1233VITAL STATISTICS.

county, which had a population of 322,316 in 1891, has notmuch to say in its annual summary for 1899 as to the

sanitary requirements of the districts under its care. The

general death-rate was 16’08 per 1000 and the zymoticdeath-rate was 1’132 per 1000. The infantile mortality was135’27 per 1000 births, as compared with a rate of 163 per1000 births for England and Wales for the same period. As

regards measles *’ the mortality-rate worked to two placesof decimals is represented by zero." The diarrhoeal death-rate was 0’48 per 1000, as against 0’98 for England andWales. The enteric fever death-rate amounted to 0’14 per1000. We should have been glad of some information relativeto water-supply, sewage disposal, isolation accommodation,&c., in the county.

The Island of fluernsey.-Dr. John Brownlee, the newly-appointed medical officer to the board of health of Guernsey,embodies some interesting information in his first annual

report. There is, unfortunately, no system of the registra-tion of the causes of death by qualified practitioners inGuernsey and hence the records of the island in this senseare very defective. Dr. Brownlee has, however, been ableto extract (a) the number of births and deaths for the last20 years, (b) the ages of all who died between 1887 and 1898,and (e) the causes of death in so far as they relate toinfectious diseases. It seems that this sanitary quickeningin the case of Guernsey may be traced to the prevalenceof diphtheria in recent years, an occurrence which led tothe appointment of a special committee of inquiry whichin turn recommended the appointment of a medical officerof health. Moreover, public lectures were arranged for,isolation accommodation of a sort was provided, and a labo-ratory was fitted up, and Soally it was determined to forma board of health for the island. Diphtheria has, therefore,not been without its uses in Guernsey. The total populationof the island (including some 500 soldiers) is estimated at37,905, and the general death-rate, corrected for age distribu-tion, was for 1899 16-5 per 1000. The infantile mortalitywas 135 per 1000 births, as against a rate for the Isle of

Wight (1881-1891) of 89 and for the Scilly Isles of 117." Convulsions " figure altogether too prominently in thecauses of infantile deaths, and there is obviously much roomfor improved certification. Infectious disease has in the pastbeen but little under any control, but the medical officer ofhealth will, we think, soon modify this condition of affairs.An improved water-supply seems to us one of the most

pressing needs of the population. We congratulate Guernseyupon its sanitary awakening.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6416 births and 3815deaths were registered during the week ending Oct. 20th.The annual rate of mortality in these towns, whichhad declined from 18-4 to 17-1 per 1000 in the threepreceding weeks, was again 17-1 last week. In Londonthe rate was 15-8 per 1000, while it averaged 18-0in the 32 provincial towns. The lowest death-rates inthese towns were 10-4 in Halifax, 10-7 in Cardiff, 11-3in Norwich, and 11’9 in Croydon ; the highest rates were22-3 in Manchester, 22-7 in Sheffield, 23-6 in Salford,and 28-6 in Gateshead. The 3815 deaths in thesetowns included 468 which were referred to the principalzymotic diseases, against numbers decreasing from 776 to563 in the three preceding weeks ; of these, 197 resulted fromdiarrhoea., 85 from diphtheria, 71 from "fever" (principallyenteric), 43 from whooping-cough, 37 from measles, and 35from scarlet fever. The lowest death-rates last week fromthese diseases occurred in Plymouth, Birkenhtad, Bolton,and Halifax ; and the highest rates in Swansea, Leicester,Salford, and Blackburn. The greatest mortality frommeasles occurred in Swansea ; from scarlet fever in

Sunderland ; from whooping-cough in Gateshead ; from"fever" in Portsmouth, Wolverhampton, Nottingham, andPreston ; and from diarrhaea in Cardiff, Norwich, Blackburn,and Gateshead. The 85 deaths from diphtheria in-cluded 36 in London, nine in Leicester, eight in Leeds,and eight in Sheffield. No fatal case of small-pox was registered last week in any of the 33towns ; and only one small-pox patient was under treat-ment on Saturday last, Oct. 20th, in the Metropolitan

Asylums hospitals. The number of scarlet fever patients inthese hospitals and in the London Fever Hospital at theend of the week was 2342, against numbers increasing from1703 to 2187 on the seven preceding Saturdays ; 328 new caseswere admitted during the week, against 318, 313, and 322in the three preceding weeks. The deaths referred to

diseases of the respiratory organs in London, which hadbeen 164 and 173 in the two preceding weeks, furtherrose last week to 182, but were 106 below the correctedaverage. The causes of 52, or 1 4 per cent., of the deathsin the 33 towns were not certified either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in Nottingham, Bradford, Leeds,Hull, Newcastle, and 12 other smaller towns; the largestproportions of uncertified deaths were registered in WestHam, Birmingham, Liverpool, Preston, Sheffield, and Gates-head.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 19 and 18-0 per 1000 in the two

preceding weeks, further declined last week to 17’5,but showed an excess of 0’4 per 1000 over the mean death-rate during the same period in the 33 large Englishtowns. The rates in the eight Scotch towns rangedfrom 11-9 in Leith and 12-0 in Greenock to 18-9 inGlasgow and 23-0 in Aberdeen. The 542 deaths in thesetowns included 30 which were.referred to diarrhoea, 14 towhooping. cough, eight to diphtheria, six to " fever," five toscarlet fever, two to small-pox, and two to measles. In all,67 deaths resulted from these principal zymotic diseases,against 107 and 74 in the two preceding weeks. These 67deaths were equal to an annual rate of 2-2 per 1000,being 0’1 per 1000 above the mean rate last week fromthe same diseases in the 33 large English towns. Thefatal cases of diarrhoea, which had been 53 and 36 inthe two preceding weeks, further declined last week to30, of which 12 occurred in Glasgow, eight in Dundee, fivein Edinburgh, and four in Aberdeen. The deaths from

whooping-cough, which had been 18 and 13 in the two

preceding weeks, rose again to 14 last week, and includedseven in Glasgow and four in Greenock. The fatal cases ofdiphtheria, which had been five and seven in the two

preceding weeks, further rose last week to eight, of whichfive were registered in Glasgow and two in Edinburgh. Thedeaths referred to different forms of "fever," which hadbeen 13 and five in the two preceding weeks, rose againto six last week, and included five in Glasgow. The fatalcases of scarlet fever, which had been seven in each of thetwo preceding weeks, declined last week to five, of whichthree occurred in Glasgow, where the two deaths from small-pox were also registered. The deaths referred to diseases ofthe respiratory organs in these towns, which had been 98 and104 in the two preceding weeks, further rose last week to117, and showed an excess of 33 over the number in thecorresponding period of last year. The causes of 18, ormore than 3 per cent., of the deaths in these eight towns lastweek were not certified.

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HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 26’0 and 26’4per 1000 in the two preceding weeks, declined again to 24-9during the week ending Oct. 20th. During the past fourweeks the death-rate in the city has averaged 25’5 per 1000,the rate during the same period being 15’8 in Londonand 16 8 in Edinburgh. The 167 deaths belonging to Dublinregistered during the week under notice showed a decline of10 from the number in the preceding week, and included 19which were referred to the principal zymotic diseases, against36 and 21,in the two preceding weeks ; of these nine resultedfrom diarrhoea, five from "fever," three from diphtheria,and two from whooping-cough. These 19 deaths were equalto an annual rate of 2’8 per 1000, the zymotic death-rateduring the same period being 1-7 in London and 1-5 inEdinburgh. The fatal cases of diarrhoea, which had been36 and 21 in the two preceding weeks, further declinedlast week to 19. The deaths referred to different forms of" fever," which had been three and four in the two pre.ceding weeks, further rose to five last week. The threedeaths from diphtheria showed a marked increase over thenumbers in recent weeks. The 167 deaths in Dublin lastweek included 36 of infants under one year of age and 32 ofpersons aged upwards of 60 years ; the deaths both of

1234 THE SERVICES.—"THE ETIOLOGY OF SCARLET FEVER."

infants and of elderly persons showed a decline from the I

numbers recorded in the preceding week. One death fromviolence and four inquest cases were registered, and 55, ornearly one-third, of the deaths occurred in public institu-tions. The causes of 9, or more than 5 per cent., of thedeaths in the city last week were not certified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.FLEET SURGEON WILLIAM GEORGE JACK has been placed

on the retired list of his rank. Surgeon M. W. Falkner isplaced on the retired list.The following appointments are notified :-Fleet Surgeon

C. E. Geoghegan to the 60 ; Staff Surgeon H. Harries tothe Nile. Surgeons : H. Huskinson and J. G. Wallis to theGlory; J. G. Corry to the Oondor; E. T. Burton to the

,8andpi.per ; L. A. Baiss to the Woodcock; R. A. Ross to theMonarch, additional for Ascension Hospital; and C. H. J.Robinson to the Excellent.

ROYAL ARMY MEDICAL CORPS.

Captain H. C. French has been transferred from the Mhowdistrict to the Nagpore district and Captain W. Tibbits fromthe Nagpore district to the Mhow district. Major F. J.Greig has taken over medical charge of staff and depart-ments in Dover.

INDIA AND THE INDIAN MEDICAL SERVICES.Lieutenants to be Captains :-John George Patrick Murray,

Samuel Anderson, Francis Hope Grant Hutchinson. JamesLeslie Marjoribanks, Alexander Fenton, James Allen Dredge,and Robert Welland Knox. Lieutenant-Colonel Edgar GeerRussell, Bengal Establishment, retires.

TRANSVAAL WAR NOTES.

Surgeon-Major Davies, Imperial Light Horse, has arrived’invalided at Plymouth from South Africa.The following sick or wounded officers have left South

Africa for England :-Lieutenant-Colonel Irvine, R.A.M.C.,in the Britannic, and Major Reade, R.A.M.C., and CivilSurgeons E. Laming Evans and Day in the ginfauns Castle.These vessels left Cape Town on Oct. 6th and llthrespectively.The Saxon, with members of the medical staff of the

Welsh Hospital on board, arrived at Southampton on

Oct. 19th.The Welsh Hospital, which was located at Springfontein;

was handed over to the Government on Sept. 30th as aconvalescent hospital. Four members of the staff havedied. The hospital was visited several times by Lord andLady Roberts.THE MATERIAL SUSCEPTIBLE TO ENTERIC FEVER IN

INDIA.

The Sanitary Commissioner with the Government of Indiain his annual report for 1898, in commenting upon a tablewhich gives some information regarding the relation ofadmission from enteric fever among European troops servingin India to age and length of residence in that country putsthe matter very succinctly and in a striking light. The age-period 20 to 25 years included 51 per cent. of the totalstrength of the army, and in the same period the liabilityto fall sick from enteric fever was greatest, 46 per cent. Inthe succeeding periods the liability rapidly declined. Again,though 18 per cent. of the men of the army were of lessthan one year’s service in India, 18 per cent. of more thanone and less than two years’ service, and 18 per cent. of morethan two and less than three years’ service, yet the liabilitiesof the men of these three equal percentages to, contractenteric fever were respectively 43, 18, and 12 per cent.

CHINA.From a military point of view matters are apparently

stationary in China. The allied troops are working north andsouth of Paotingfu. It was reported that Count von Walderseehad been suffering from a mild form of dysentery which had,however, only caused a comparatively slight and temporaryindisposition. The 4th Brigade from India had arrivedin China. As far as the medical branch of the armyserving with the Indian contingent is concerned it isbelieved to be ample for the requirements of the force Inow operating in China. From a political and Foreign Office I

point of view it is generally thought that Lord Salisbury’saction in the matter of the Anglo-German agreementpromises to be a diplomatic success. The terms of the con-vention offer a reasonable and practical platform for acombined international line of action, and there seems to bea growing impression among the Powers in favour of the

Anglo-German agreement.AMBULANCE RESERVES FOR INDIA.

It may probably be in the recollection of our readers thatsome time ago Major A. C. Yate, of the 29th BombayInfantry, called attention to this subject, which has acquiredsome additional importance from the fact that an Indianforce is operating in China and has had to draw on ourIndian Empire for the supply of its ambulance system.Major Yate pointed out that India has an army of 70,000British, 150,000 native, 30,000 volunteer, and 25,000 ImperialService troops, for which she possesses no ambulance reservewhatever. This is a subject which calls for further investi-gation and consideration, and we are consequently glad tonotice that the limes of India has recently called theattention of the military and medical authorities to it.

Correspondence.

"THE ETIOLOGY OF SCARLET FEVER."

"Audi alteram partem. "

To the Editors of THE LANCET.SIRS,-In THE LANCET of Sept. 29th, 1900, p. 927,

there appears an article on the Etiology of Scarlet Feverby Dr. William J. Class of Chicago, in which he attacksa communication of ours on the same subject which appearedin the Berliner Klinische Wochenseltrift of July 9th, 1900.He expresses himself in what seems to us a ratherexcited tone, as if he thought that his communications,which appeared in an American journal, had not receivedappropriate credit from us. For this there is not the leastpossible reason. From a perusal of our publication thereader will readily be convinced that, so far as lay withinthe bounds of possibility, account is taken in our article of awide range of literature. Notwithstanding the difficulty, acertain number of foreign journals were carefully perused,among them a goodly number of American publications, butwe are sorry to admit that it is only through the article inTHE LANCET that Dr. Class’s work became known to us.Dr. Class must be ignorant of the customs of earnest

Germans, and especially of our work, if he thinks that wewish to rob him of the merits of this investigation.As far as we are concerned, it is sufficient for us to see

the results of one of the most obscure and difficultpoints in the pathology of childhood enlarged. Far from

any feeling of jealousy we would consider ourselves mostfortunate if our results should coincide with those ofan investigator who has worked along the same lines whileso widely separated from us. This would ascertain the

importance of both. It is, however, quite impossible to

render an absolute judgment upon the coincident results,without a comparison of the cultures. In one thing weoppose Dr. Class and strongly declare that we have obtainedabsolutely pure cultures, and if we have met with differentforms, diplococci and streptococci, the question may beraised if our results conform with those of Dr. Class. Thisdifference will demand a further solution, and perhaps is tobe explained in the differences of the culture-media.

In regard to the experiments of Dr. Class with largeranimals, especially with the infection of scarlet fever or asimilar disease upon swine, we are very glad that if hisfurther results are successful he has advanced so far.Then one may hope to arrive at practical valuable results.In our own work we have, as mentioned, above allsimply investigated into the cause of the disease whichhere in our Fatherland appears with such fearful devasta-tions. Nevertheless, we thought that after our years of studyat least we had shed a little light upon the subject. In con-sequence of the limited means at our command for laboratorywork we were not in a position to carry out the experimentsto the necessary, nor by us desired, extent. Now that we

have interested for further work a well-appointed institutewe are at the present moment eagerly engaged in testing