931

C. C. Coghlan is granted temporary honorary rank of Lieu-tenant whilst serving with the Australian VolunteerHospital.Captain D. J. McLaren, from Somersetshire Light Infantry

(T.F.), to be temporary Captain. Temporary Lieutenants to betemporary Captains :-H. W. B. Danaher, H. A. Beaver,H. F. Blood, A. Bloom, J. D. MacEwen, J. V. Buchanan,E. C. Williams, G. R. Lawless, J. C. Lorraine, A. J. Smith,W. A. Kennedy, C. C. Weeks, and D. L. Tate.M. K. Robertson to be temporary honorary Lieutenant.

Temporary Lieutenants who relinquish their commissions:-W. H. Croly, C. S. Palmer, J. T. Anderson, E.-T. Pinhey,C. Mathews. J. B. Dawson, B. D. Crichton, J. McG. H. Reid,J. L. Davies, V. C. Pennell, A. E. Gravelle, C. P. M. Joubert,and E. H. Drinkwater.

TERRITORIAL FORCE.

Army Medical Services.

Major (temporary Lieutenant-Colonel) E..T. R. Evatt,Welsh Field Ambulance, to be Assistant Director, MedicalServices, Welsh Division.Captain J. F. Edmiston, from Attached to Units other than

Medical Units, to be Deputy Assistant Director, MedicalServices, West Lancashire Division.

Royal Army Medical Corps. ,

Wessex Casualty Clearing Station: Captain A. Greene, fromEast Anglian Field Ambulance, to be Captain. LieutenantJ. Fenton to be Captain.London Sanitary Company: Captain H. Beeney relin-

quishes his commission on account of ill-health. !

West Lancashire Field Ambulance: Captain J. E. W. iMacFall, from T.F. Reserve, to be Captain. CaptainJ.E. W. MacFall to be temporary Major. Captain F. W. K.Tough to be temporary Major whilst in command of a Field ) Ambulance. iLondon Field Ambulance: To be Captains: Lieutenant

(temporary Captain) R. Carswell and W. M. Langdon. Southern General Hospital: Lieutenant D. R. Dow 1

relinquishes his commission on account of ill-health. (

Northern General Hospital: Captains to be Majors: 0. H. iChapman, G. A. C. Shipman, and B. McFarland. Lieutenant e

J. Pearson to be Captain. I

East Lancashire Field Ambulance : R. J. Chapman to be Lieutenant. Highland Field Ambulance : Lieutenant J. B. Foubister to

be Captain.South Midland Mounted Brigade Field Ambulance: 0.

Cook to be Lieutenant.South Wales Mounted Brigade Field Ambulance: S. Child t

to be Lieutenant. 1Lowland Field Ambulance : Lieutenant R. Armstrong to e

be Captain. iEast Lancashire Division, Sanitary Section : Lieutenant I

N. S. Golding, from London Sanitary Company, to be Lieu- 1tenant. tHighland Casualty Clearing Station : To be Lieutenants : t

W. Alexander and A. A. McKenzie. IAttached to Units other than Medical Units.-Major W. F.

Roe to be temporary Lieutenant-Colonel whilst in command i:of a Field Ambulance. Major J. E. B. Wells, from London r

Field Ambulance, to be Major. Lieutenants to be a

Captains: M. B. Dawson, D. L. Wall, D. G. Dingwall, and dF. F. C. Jagger. W. Taylor to be Lieutenant.

VITAL STATISTICS. - w

wHEALTH OF ENGLISH TOWNS. K

IN the 96 English and Welsh towns with populations exceeding 50,000 persons at the last Census 7947 births hiand 5766 deaths were registered during the week ended toSaturday, April 15th. The annual rate of mortality in ca

these towns, which had been 17-2, 17-7, and 17-7 per 1000 of 8their aggregate civil population in 1915 (7,312,295 persons), pIfell to 17-4 per 1000 in the week under notice. The death-rate ar

in the several towns ranged from 6-8 in Southend-on-Sea, 8-5 w.

in Oxford, 8-7 in Ealing, 9 0 in Ilford, and 9-4 in Smethwick, wi

to 22-7 in Middlesbrough, 23-1 in Warrington, 23-9 in Sunder- ea

land, 26-7 in West Bromwich, and 29’6 in Tynemouth. inThe 5766 deaths from all causes were 102 below the number ha

in the previous week, and included 452 which were referred fe.to the principal epidemic diseases, against 420 and 381 in cathe two preceding weeks. Of these 452 deaths, 182 resulted ’

from whooping cough, 120 from measles, 65 from diphtheria, wl57 from infantile diarrhoeal diseases, 16 from scarlet fever, WEand 12 from enteric fever, but noij one from smal’-pox. The abannual death-rate from these diseases was equal to 1-4, or la0.3 per 1000 above that recorded in the previous week. The 29deaths attributed to whooping-cough, which had increased from 85 to 141 in the five preceding weeks, further rose to wE

182, and caused the highest annual death-rates of 1-7 in TlBirmingham and in Darlington, 2-1 in West Ham, and 2-9 in 19.

Cambridge. The deaths referred to measles, which hadbeen 115, 122, and 121 in the three preceding weeks, numbered120; the highest rates from this cause were 1’7 in Salford, 1’9in Swansea, 3-6 in Grimsby, and 4-0 in Rochdale. The fatalcases of diphtheria, which had been 53, 71, and 45 in thethree preceding weeks, rose to 65, and included 13 inLondon, 8 in Liverpool, 5 in Stoke-on-Trent, 4 each inLeeds and Middlesbrough, and 3 in St. Helens. The deathsof infants (under 2 years) from diarrhoea and enteritis,which had been 65, 66, and 50 in the three precedingweeks, rose to 57, of which 16 were recorded in London,4 in Manchester, and 3 each in Birmingham and Salford.The deaths attributed to scarlet fever, which had been12, 20, and 15 in the three preceding weeks, numbered 16,and included 3 in London. The fatal cases of entericfever, which had been 9, 7, and 8 in the three precedingweeks, rose to 12, and included 2 each in Wigan andBradford.The number of scarlet fever patients under treatment in

the Metropolitan Asylums Hospitals and the London FeverHospital, which had been 1783, 1768, and 1778 at the end ofthe three preceding weeks, fell to 1717 on Saturday, April 15th ;163 new cases were admitted during the week, against 210,214, and 252 in the three preceding weeks. These hospitalsalso contained on the aforementioned date 1392 cases ofdiphtheria, 249 of whooping-cough, 142 of measles, and 40 ofenteric fever, but not one of small-pox. The 1433 deathsfrom all causes in London were 49 below the number inthe previous week, and corresponded to an annual death-rate of 17-3 per 1000. The deaths referred to diseases ofthe respiratory system, which had declined from 405 to 326in the four preceding weeks, further fell to 323 in the weekunder notice.Of the 5766 deaths from all causes in the 96 towns, 190

resulted from violence, 406 were the subject of coroners’inquests, and 1711 occurred in public institutions. Thecauses of 47, or 08 per cent., of the total deaths werenot certified either by a registered medical practitioner orby a coroner after inquest. All the causes of death werefuly certified in London and in its 14 suburban districts,in Sheffield, Leeds, Bristol, Bradford, and in 61 othersmaller towns. Of the 47 uncertified causes, 16 wereregistered in Birmingham, 8 in Liverpool, 4 in SouthShields, 3 in West Bromwich, and 2 each in St. Helens,Manchester, Stockton-on-Tees, and Tynemouth.

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns with an aggregate popula-sion estimated at 2,372,000 persons at the middle of this year,.090 births and 933 deaths were registered during the weeksnded Saturday, April 8th. The annual rate of mortalityn these towns, which had been 20-7, 19-9, and 19-6per 1000 in the three preceding weeks, rose to 20-5 per.000 in the week under notice. Among the several towns.he death-rate ranged from 14-1 in Greenock, 14-9 in Clyde-)ank, and 16-1 in Motherwell, to 21-9 in Edinburgh, 22-4 inKilmarnock, and 23-3 in Ayr.The 933 deaths from all causes exceeded the number

n the previous week by 43, and included 77 which wereeferred to the principal epidemic diseases, against 82,nd 96 in the two preceding weeks. Of these 77leaths, 36 resulted from measles, 14 from scarlet fever,0 from whooping-cough, 8 each from diphtheria andnfantile diarrhœal diseases, and 1 from enteric fever,mt not one from small-pox. The death-rate from theseliseases was equal to 1-7, against 1-1 per 1000 in thearge English towns. The deaths attributed to measles,/hich had increased from 23 to 52 in the five precedingeeks, fell to 36, and included 21 in Glasgow, 6 iniilmarnock, and 2 each in Edinburgh, Paisley, andloatbridge. The deaths referred to scarlet fever, whichad been 12, 8, and 7 in the three preceding weeks, rose

14, of which 8 were registered in Glasgow. The fatalases of whooping-cough, which had been 8, 3, andin the three preceding weeks, rose to 10, and com-

rised 5 in Glasgow, 2 each in Aberdeen and Kirkcaldy,nd 1 in Paisley. The deaths attributed to diphtheria,’hich had been 16, 15, and 8 in the three preceding weeks,’ere again 8 in the week under notice, and included 2Mh in Edinburgh, Aberdeen, and Ayr. The deaths oflfants (under 2 years) from diarrhoea and enteritis, whichad increased from 8 to 18 in the four preceding weeks,11 to 8, of which 6 were recorded in Glasgow. The fatalase of enteric fever occurred in Falkirk.The deaths referred to diseases of the respiratory system,hich had been 195, 212, and 189 in the three precedingeeks, rose to 193 in the week under notice, and were 11pove the number registered in the corresponding week ofst year. The deaths from violence numbered 39, againstand 24 in the two preceding weeks.In the 16 largest Scotch towns 1249 births and 801 deathsere registered during the week ended Saturday, April 15th.he annual rate of mortality in these towns, which had been- 9, 19-6 and 20-5 per 1000 in the three preceding weeks,

932

fell to 17’6 per 1000 in the week under notice. Among theseveral towns the death-rate ranged from 10.0 in Porth, 10’3in Clydobank, and 12-4 in Motherwell, to 22’2 in Edinburgh,22’4 in Paisley, and 22-8 in Groenock.The 801 deaths from all causes wore 132 below the

number in the previous week, and included 75 which werereferred to the principal epidemic diseases, against 96and 77 in the two preceding weeks. Of those 75deaths, 42 resulted from measles, 13 from infantilediarrhocal diseases, 8 each from scarlet fever and diph-theria, and 4 from whooping-cough, but not onefrom enteric fever or from small-pox. The annual death-rate from these diseases was equal to 1’6, or 0’2 per 1003 inexcess of that recorded in the large English towns. Thedeaths attributed to measles, which had been 43, 52, and 36in the three preceding weeks, rose to 42, and included 27 inGlasgow, 4 in Coatbridge, and 3 each in Edinburgh andPaisley. The deaths of infants (under 2 years) referred todiarrhooa and enteritis, which had been 12, 18, and 8 in thethree preceding weeks, rose to 13, of which 6 were registeredin Glasgow and 2 in Hamilton. The fatal cases of scarlet fever,which had been 8, 7, and 14 in the three preceding weeks, fellto 8, and included 4 in Glasgow and 2 in Paislev. The’deaths attributed to diphtheria, which had been 15, 8, and8 in the three preceding weeks, again numbered 8 in theweek under review ; 3 deaths occurred in Dundee and 2in Edinburgh. The fatal cases of whooping-cough, wluchhad been 3, 8, and 10 in the three preceding weeks, fell to4, all of which were recorded in Glasgow.The deaths referred to diseases of the respiratory system,

which had been 212, 189, and 193 in the three precedingweeks, fell to 167 in the week under notice, and were 11below the number registered in the corresponding week oflast year. The deaths from violence numbered 23, against24 and 39 in the two preceding weeks.

HEALTH OF IRISH TOWNS.

In the 19 town districts of Ireland with populationsexceeding 10,000 persons at the last Census, 552 births and469 deaths were registered during the week ended Saturday,April 15th. The annual rate of mortalitv in these towns,which had been 243, 26-0, and 21-5 per 1000 in the threepreceding weeks, fell in the week under notice to 21-3 per1000 of their aggregate population, estimated at 1,148,468persons at the middle of last year. The death-ratewas equal to 23-6 in Dublin (against 17 3 in London and17-7 in Glasgow), 19-7 in Belfast, 21-8 in Cork, 22-8 in

Londonderry, 16-2 in Limerick, and 13-3 in Waterford,while in the 13 smaller towns the mean rate was 21-5per 1000.The 469 deaths from all causes were 5 fewer than the

number in the previous week, and included 33 which werereferred to the principal epidemic diseases, against 47 and41 in the two preceding weeks. Of these 33 deaths, 16resulted from measles, 9 from whooping-cough, 5 frominfantile diarrhœal diseases, 2 from enteric fever, and 1from scarlet fever, but not one from small-pox or diphtheria.The annual death-rate from these diseases was equal to 1-5,against 1-4 per 1000 in the large English towns. The deathsattributed to measles, which had been 18, 18, and 13 in thethree preceding weeks, rose to 16, and comprised 12 inBelfast, 3 in Dublin, and 1 in Cork. The deaths referred towhooping-cough, which had been 15, 13. and 16 in the threepreceding weeks, fell to 9, and comprised 6 in Dublin,2 in Belfast, and 1 in Lisburn. The fatal cases ofdiarrhoea and enteritis (among infants under 2 years), whichhad been 5, 8, and 8 in the three preceding weeks, fell to 5,but showed no excess in any town. The 2 deaths fromenteric fever were registered in Dublin and that fromscarlet fever in Belfast.The deaths referred to diseases of the respiratory system,

which had been 134, 142, and 120 in the three precedingweeks, numbered 119 in the week under notice, and were1 above the number registered ill the corresponding week of Ilast year. Of the 469 deaths from all causes, 149, or 32 per cent., occurred in public institutions, and 6 resulted fromviolence. The causes of 11, or 2-3 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest, and included5 in Dublin; in the large English towns the proportion ofr.ncertified causes did not exceed 0-8 per cent.

CHILDREN AND FRUIT.-At a meeting held on behalfof the National Children’s Home and Orphanage at theMansion House on April 25th, Sir Thomas Barlow saidthat we did not sufficiently realise the need for makingfood attractive for growing children. Meat should be wellcooked with a good supply of properly cooked vegetables.The importation cf bananas and oranges had had a far-reaching effect on the digestion of the children, and if theimportation of fruit was Illterfered with, the children of thehumblest classes would certainly suffer.

Correspondence."Audi alteram partem."

INFLUENCE OF FEBRILE CONDITIONS ONINOCULATION AGGLUTININS.

To the Editor of THE LANCET.

SIR,-In his adroit and skilful letter in your issue of

April 22nd, replying to certain criticisms put forward byProfessor Dreyer, Dr. Gibson, and myself, Dr. H. L. Tidyhas unfortunately been misled into instituting a comparisonbetween dissimilar materials. Our figures were obtainedfrom cases examined at a much longer average interval of timefrom their inoculation than Dreyer and Inman’s figures for thehealthy inoculated individuals 2 whom they examined justa year ago within some few months of their dates of inocula-tion. It follows that even had the individuals who consti.tuted our material remained in perfect health instead ofsuifering from febrile disorder, they would still have exhi.bited a much lower range of agglutinin titre than Dreyerand Inman’s subjects, since the agglutinin titre of inoculatedpersons falls with lapse of time. Hence our figures do not,as Dr. Tidy supposes, support his views, even in theirgreatly modified form, which he now appears to substitutefor his original revolutionary contentions. Moreover, themanner in which Dr. Tidy uses the two sets of figuresexposes him to further criticism. For it cannot be acceptedas a legitimate statistical procedure to strike means as Dr.

Tidy does from what are relatively small numbers of obser.vations, where the ranger of individual variation is so

enormous, as, for example, 74 observations in which therange of titre runs from 30 to 1390 agglutinin units, aforty-six-fold variation.Owing to these misconceptions Dr. Tidy’s main argument

clearly falls to the ground. It is, therefore, unnecessary forme to trespass on your space by dealing with a number ofsubsidiary points in Dr. Tidy’s letter, in which there areevident other misinterpretations or misunderstandings ofwhat one or other of us has written on the subject of

agglutination. I should, however, be glad to take this

opportunity of saying, in reference to the very emphatic"character which Dr. Tidy noted in our denials of his con-tentions, that while we thought it necessary to expressourselves as forcefully as possible, I trust Dr, Tidy will bewilling to acquit our emphasis of any suspicion of intentionaldiscourtesy. I am- Sir. vnurs faithfnllv.

E. W. AINLEY WALKER.University College, Oxford, April 24th, 1916.

TRANSMISSION AND EXAMINATION OFPLAGUE SPECIMENS.To the Editor of THE LANCET.

SIR,-In the report of the Manchurian Plague Commission(1911) is a paper by Dr. Broquet recommending his solu.tion-neutral glycerine 20 c.c , distilled water 80 c.c.,calcium carbonate 2 gm -as a medium for plague materialduring transmission to the laboratory, by post or otherwise,in order to prevent putrefaction. It would appear thatduring the Manchurian outbreak this solution was exten-

sively used with satisfactory results. As in South Africaspecimens sometimes take several days to reach the labora-tory, and are extremely liable to undergo putrefaction, thesolution was welcomed as supplying a much-felt want; itwas much used in sending specimens from Queenstown anddistrict to Cape Town during the earlier part of the recentplague outbreak in the Cape Province. These specimenswere three or four days, and sometimes longer, in transit.Usually cubes of tissue, measuring about one inch each way,were cut from the lungs, liver, spleen, &c., and forwarded inwide-mouthed bottles. The solution prevented putrefaction,bnt rendered smears much more difficult to fix on the slides.The best results were obtained by using the centra!parts of the cubes (least affected by the glycerine) formicroscopic and inoculation purposes. It was, however,found that inoculations of such material gave negative

1 THE LANCET, April 8th, 1916.2 THE LANCET, July 31st, 1915.