551VITAL STATISTICS.-THE SERVICES.

Aug. 24th. The annual rate of mortality in these towns, whichhad been 20’8 and 19’1 per 1000 in the two preceding weeks,rose again to 19’9 last week. In London the rate was17’0 per 1000, while it averaged 22’0 in the thirty-twolarge provincial towns. The lowest rates in these townswere 11’8 in Croydon, 12-4 in Swansea, 12’9 in Plymouth,15’5 in Bristol, and 15’9 in Leicester ; the highest rates ’,,were 28-2 in Liverpool, 29-0 in Salford, 30-4 in Man-chester, 33-2 in Hull, and 35-6 in Blackburn. The 4045deaths included 977 which were referred to the principalzymotic diseases, against 1076 and 929 in the two

preceding weeks ; of these, 657 resulted from diarrhoea,115 from measles, 64 from whooping-cough, 47 from diph-theria, 46 from scarlet fever, 40 from "fever" (principallyenteric), and 8 from small-pox. In the large towns thesediseases caused the lowest death-rates in Bristol, Croydon,Swansea, Halifax, and Plymouth ; and the highest rates inBolton, Wolverhampton, Salford, Hull, and Blackburn. The

greatest mortality from measles occurred in West Ham,Salford, and Blackburn ; from whooping-cough in Liverpool,Gateshead, Blackburn, and Birkenhead ; and from diarrhoea inSheffield, Derby, Wolverhampton, Preston, Salford, Bolto n,and Hull. The mortality from scarlet fever and from"fever" showed no marked excess in any of the largetowns. The 46 deaths from diphtheria included 24 inLondon and 3 in Liverpool. Six fatal cases of small-poxwere registered in London and 2 in Oldham, but not onein any other of the thirty-three towns. There were 357cases of small-pox under treatment in the Metro-

politan Asylum Hospitals and in the Highgate Small-poxHospital on Saturday last, the 24th inst., against 237, 273,and 336 at the end of the three preceding weeks; 65 newcases were admitted during the week, against 60, 54, and79 in the three preceding weeks. The number of scarletfever patients in the Metropolitan Asylum Hospitals and inthe London Fever Hospital at the end of the week was 2507,against 2423, 2511, and 2529 on the three preceding Satur-days ; 307 new cases were admitted during the week, against247, 276, and 357 in the three preceding weeks. The deathsreferred to diseases of the respiratory organs in London,which had been 159 and 137 in the two preceding weeks,rose again to 170 last week, and were 1 below the correctedaverage. The causes of 31, or 0-8 per cent., of the deathsin the thirty-three towns were not certified either by aregistered medical practitioner or by a coroner. All the

causes of death were duly certified in Bristol, Nottingham,Bradford, Hull, Newcastle, and in seventeen other smallertowns; the largest proportions of uncertified deaths were

registered in Blackburn and in Birkenhead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 17-6 and 16-6 per 1000 in the two precedingweeks, was again 16’6 during the week ending Aug. 24th,and was 3-3 per 1000 below the mean rate during the sameperiod in the thirty-three large English towns. The rates inthe eight Scotch towns ranged from 12-1 in Leith and 15-0in Glasgow to 20-6 in Perth and 21-4 in Aberdeen, The479 deaths in these towns included 42 which were referred todiarrhoea, 24 to whooping-cough, 8 to scarlet fever, 6 toto "fever," 2 to measles, 1 to diphtheria, and not one tosmall-pox. In all, 83 deaths resulted from these principalzymotic diseases, against 102 and 99 in the two precedingweeks. These 83 deaths were equal to an annual rate of2-9 per 1000, which was 1-9 below the mean rate last weekfrom the same diseases in the thirty-three large Englishtowns. The fatal cases of diarrhoea, which had been 55, 68,and 60 in the three preceding weeks, further declined to 42last week, of which 17 occurred in Glasgow, 10 in Edinburgh,and 9 in Dundee. The deaths referred to whooping-cough,which had been 12, 17, and 15 in the three preceding weeks,rose again to 24 last week, and included 6 in Glasgow, 5 inDundee, and 4 in Aberdeen. The deaths from scarlet fever,which had increased from 3 to 7 in the three precedingweeks, further rose to 8 last week, of which 6 occurredin Glasgow. The fatal cases of "fever," which hadbeen 5, 4, and 6 in the three preceding weeks, were again6 last week, and of these 4 occurred in Glasgow. Thedeaths from measles, which had decreased from 11 to 7 inthe four preceding weeks, further fell to 2 last week, andincluded 1 in Glasgow and 1 in Greenock. Only 1 deathfrom diphtheria was recorded, being 3 less than in the pre-ceding week, and that occurred in Dundee. The deathsreferred to diseases of the respiratory organs in these

towns, which had been 67 and 57 in the ’two pre..ceding weeks, further declined to 55 last week, butexceeded by 4 the number in the corresponding week oflast year. The causes of 31, or nearly 7 per cent., of thedeaths in these eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 22’2 and 24.0’per 1000 in the two preceding weeks, fell again to20’9 during the week ending Aug. 24th. During the pasteight weeks of the current quarter the death-rate in the cityhas averaged 23’3 per 1000, the rate during the same periodbeing 20’1 in London and 16’5 in Edinburgh. The 140deaths registered in Dublin during the week under noticeshowed a decline of 21 from the number in the precedingweek, and included 11 which were referred to the principalzymotic diseases, against 27 and 21 in the two pre-ceding weeks ; of these, 9 resulted from diarrhoea,1 from scarlet fever, 1 from whooping-cough, and notone from small-pox, measles, diphtheria, or " fever,"These 11 deaths were equal to an annual rate of1-6 per 1000, the zymotic death-rate during the same-

period being 3’0 in London and 0’8 in Edinburgh. Thefatal cases of diarrhoea, which had been 17, 23, and 16 inthe three preceding weeks, further fell to 9 last week.The mortality from whooping-cough corresponded with thatrecorded in the preceding week, while that from scarlet.fever showed a decline. The 140 deaths in Dublin lastweek included 26 of infants under one year of age, and 32.of persons aged upwards of sixty years; the deaths both ofinfants and of elderly persons showing a decrease. Seven

inquests were held and 8 deaths from violence were registered; ;.and 45, or nearly a third, of the deaths occurred in publicinstitutions. The causes of 10, or more than 7 per cent., ofthe deaths in the city last week were not certified.

THE SERVICES.

ARMY MEDICAL STAFF.SUEGEON-LIEUTENANT-COLONEL RANDOLPHE HARMAN,

M.B., to be Brigade-Surgeon-Lieutenant-Colonel.INDIA AND THE INDIAN MEDICAL SERVICES.

Surgeon-Captain H. B. Luard, at present officiating AgencySurgeon at Gilgit, is appointed to the permanent MedicalCharge of the 45th Sikhs, and Surgeon-Captain G. H. Frost tothe permanent Medical Charge of the 22nd Punjaub Infantry.Surgeon-Major R. J. Baker, M.D. (Bombay), Officiating Medi-cal Officer of the 2nd Regiment, Central India Horse, and ofthe Poona Political Agency, is appointed to officiate as MedicalOfficer of the lst Regiment, Central India Horse, and of theWestern Malwa Political Agency, and during the absenceon leave of Surgeon-Captain T. W. Shaw, M.B., or untilfurther orders. Surgeon-Major A. E. J. Croly, F.R.C.S.I.,is appointed to act as Medical Officer on the staff of hisExcellency the Governor during the absence of Surgeon-Major H. Martin, M.B., or pending further orders.

NAVAL MEDICAL SERVICE.The undermentioned surgeons have been promoted to

the rank of Staff-Surgeon in Her Majesty’s Fleet :-EdwardJohn Morley, Hugh Winckworth Macnamara, Joseph HenryWhelan, M.D., Percy William Bassett-Smith, John PatrickJoseph Coolican, Edgar Ralph Dimsey, Joseph RevilleMcDonnell, M.D., Hamilton Meikle, and Herbert Canton.The following appointments are announced :-Staff-

Surgeon J. H. Whelan to the Volage. Surgeons : JamesL. Smith, M.B., to the Blonde Frederick Fedarb, M.B.,to Haslar Hospital; E. P. Mourilyan to the Corvioraibt, ;W. J. Maillard to the Excellent; F. Bradshaw to the Plassy ;H. Elliott to the Sphinx; T. Austen to the Wildfire; G. Leyto Bermuda Hospital; H. S. Burniston to the Active; J. H.Thomas to the Pembroke; G. Welch to the Tyne; and E.St. M. Nepean to the Victory (additional).

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Lieutenant Percival M. Yearsley, having vacatedhis Volunteer Medical appointment, ceases to be an Oflicerof the Army Medical Reserve of Officers.

VOLUNTEER CORPS.Rifle : 1st Volunteer Battalion the Suffolk Regiment e

552 COUNTRY PRACTITIONERS AND LOCUM-TENENTS.

Surgeon-Lieutenant P. J. L. Morris resigns his commission.2nd Volunteer Battalion the Suffolk Regiment : SamuelJohn James Kirby, M.D., to be Surgeon-Lieutenant. lst

.(Cumberland) Volunteer Battalion the Border Regiment:Surgeon-Lieutenant S. Braithwaite resigns his commission.1st Volunteer Battalion the Gordon Highlanders: Surgeon-Lieutenant G. M. Edmond, M.D., to be Surgeon-Captain.

THE ARMY REORGANISATION.The Ministerial statement in the House of Lords in

reference to the forthcoming reorganisation of the WarOffice is sufficiently clear and explicit as far as it goes. Thenew policy is not only based upon, but it is almost identicalwith, the recommendations of the Hartington Commission,except in one important particular-viz., that there will notbe a Chief of the Staff appointed as recommended by thatCommission. Lord Wolseley will for the next five years bethe military head of the Queen’s Army and exercise thosefunctions which have hitherto been discharged by the Dukeof Cambridge. There are, of course, a number of other im-

portant points embodied in the new scheme of reorganisation,but the foregoing really includes the main considerations ofinterest to the army and the nation.

DEATHS IN THE SERVICES.

Brigade-Surgeon-Lieutenant-Colonel J. F. Sargent, LM.S.,Madras Establishment, died at Hingoli on July 20th fromabscess on the liver, aged fifty-one. He was appointed sur-geon in 1873 and surgeon-major in 1878, and attained therank of brigade-surgeon-lieutenant-colonel in 1890.

Brigade-Surgeon-Lieutenant-Colonel J. Riddick, A.M.S.,died in India on July 27th. He joined the Army in 1857,became surgeon in 1873, surgeon-major in 1879, and brigade-surgeon - lieutenant - colonel in 1894 ; Afghan War, 1880,(medal).

THE WAZIRISTAN HONOURS.

Surgeon-Colonel Lionel Dixon Spencer, LM.S., is to beOrdinary Member of the Military Division of the Third Class,or Companion, of the Most Honourable Order of the Bath, andBrigade-Surgeon-Lieutenant-Colonel George McBride Davis,I.M.S., is to be a Companion of the Distinguished ServiceOrder.

The War Office have instructed Messrs. Paterson andCooper to proceed with the erection at Netley Hospital of theHermite sanitation plant, the cost of which has been pro-vided for in this year’s Parliamentary estimates.

Correspondence.

COUNTRY PRACTITIONERS AND LOCUM-TENENTS.

To the Editors of THE LANCET.

" Audi alteram partem."

SIRS,—Kindly allow me space for a few remarks about thetroubles, losses, &c. country practitioners experience fromindividuals they engage to take charge of their practiceswhilst taking the much-needed holidays. My experiences havebeen very painful, but, I believe, not worse than those of othergeneral practitioners. Out of seven (all except Nos. 1 and 7were supplied by agents) No. 1 alone gave satisfaction.No. 3 lamed my horse by jumping it over fences or by otherwork it was not fitted for. No. 5 took fright at a case ofsmall-pox and bolted after helping himself to money he wasnot entitled to. No. 6 was so drunken that I had to give up my holiday at an hour’s notice to get rid of him just beforehe had delirium tremens. In fact, all except No. 1 acted asif on a holiday or spree, doing as little as possible andnever booking that little legibly or fully, neglectingpatients, and during such few hours they thought fit to stayin my house making themselves as untidy, slovenly, anddisagreeable as possible. These gentlemen demand threeguineas a week, board, lodging, and all expenses. Havinggot all immediately after the employer’s return, there are nomeans of calling them to account, as their delinquencies areonly discovered later on, after their being paid and dis-missed. I suggest that two recent references should be

required from each applicant, and that even if he is recom-mended by an agency. If honest replies are sent, then the

necessary holiday can be taken without the losses andannoyances 1 have written about. I quote the followingfrom a letter from -,i, country practitioner whom, althoughI have never met him, I am glad to know I warned againstemploying as locum-tenent one of the most ungentle-manly persons that I ever met with. He writes as follows :"I deeply sympathise with your having been served thesame way as myself by such worthless, indifferent, andincompetent men going about the country....... I am deter-mined before I engage another man to find out his ante-cedents....... If employers were more honest and truthfulmuch heart-burning would be saved." I trust generalpractitioners will take the advice given by my correspondent,and not only decline to recommend but expose anyone whodoes not carry out his duties and behave himself as a gentle-man ought to do whilst in their employ.

I am, Sirs, yours faithfully,HENRY PILKINGTON, M.R.C.S. &C.

Ormskirk, Lanes, Aug. 26th, 1895.

THE PAYMENT OF MEDICAL WITNESSES.To the Editors of THE LANCET.

SIRs,-My partner and I had to attend the lastAssizes held at Lincoln as medical witnesses in a man-

slaughter case. On each of three days we had to leave homeat 9.20 A.M. On two of the days the earliest time we couldpossibly get back was 5.20 P.M., and on the third day 1 P.M.We were paid one guinea per diem each, and an allow.ance of 12s. 10d. each for expenses-a total of E3 15s. lOd.for an enforced absence from our practice of nine-teen hours and forty minutes. I am writing you this

simple statement hoping that you, or some of the numerousreaders of THE LANCET, will suggest some means wherebyunited action can be taken, in order that the present stateof things may be altered, so that medical witnesses insimilar cases shall be paid reasonable fees for their los,of time and trouble.

I am, Sirs, yours faithfully,- --1 ---

Gainsborough, Aug. 22nd, 1895. JOHN E. S. PASSMORE.

*** Our correspondent will note that the subject-matterof his letter is dealt with in a leading article in our presentissue.-ED. L.

"AN IMPOSTOR."To the Editors of THE LANCET.

SIRS.&mdash;The letter you publish in THE LANCET of Aug. 24tltfrom Dr. F. W. Saunders has interested me, for I, too, wa.<

favoured the other day from the Goswell-road. In thiscase the writer sign;-! himself Arthur E. Ronald, whichis the name of an old friend of mine who was at

Cambridge and St. Thomas’s Hospital with me. The

letter asks for an immediate loan and promises subse-

quent explanations. Certain circumstances and signs, how-ever, made me doubt the genuineness of the communica-tion and so save myself from the imposition. A friend ofmine writes to me from Cambridge and tells me that a shorttime ago he actually fell a victim to some (probably thesame) rascal, who wrote to him from an address in the

Gray’s-inn-road, signing himself George Anson, and askingfor an immediate loan. In these two instances the four

persons written to and from were intimate friends both atCambridge and at Thomas’s Hospital. Drs. Ronald andAnson are at present in practice abroad, the former in llel-bourne and the latter in New Zealand. The letters showthat their whereabouts were well known to the writer.

I am, Sirs, yours faithfully, - -

Cheltenham, Aug. 23rd, 1895.EDGAR TREVITRICK, M.D. Cantab.895.

"THE TREATMENT OF ACUTE RHEUMATICENDOCARDITIS."

To the Editors of THE LANCET.SIRS,-In THE LANCET of Aug. 17th there is a valuable

contribution to this important question by Dr. Caton ofLiverpool. I should not have been prompted by the generaltenour of his paper to trouble you with any words from me onthe subject, but I am tempted to accede to his request whenhe so pointedly says, "I I am anxious to know what the