uncertified oauses of deathlast week included 9 in Liverpool, 8 in Birmingham, 3 inPreston, 2 in Salford, and 2 in South Shields.

HEALTH OF SCOTCH TOWNS.

In the 18 largest Scotch towns, having an estimated popu-lation of 2,182,400 persons in the middle of this year, 1138births and 731 deaths were registered during the week

ending March 9th. The annual rate of mortality in thesetowns, which had been 18 - 5 and 18’ 7 per 1000 in thetwo preceding weeks, declined to 17’ 5 per 1000 in theweek under notice. Daring the first ten weeks of thecurrent quarter the mean annual rate of mortality in thesetowns averaged 18’ 9 per 1000, and was 2 - 2 per 1000 inexcess of the mean rate recorded during the same period inthe 94 large English towns. The annual death-rates in theseveral Scotch towns last week ranged from 4. 6 in Partick,

’7 6 in Falkirk, and 9’0 0 in Clydebank, to 22. 0 in Greenock,Z2 - 5 in Kilmarnock, and 23’1 1 in Perth.The 731 deaths from all causes were 53 fewer than the

number in the previous week, and included 76 which werereferred to the principal epidemic diseases, against 120and 93 in the two preceding weeks. Of these 76 deaths,39 resulted from measles, 10 from scarlet fever, 8 from

whooping-cough, 8 from diphtheria, 8 from infantile diarrhoea,and 3 from enteric fever, but not one from small-pox.These 76 deaths from the principal epidemic diseaseswere equal to an annual death-rate of 1.8 per 1000,or 0-7 per 1000 above that recorded in the 94 largeEnglish towns. The deaths attributed to measles, whichhad decreased from 63 to 56 in the three precedingweeks, further declined to 39 last week, and included21 in Glasgow, 6 in Edinburgh, 4 in Greenock, and3 in Leith. The deaths referred to scarlet fever, whichhad been 2, 3, and 6 in the three preceding weeks,further rose to 10 last week, and comprised 5 in Glasgow,3 in Greenock, and 2 in Aberdeen. The fatal cases

of whooping-cough, which had been 14 18, and 16 in thethree preceding weeks, fell to 8 last week, and included 3in Glasgow and 2 in Edinburgh. The deaths referred todiphtheria, which had been 6, 22 and 9 in the three previousweeks, were 8 last week, of which number 5 occurred inGlasgow. The deaths of infants under two years of agefrom diarrhceal diseases numbered 8, against numbers

declining from 14 to 5 in the three preceding weeks ; 2 deathswere recorded in Glasgow, in Dundee, and in Paisley. The3 fatal cases of enteric fever were registered in Glasgow.The deaths referred to diseases of the respiratory system

in the 18 towns, which had decreased from 220 to 138 inthe four preceding weeks, further declined to 136 in theweek under notice, and 29 deaths were attributed to differentforms of violence.

____

HEALTH OF IRISH TOWNS.

In the 22 town districts of Ireland, having a populationof 1,157,014 persons in the middle of this year, 622 birthsand 512 deaths were registered during the week endingMarch 9th. The annual rate of mortality in these towns,which had steadily declined from 31-0 to 22.1 per 1000in the four preceding weeks, rose to 23,1 per 1000 in theweek under notice. During the first ten weeks of the currentquarter the mean annual death-rate in these Irish towns

averaged 23’ 5 per 1000 ; in the 94 large English townsthe mean annual death-rate during the same period didnot exceed 16’ 7 per 1000, while in the 18 Scotch towns it wasequal to 18 - 9 per 1000. The annual death-rates in the severalIrish towns last week were equal to 26 9 in Dublin (against13 - 3 in London), 20 - 3 in Belfast, 24 5 in Cork, 30 - 6 in

Londonderry, 19. 0 in Limerick, and 7.6 in Waterford;while in the 16 smallest of these Irish towns the meanannual death-rate last week was equal to 21’ 3 per 1000.The 512 deaths from all causes in the 22 Irish towns

were 22 in excess of the number in the previous week.and included 41 which were referred to the principalepidemic diseases, against 27 and 36 in the two precedingweeks ; of these 41 deaths, 13 resulted from whooping-cough,13 from infantile diarrh&oelig;al diseases, 5 from enteric fever,5 from diphtheria, 4 from measles, and 1 from scarlet fever,but not one from small-pox. These 41 deaths from the principalepidemic diseases were equal to an annual death-rate of1’ 8 per 1000; the death-rate last week from thesediseases did not exceed 1. 1 per 1000 in the 94 large Englishtowns, while in the 18 Scotch towns it was equal to 1-8. Thedeaths attributed to whooping-cough, which had declinedfrom 25 to 16 in the four preceding weeks, further fell to 13last week, and included 11 in Belfast. The deaths ofinfants under two years of age from diarrh&oelig;al diseases, whichhad been 5 and 9 in the two previous weeks, further rose to13 last week; 6 deaths were registered in Dublin and 4 inBelfast. The 5 fatal cases of enteric fever were in excessof recent weekly numbers, and comprised 2 in Dublin, 2 inBelfast, and 1 in Limerick. The 5 deaths referred to

diphtheria were 3 in excess of the average in the three

preceding weeks, and included 3 deaths in Dublin. The4 deaths from measles were recorded in Dublin, and thatfrom scarlet fever in Belfast.The deaths referred to diseases of the respiratory system,

which had steadily declined from 239 to 135 in the four

preceding weeks, were again 135 last week. Of the 512

754

deaths from all causes in the 22 Irish towns, 149, or 29 percent., occurred in public institutions, and 11 resulted fromdifferent forms of violence. The causes of 32, or 6’3 percent., of the total deaths were not certified either by aregistered medical practitioner or by a coroner afterinquest; in the 94 large English towns the proportion ofuncertified causes of death in the week under notice did notexceed 0 - 8 per cent.

.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE. (

TBE following appointments have been notified :-Staff i

Surgeons : A. McCloy to the Research, and J. R. A. Clark-Hall to the Triton. Surgeons : E. Moxon-Browne to the

Hearty; D. A. Mitchell to the Dido and to the Alert, on recommissioning; and J. H. Wright to the Terrible,temporary.

ROYAL ARMY MEDICAL CORPS.

Lieutenant Edward S. Calthrop resigns his commission(dated March 9th, 1912).

Surgeon-General G. D. Bourke, C.B., K.H.P., has beenappointed on the directing staff of the Irish Command Stafftour to be held from March 25th to the 28th.

Colonel L. E. Anderson has been granted 2t months com-bined leave of absence. Colonel H. J. Barratt has taken upduty as Principal Medical Officer of the Allahabad Brigade.

Lieutenant-Colonel S. C. Philson has been selected for theincreased rate of pay under Article 317 of the Royal Warrant.Lieutenant-Colonel C. H. Melville has been selected for pro-motion to the rank of Brevet-Colonel. Lieutenant-ColonelA. L. F. Bate, on return from India, has been posted to theWestern Command. Lieutenant-Colonel J. V. Savage hasbeen transferred from Muttra to the station hospital at

Secunderabad.Major J. Cowan, from Woolwich, has embarked for a tour

of service in India. Major F. G. Richards has taken up dutyin the Cork District. Major P. MacKessack has joined thsEastern Command headquarters as Specialist Sanitary Officer,vice Major C. H. Stratton, who has embarked for serviceabroad. Major R. S. H. Fuhr, D.S 0., and Major W. E.Hardy have been permitted by the Director-General to

exchange places on the foreign service roster. Major L.Wood has been appointed to the Fourth (Qaetta) Division.Major C. W. Reilly has been ordered to join the IrishCommand on March 21st and will be posted to the CorkDistrict. Major C. Dalton and Major D. J. Collins have beendetailed for duty in connexion with the Irish Command StaffTour. Major G. S. McLoughlin, D.S.O., has taken up dutyat Winchester. Major M. Swabey has been transferred fromWellington to St. Thomas’s Mount, Madras.

Captain C. G. Browne has been granted six months’

general leave of absence home from India. Captain T. S.Blackwell has been directed to join for duty in the IrishCommand on March 21st and will be posted to the BelfastDistrict. Captain G. Baillie has embarked for a tour ofservice on the West Coast of Africa. Captain M. Keane hasbeen appointed to the Eastern Command. Captain W. R.Galwey has been appointed Specialist Sanitary Officer to theNinth (Secunderabad) Division, in succession to Major R. W.Clements. The following transfers have been made inIndia : Captain J. B. Hanafin from the Second (Rawal Pindi)Division to the First (Peshawar) Division ; Captain C. D.Caddell from the Fifth (Mhow) Division to Aden ; CaptainT. S. Eves from the Seventh (Meerut) Division to the Eighth(Lucknow) Division ; and Captain D. Coutts from the Eighth(Lucknow) Division to the Seventh (Meerut) Division.Captain A. Dawson has been selected for appoint-ment to hold charge of the Brigade Research Labo-

ratory at Aden. Captain A. H. Bond has been

granted six months’ general leave of absence home fromIndia. Captain L. L. G. Thorpe has been transferred fromthe Royal Victoria Hospital, Netley, to Golden Hill.

Captain V. T. Carruthers has been posted to the CorkDistrict. Captain C. P. O’Brien Butler has been transferredfrom Poona to Purandhar. Captain C. T. Edmunds has

joined the station hospital, Peshawar, for duty. CaptainW. E. C. Lunn has been granted six months’ general leave ofabsence home from India from March 12th. CaptainG. A. K. H. Reed has been appointed Company Officer at the

Royal Army Medical Corps Depot, Aldershot. CaptainP. C. Douglass, from Weedon, and Captain H. A. Bransbury,from Woolwich, have embarked for a tour of service in India.Captain M. W. Falkener has joined for duty in Bermuda.Captain F. C. Sampson has been transferred to the homeestablishment from South Africa. Captain W. J. E. Bell hasarrived home on duty from Hong-Kong.

INDIAN MEDICAL SERVICE.Lieutenant-Colonel J. Chaytor White has been granted an

extension of three months’ leave on medical certificate.Lieutenant-Colonel A. W. Dawson has been appointed to holdCivil Medical Charge at Roorkee. The services of Lieutenant-Colonel A. 0. Evans, civil surgeon of Maymyo, Burma, havebeen placed at the disposal of the Government of India in theHome Department.Major E. J. O’Meara has been appointed a Civil Surgeon at

Agra. Major C. Milne, from Jhansi, has been transferred asCivil Surgeon at Mussooree in succession to Major G. T.Birdwood appointed as a temporary measure to Agra. MajorLeonard Rogers, C.LE., has been appointed a Member of theCommittee of Management of the Royal Zoological Gardensat Calcutta. Major C. B. Prall, Bengal Presidency, hasarrived home from India. Major R. W. Anthony has beenappointed Civil Surgeon at Dharwar. Lieutenant R. I.

Binning has taken over Medical Charge at Ahmedabad.Major E. S. Peck has assumed charge of the office of CivilSurgeon at Jullundur, relieving Captain H. C. Keates,transferred. Major J. W. D. Megaw, officiating professorof pathology at the Medical College. Calcutta, has beengranted privilege leave, combined with furlough, for 15months.The services of Captain J. H. Horne have been placed at

the disposal of the Government of India for special duty inconnexion with the prevention of malarial fevers in MadrasPresidency. Captain H. W. Illius, on return from leave, hasbeen appointed Civil Surgeon at Jhansi. Captain 1. M.Macrae, officiating superintendent of the Central Prison atLucknow, has been confirmed in that appointment. CaptainW. Gillitt has arrived home on leave of absence from India.Captain R. T. Wells has taken up duty as Superintendent ofthe District Jail at Dera Ghazi Khan. Captain D. S. Pattonhas been appointed to officiate as Director of the KingInstitute at Guindy. Captain F. V. 0. Beit has been

appointed to the Civil Medical Charge of the Shwebo Dis-trict, in place of Captain W. Egan, R.A.M.C. CaptainM. L. Puri has passed the lower standard examination inthe Baluchi language. Captain M. Corry has beenappointed Superintendent of the District Jail at Multan,in succession to Captain W. W. Jeudwine. CaptainP. S. Mills, plague medical officer at Delhi, has beentransferred to Hoshiarpur. Captain H. C. Buckley, plaguemedical officer at Rohtak, has been transferred to Sialkot.Captain A. J. H. Russell has been granted an extension offive months of his leave of absence on the recommendation ofa medical board. Captain M. MacKelvie, officiating civilsurgeon at Darbhanga, has been granted privilege leavecombined with furlough for one year. Captain E. C. C.Maunsell has joined the Madras Civil Medical Department.Captain H. E. S. Leathes has been appointed to act as

personal assistant to the Surgeon-General with the Govern-ment of Bombay during the absence on deputation of

Captain J. L. Lunham. Captain R. D. MacGregor hasreceived six months’ extension of his leave on medical

’ certificate.ROYAL NAVAL VOLUNTEER RESERVE.

Surgeon Arthur Robertson Brailey to be Staff-Surgeon(dated Nov. 7th, 1911).

SPECIAL RESERVE OF OFFICERS.’

Royal Army Medioal Corps.Lieutenant George H. Usmar to be Captain (dated

Feb. 24th, 1912). Lieutenant Harry D. Rollinson is con-firmed in his rank.

, DEATHS IN THE SERVICES.

Colonel Francis Joseph Lambkin, R.A.M.C., at Bloem-1 fontein, on March 8th, aged 54. He entered the army ins 1881, and after serving in India and the West Indies was1 appointed senior medical officer to Lord Dundonald’s brigadef during the South African war of 1899-1902. He was presenti at the relief of Ladysmith and at the action at Colenso, ate Spion Kop, and other operations, and in the Orange Free