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Public Health Services.INFECTIOUS DISEASE IN ENGLAND ANDWALES DURING THE WEEK ENDED

APRIL 27TH, 1929. *

Notifications.—The following cases of infectiousdisease were notified during the week :-Small-pox,354 (last week 374) ; scarlet fever, 1884 ; diphtheria,1083 ; enteric fever, 40 ; pneumonia, 1244 ; puerperalfever, 52 ; puerperal pyrexia, 82 ; cerebro-spinalfever, 22 ; acute poliomyelitis, 3 ; encephalitislethargica, 22 ; dysentery, 17 ; ophthalmia neo-

natorum, 121. No case of cholera, plague, or typhusfever was notified during the week.The number of cases in the Infectious Hospitals of the

Metropolitan Asylums Board on April 30th to May 1st wasas follows :-Small-pox, 308 under treatment, 22 underobservation (last week 276 and 13 respectively), scarletfever, 1535 ; diphtheria, 1685 ; enteric fever, 12 ; measles,101 ; whooping-cough, 1092 ; puerperal fever, 26 (plus10 babies), encephalitis lethargica, 79; poliomyelitis, 4;"’ other diseases," 60. At St. Margaret’s Hospital there were16 babies (plus 5 mothers) with ophthalmia neonatorum.

Deaths.—In the aggregate of great towns, includingLondon, there were 2 (0) deaths from small-pox,3 (2) from enteric fever, 65 (0) from measles, 3 (0) fromscarlet fever, 111 (45) from whooping-cough, 46 (9)from diphtheria, 36 (14) from diarrhoea and enteritisunder two years, and 108 (15) from influenza. Thefigures in parentheses are those for London itself.The two deaths provisionally classified to small-pox were

assigned to Northampton C.B., and Brentford and ChiswickU.D. Returns received for the month of March lastincluded one death from small-pox assigned to Strood R.D.(Kent). No great town reported more than three deathsfrom influenza except Birmingham with 8. Birminghamreported 14 deaths from measles, Sunderland 7, Nottingham,Liverpool, and Leeds 5 each. The deaths from whooping-cough are still as widely distributed, with individually higherfigures such as Liverpool 8, Birmingham 7, Manchester 6.The number of stillbirths reported during the weekwas 285 (corresponding to a rate of 43 per 1000births), including 48 in London.

Deathfrom Small-pox.—The death assigned to the Borough- of Gillingham in the week ended April 20th was that of a

female, aged 29 years, who was a passenger on the s.s.

Tuscania. The cause of death was certified as hæmorrhagicsmall-pox. We are informed by Dr. W. A. Muir, medicalofficer of health, that the patient first felt ill on the eveningof the 9th, complaining of pains in the lower back andsevere frontal headache. When seen on the llth she wasacutely ill, and the trunk was covered with an erythematousscarlatiniform rash, while on the lower abdomen a largenumber of macules were present. On the 12th theerythematous rash was still present, but much duskier intint, and scattered papules were present on the face, upperand lower arms. On the evening of the 13th the patient,who was six and a half p1.onths pregnant, had an abortion,but the child only lived a few seconds. On the 14th thepatient was markedly toxic, the face was flushed, theerythematous rash was almost livid in tint, and three smallpetechise were present below the umbilicus ; one vesiclewas present on the upper chest, and about half a dozenon the anterior abdominal wall below the umbilicus.Vesicles were present on the wrists and the palms of thehands, and macules on the dorsum of the feet and lower legs.’The patient gradually became worse, and had haemorrhagesfrom the mouth and vagina. The trunk and the upper andlower limbs were covered with minute haemorrhagic points.She died on the 15th, being the sixth day of the illness.With regard to the vaccinal state of the patient, Dr. Muir

adds that she had been vaccinated in infancy, and again (with- success) on arrival at Liverpool on April 2nd-that is, sevendays before symptoms developed. Her husband (aged 30)and only child (aged 2) who accompanied her on the voyageboth escaped infection ; the former was vaccinated in infancy,again in 1925, and on arrival at Liverpool; the latter ininfancy and on arrival at Liverpool. In neither case didthe vaccination on April 2nd take.

* We regret the misprint of 29th for 20th Aprilin the heading last week.

Correspondence.

THANK-OFFERING FUND FOR THE KING’SRECOVERY.

" Audi alteram partem."

’1.’0 Ll22 lSanor OJ 1HB LANCET.

SIR,—Now that the National Radium side of theThank-offering Fund has completed the .8150,000which it set out to obtain for radium, it would be thewish of all connected with King Edward’s HospitalFund that the needs of hospitals outside Londonshould be more directly associated with the Thank-offering Fund.’, King Edward’s Hospital Fund, selected byAudax " for his munificent gift, is partially a

national object for a thank-offering, in the sense thatthe London hospitals are national institutions andthat His Majesty is personally associated with theKing’s Fund, of which he was President for nine yearsand is now Patron. The feeling of thankfulness forthe King’s recovery is, of course, national in the verywidest sense. The desire of donors outside Londonto help their own hospitals could no doubt be metby the opening of local funds, but if donors preferto send contributions to the offices of the Thank-offering Fund at 103, Kingsway, London, W.C. 2,earmarked wholly or partly for hospitals in whichthey are particularly interested, we will take carethat such gifts are allocated in accordance with theirwishes.The main thing is that the nation’s thankfulness

should be expressed by as large a total as possible forthe benefit of hospitals, which form such a suitableobject for a Thank-offering Fund for the recovery ofa beloved Sovereign from a severe illness.

I am, Sir, your obedient servant,DONOUGHMORE,

Treasurer, Thank-offering Fund.103, Kingsway, W.C.2, May 4th, 1929.

DONOUGHMORE,Treasurer, Thank-offering Fund.

THE NEW IMPORTANCE OF RADIUM.

To the Editor of THE LANCET.SIR,—The interesting discussion on radiation in

your issue of last week raises several fundamentalprinciples that require recognition before the value ofany given method of radiation can be accuratelyestimated. The state of radio-sensitivitv of thetumour is one of the most important of these principles.The degree of radio-sensitivity of a tumour is of lessimportance in interstitial radiation than it is inexternal radiation for the reason that in the formerinstance the source of radiation is so close to thetumour cells that the factor of radio-resistance isthereby overcome. For example, a group of tumourcells in juxtaposition to an adequate source of radiumwill regress whether they are sensitive or resistant toradiation.On the other hand, the response of a tumour to a

given dose of external radiation chiefly depends uponits degree of radio-sensitivity. For example, whenhigh voltage X ray therapy was first introduced, theimmediate regression of certain tumours was attributedto this method, although the application of the samemethod did not induce regression in other tumours.Further analysis demonstrated that retrogressionof these tumours did not depend upon the applicationof high-voltage X rays, but was due to their greaterradio-sensitivity, and that they would have respondedequally well to low-voltage X rays. Still furtherstudies have revealed the fact that radio-sensitivetumours possess distinctive histological characterswhich distinguish them from tumours that are radio-resistant.A knowledge of the radio-sensitivity or radio-

resistance of a tumour is essential in estimating theefficiency of any given method of radiation treatment.