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will in a measure constitute a separate congress of itself,and will be presided over by the President of the Inter-national Commission on Cremation. On each of the eightsubjects printed reports are to be placed in the hands ofthe members of the Congress to serve as a basis of discussion.The reports for Section 3 and Section 7 are already incirculation. Such are the principal details concerning thisimportant international meeting. It will be seen that theFrench authorities have spared no pains to provide agree-able and instructive entertainment for those who respondto their invitation, that the subjects to be discussed aremost important, that the Governments of newer civilisations(such as the South American Republics) are anxious to

gain every possible information, and that therefore theEnglish sanitary reformers who have so often led in the vanof progress, should be present in large numbers on thisoccasion. It is not too late to give notice of an intentionto take part in the proceedings of the Congress. Theentrance fee is twenty francs, and communications shouldbe sent at once to the secretary of the International Congressof Hygiene at the Faculte de Médecine, Paris. All whoare concerned in hygiene, as medical men, engineers, archi-tects, inspectors, administrators, municipal councillors, &c.,will be welcomed.

It is unfortunate that space does not admit of the fulldescriptions of all the Congresses that are now meeting inParis. The International Congress for the Assistance ofthe Wounded in Time of War, for instance, gave rise tosome very important debates. The question of antisepticdressing, the mobilisation of the ambulance services, andthe best means of teaching quickly how to tender the firstnecessary help on the field of battle were all fully investi-gated. M. le Dr. Riaut naturally took the lead in many ofthese discussions, but lie was ably supported by MM. Rom-berg, Felix, John Furley, &c. The latter insisted on the caretaken in England to educate women in ambulance work.Dr. Schneider read an important paper on the salubrityof the battlefield, how best to bury the dead withoutinfecting the neighbouring residents, and without runningthe risk of burying those who were still alive. Amongother suggestions, he urged that soldiers should wear roundtheir necks or about their clothing a medal by whichthey could be identified. This would save much time.Burying parties need only remove the medal, and thusavoid all the trouble of identification. The promptness ofburials contributed very materially to the salubrity of thebattlefield. The Congress spent a considerable time visitingthe exhibits on the Esplanade of the Invalides, notably theTollet ambulances and the installations of the Societe desFemmes de France. Dr. Renault also rendered good serviceby insisting on the absolute necessity of maintaining inthe ambulance service the strictest neutrality during activewarfare. The necessity of such neutrality, though veryemphatically laid down by the Geneva Convention of 1863,was,not sufficiently understood.

MALCOLM MORRIS INDEMNITY FUND.

THE following additional subscriptions to the above fund have been received :-

The costs amount to £480. Subscriptions may be sent toMr. G. P. Field, 34, Wimpole-street; or to Dr. SidneyPhillips, 21, Upper Berkeley-street.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5471 birthsand 3850 deaths were registered during the week endingJuly 27th. The annual rate of mortality in these towns,which had been 21 ’5 and 21 ’0 per 1000 in the preceding two>weeks, was again 21’0 last week. During the first fourweeks of the current quarter the death-rate in these townsaveraged 20’3 per 1000, and was 0’2 above the mean ratein the corresponding periods of the ten years 1879-88.The lowest rates in these towns last week were 10-7 inHuddersfield, 12-2 in Derby, 14 6 in Brighton, 16-4 inBristol, and 16-5 in Oldham. The rates in the other townsranged upwards to 26-3 in Liverpool, 27-2 in Sunderland,28’0 in Plymouth, and 48’6 in Preston. The deaths referreolto the principal zymotic diseases in these towns, which hadsteadily increased in the previous five weeks from 400 to1018, declined again last week to 999; they included 682 fromdiarrhoea, 91 from measles, 71 from whooping-cough, 6?from diphtheria, 57 from scarlet fever, 31 from "fever"(principally enteric), and not one from small-pox. Thesezymotic diseases caused the lowest death-rates last week iuWolverhampton and Huddersfield, and the highest rates inSalford, Plymouth, and Preston. The greatest mortalityfrom diarrhoea occurred in Sheffield, Salford, Birmingham,Sunderland, Derby, Leeds, Leicester, and Preston; frommeaslesin Halifax, Leeds, Hull, and Preston; from whooping-cough in Oldham, Preston, Bradford, and Birkenhead; ;,from scarlet fever in Liverpool, Oldham, Huddersfield,Blackburn, and Plymouth; and from "fever" in Preston.The deaths from diphtheria included 44 in London, 7 inBradford, 5 in Salford, 3 in Plymouth, and 2 in Liverpool.Small-pox caused no death in any of the twenty-eightgreat towns; and no small-pox patient was under treatmentat the end of the week either in the Metropolitan AsylumHospitals or in the Highgate Small-pox Hospital. Thenumber of scarlet-fever patients in the Metropolitan Asylumand London Fever Hospitals at the end of last week was660, against numbers increasing in the preceding fourweeks from 559 to 623 ; 108 cases were admitted to thesehospitals during the week, against numbers increasing from33 to 92 in the previous five weeks. The deaths referredto diseases of the respiratory organs in London, which hadbeen 158 and 141 in the preceding two weeks, rose againlast week to 160, but were 29 below the corrected average.The causes of 79, or 2’2 percent., of the deaths in thetwenty-eight towns last week were not certified either bya registered medical practitioner or by a coroner. All thecauses of death were duly certified in Leicester, Portsmouth, Brighton, and in three other smaller towns. The

largest proportions of uncertified deaths were registered inLiverpool, Salford, and Sunderland.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 18 6 and 19’6 per 1000 in the precedingtwo weeks, declined to 17’9 in the week ending July 27ththis rate was 3’1 below the mean rate during the sameweek in the twenty-eight large English towns. The ratesin these Scotch towns ranged last week from 10 8 and15 ’0 in Dundee and Edinburgh, to 20 0 in Glasgow and28’3 in Paisley. The 459 deaths in the eight towns showeda decrease of 41 from the number in the previous week,and included 41 which were referred to diarrhoea, 21 to.

whooping-cough, 20 to measles, 6 to diphtheria, 4 to"fever" (principally enteric), 3 to scarlet fever, and notone to small-pox ; in all, 95 deaths resulted from theseprincipal zymotic diseases, against 81, 91, and 94 in the pre-ceding three weeks. These 95 deaths were equal to anannual rate of 3’7 per 1000, which was 1’8 below themean rate from the same diseases in the twenty-eightEnglish towns. The deaths attributed to diarrhoea, whichhad increased in the preceding four weeks from 17 to 38,further rose last week to 41, and exceeded by 20 the numberin the corresponding week of last year. The 21 fatal casesof whooping-cough exceeded the number in the previous.week by 1, and included 13 in Glasgow, 3 in Paisley, and2 in Green,)ck. The deaths from measles, which had been19 and 18 in the previous two weeks, rose last week to 20,of which 7 occurred in Leith, 6 in Aberdeen, 4 in Glasgow,and 3 in Edinburgh. The 4 deaths from "fever," including

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3 in Glasgow, showed a decline from recent weekly numbers;and of the 6 fatal cases of diphtheria, 4 occurred in (Glasgow.The deaths referred to the principal diseases of the respira-tory organs, which had been 56 and 69 in the precedingtwo weeks, declined last week to 55, but exceeded thenumber in the corresponding week of last year by 6. Thecauses of 69, or 15 per cent., of the deaths registered inthe eight towns during the week were not certified.

HEALTH OF -DUBLIN.

The death-rate in Dublin, which had been 16.3 and 22’8per 1000 in the preceding two weeks, further rose to 24’8in the week ending July 27th. During the first fourweeks of the current quarter the death-rate in the cityaveraged 21-7, the mean rate during the same period being18.2 in London and 16-2 in Edinburgh. The 168 deathsin Dublin showed a further increase of 14 upon the numbersin the preceding two weeks; they included 12 which werereferred to diarrhoea, 4 to " fever," 4 to measles, 3 to whoop-ing-cough, and not one either to small-pox, scarlet fever,or diphtheria. Thus the deaths from these principalzymotic diseases, which had been 11 and 25 in the previoustwo weeks, were 23 last week ; they were equal to an annualrate of 3 4 per 1000, the rates from the same diseases being4’4 in London and 2 3 in Edinburgh. The deaths referredto diarrhoea, measles, and whoopinn-couah were fewer thanthose returned in the previous week, while those of " fever"showed an increase. The deaths of infants were fewer, andthose of elderly persons more numerous, than those in theprevious week. Five inquest cases and 1 death fromviolence were registered; and 54, or nearly a third, of thedeaths occurred in public institutions. The causes of 11,or more than 6 per cent., of the deaths in the city were notcertified.

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Correspondence.THE

HYDERABAD COMMISSION ON CHLOROFORM.

"Audi alteram partem."

To tlte Editors of THE LANCET.SIRS,—I have referred with interest to the annotations in

your issues of Feb. 23rd and March 2nd, and notice withsurprise in the report of 128 dogs poisoned with chloroformthat, "no matter in what way it was given, in no case didthe heart become dangerously aff’ected by chloroform untilafter the breathing had stopped." The fewer number ofexperiments performed by myself with the view of findingthe best means of procuring resuscitation in cases of chloro-form poisoning, and which were published in THE LANCETin 1885, showed conclusively that in some instances thepulse stops before the respiration, but in others the respira-tion before the pulse. Reference to the detailed reports ofmy observations1 also shows that if any impediment tothe respiration exists, death results from asphyxia, the

,respiration ordinarily stopping before the circulation. Onthe other hand, if all impediment to respiration be removedby drawing forwards both the tongue and epiglottis duringthe administration of the anesthetic, when poisoning occurs,t is from cardiac syncope, the circulation stopping beforethe respiration ; although these rules are not invariable.’The danger of cardiac syncope may also be reduced hy the- exhibition of atropine and ammonia prior to the administra-tion of chloroform. In illustration of the fact that respirationsometimes ceases before circulation, and vioe versâ, allowme to quote the following extiacts from some of my experi-ments already referred to.

Exp. 5.—Weight of dog, lllb. At 3.5 PM. chloroformwas freely administered on a towel, with a small supply of;air. At 4.1 the respiration ceased entirely. At 4.2 20 sec.

the femoral pulses, which Dr. van Duyse and myself hadJbeen carefully feeling, ceased.

Exp. 6.-Weight of dog, 16.5 1b The administration ofchloroform was commenced at 6.15 P.M. The pulse becameintermittent at about 6.34, and ceased entirely at 6.34 30 sec.’The respiration ceased at the same time as the pulse, andcould not be restored by artificial respiration, the tongue’having been drawn out.

1 On Transfusion of Blood and Saline Fluid (3rd edition). Baillière,Tindall, and Cox.

E,rp. ’7. -Weight of dog, 18 lb. Chloroform administeredat 11.30 A.M. The pulse became irregular at 11.36, andceased just before the respiration, at 11.40.

E;rp. 8.—Weight of dog, 14-38 lb. Administration ofchloroform commenced at 3.34 P.M. l’tespiration stopped at3.4G. The pulse stopped at 3 51.Exp. U.—Weight of dog, 15’2 lb. Chloroform adminis-

tered at 4.10 P. M. The respiration stopped at 4 24, and thepulse at 4 32.Exp. 11.—Weiglit of dog, 11’12 lb. Administration of

chloroform at 10 21 A.M. At 10.30 the pulse became inter-mittent. At 10.34 the pulse stopped entirely, and therespiration directly afterwards.

l,’xp. 12.—Weight of dog, 7’05 lb. At 11.5d A.M. chloro-form was administered. At 12.3 P.M. the pulse becameintermittent. At 12.5 the pulse and respiration stopped,but returned after the performance of artificial respiration.Chloroform was exhibited again. At 12.8 P.M. the pulseand respiration ceased, and did not return after the renewalof artificial respiration.Exp. 13.—Weight of dog, 9.81b. At 3.49 P.M. chloroform

was administered. The pulse became intermittent at3.54 P.M.; it stopped completely once or twice, but wasrestored by artificial respiration. Finally the pulse andrespiration ceased at 4.2 p. M.Exp. 14.—Weight of dog, 16 211b. At 10.39 A.M. chloro-

form was administered. At 10.46 there was irregularity ofthe pulse, and at 10.47 it stopped. At 10.47 30 sec. therespiration stopped.Exp. 15.-Weight of dog, 27-09 lb. At 11.49 A.M. chloro-

form was administered. At 11.53 the pulse became inter-mittent, and at 11.56 it stopped. At 11.58 the rcspirationceased.Exp. 16.—W eight of dog, 26.321b. At 10.40 A.M. chloro-

form was administered. At 10.50 the pulse became inter-mittent. The respiration ceased at 10.50 36 sec. Thetongue and epiglottis had fallen back, and were both drawnforwards. Artificial respiration was performed till 10.58,the pulse having stopped at 10.55 A.M.Exp. 17.-Weight of dog, 21-8 lb. At 12.9 chloroform

was administered At 12.13 the respiration stopped, and at12.14 15 sec. the pulse also.Here are twelve experiments in which the relationship of

the cessation of respiration to circulation was noted, andit was found that in four of them (Nos. 7, 11, 14, and 15)the pulse stopped before the respiration ; in five of them(Nos 5, 8, 10, 16, and 17) the respiration stopped before thepulse ; and in three (Nos. 6, 12, and 13) the pulse andrespiration ceased simultaneously. Of the twelve dogsemployed in these experiments, five of them (Nos 5, 11, 12,14, and 15) were successfully resuscitated after apparentdeath by infusing saline fluid into the external jugularvein, with simultaneous depletion and artificial respiration,thus removing a portion of the poisoned blood and stimu-lating the respiration and circulation. In Experiment 15six minims of liquor ammoniæ in water were injectedhypodermically into the dog twelve minutes before theadministration of chloroform, in order to retard coagulationof the blood after cessation of the circulation. Ininsion ofsaline fluid was not commenced till eight minutes after thecessation of the pulse and six minutes after the cessation ofrespiration, and yet the animal recovered.

I am, Sirs, yours faithfully,CHARLES E. JENNINGS, F.R.C.S., M.S.

-LTpper Brook-street, W., July 13th, 1889.CHARLES E. JENNINGS, F.R.C.S., M.S.

DEPRESSED NIPPLES.To the Editors of THE LANCET.

SIRS,—I note on page 12 of 3 our issue of July 6th a paperby Dr. Herman on "Professor Kehrer’s Operation tor a

Depressed Nipple." Prevention is better than cure. In myhospital practice, both in and out, my attention has longbeen given to the great negligence shown by young womenand their mothers (who ought to know better) to this smallbut important organ, and I lose no opportunity, whenexamining a young female patient, of ascertaining that thenipples are properly developed, and, if not, of pointing outthe probable consequences of neglect, with advice ah to thefuture.When we consider what a pleasure it is to a woman to

nurse her bahy, we must regard a woman with an unde-veloped nipple as an incomplete human being deprived ofmuch lawful enjoyment, to say nothing of the probability