THE SERVICES.
2
1194 benefit, especially to this neighbourhood, and shows the urgent necessity for the maintenance and development of the ’hospital. " The Hon. Conrad Dillon, in submitting a resolution to the effect that, "although those patients who have paid only a proportion of their cost have contributed according to their means, the receipts have fallen short of the expenditure and prevented the hospital from being self-supporting, and there- fore it is expedient that a sum of at least E2000 should be raised forthwith to prevent its being closed," spoke of the energetic labours of Canon Erskine Clarke, who had founded the hospital and who had for the past twelve years supplied the funds. He said that the finances were now in such a state that if the hospital were to cease its work to-morrow they would be exactly solvent. Both resolutions being carried, Mr. T. Bryant, President of the Royal College of Surgeons, testified to the excellence of the hospital arrangements. In all nearly 200 large opera- tions had been performed with very little mortality, and this he attributed to the airy wards, good nursing and good food. The meeting having recorded its appreciation of the services of the committee of management and the staff in carrying on the institution, a vote of thanks to Lord Battersea terminated the proceedings. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 6375 births and 3817 deaths were registered during the week ending Nov. 12th. The annual rate of mortality in these towns, which had increased from 17 3 to 19 6 per 1000 in the preceding four weeks, declined to 19 last week. In London the death- rate was 18 ’8 per 1000, while it averaged 20 ’1 in the thirty- *two provincial towns. The lowest rates in these towns were 13 -0 in Leicester, 13’1 in Wolverhampton, 152 in Norwich, and 16’1 in Derby ; the highest rates were 25 1 in Bolton, 26-7 in Hull, 28 0 in Salford, and 29 6 in Preston. The 3817 deaths included 434 which were referred to the principal zymotic diseases, against 407 and 434 in the pre- ceding two weeks; of these, 139 resulted from measles, 81 from diphtheria, 74 from scarlet fever, 55 from whooping-cough, 46 from diarrhoea, 34 from "fever" (prin- cipally enteric), and five from small-pox. These diseases caused the lowest death-rates last week in Derby, Halifax and Norwich, and the highest rates in Plymouth, Hull, Croydon, Preston and Salford. The greatest mortality from measles occurred in West Ham, Oldham, Brighton, Croydon, Portsmouth, Hull and Salford ; from scarlet fever in Croydon, Cardiff, Plymouth, Salford and Preston ; from whooping- cough in Croydon, Salford and Preston ; from "fever" in Portsmouth, Birkenhead and Wolverhampton ; and from diarrhoea in Preston, Leicester and Oldham. The 81 deaths f!rom diphtheria included 51 in London, 4 in Sheffield, 3 in Cardiff, 3 in Manchester and 3 in Leeds. Three fatal cases of small-pox were registered in Sheffield, one in Halifax and one in Huddersfield, but not one in London or in any other of the thirty-three large towns ; 3 cases of this disease were under treatment in the Metropolitan Asylum Hospitals and 2 in the Highgate Small-pox Hospital on Saturday last. The number of scarlet fever patients in the Metropolitan Asylum Hospitals and in the London Fever Hospital at the end of the week was 4063, against 3936, 4012 and 4067 on the preceding three Satur- days ; 403 new cases were admitted during the week, against 410 and 462 in the preceding two weeks. The deaths referred to diseases of the respiratory organs in London, which had been 267, 296 and 319 in the preceding three weeks, further rose last week to 357, but were 39 below the corrected average. The causes of 75, or 2’0 per cent., of the deaths in the thirty-three towns were not certified either by a registered medical practitioner or by a coroner. All the causes of death were duly certified in Portsmouth, Cardiff, Bolton, Preston, Newcastle-upon-Tyne, and in nine other smaller towns ; the largest proportions of uncertified deaths were registered in West Ham, Birmingham, Leicester, Liverpool and Sheffield. - HEALTH OF SCOTCH TOWNS. The annual rate of mortality in eight of the largest Scotch owns, which had increased from 19’0 to 22 9 per 1000 in the preceding three weeks, declined again to 20-6 during the week ending Nov. 12th, but exceeded by 1-1 per 1000 the mean rate during the same period in the thirty-three large English towns. The rates in the eight Scotch towns ranged from 14-5 in Paisley and 14-9 in Greenock to 224 in Glasgow and 26 ’0 in Leith. The 574 deaths in these towns included 61 which were referred to measles, 19 to scarlet fever, 9 to whooping-cough, 9 to "fever," 6 to diarrhoea, 5 to diphtheria, and one to small-pox. In all, 110 deaths resulted from these principal zymotic diseases, against 80 and 108 in the preceding two weeks. These 110 deaths were equal to an annual rate of 4’0 per 1000, which exceeded by 1’8 the mean rate last week from the same diseases in the thirty-three large English towns. The fatal cases of measles, which had increased in the preceding seven weeks from 12 to 69, declined last week to 61, of which 23 occurred in Edinburgh, 19’ in Aberdeen, 11 in Leith, and 7 in Glasgow. The deaths referred to scarlet fever, which had been 14 and 13 in the preceding two weeks, rose again last week to 19, and included 14 in Glasgow, 3 in Edinburgh, and 2 in Leith. The 9 fatal cases of whooping- cough exceeded by 4 the number in the preceding week, and included 8 in Glasgow. The deaths referred to different forms of "fever " which had been 2 and 5 in the previous two weeks, further rose to 9 last week, of which 6 occurred in Glasgow. The 5 fatal cases of diphtheria showed a marked further decline from those recorded in recent weeks, and in- cluded 2 in Edinburgh and 2 in Glasgow. The death from small-pox was registered in Glasgow. The deaths referred to diseases of the respiratory organs in these towns, which had been 138 and 142 in the preceding two weeks, were again 142 last week, and were 120 below the number in the corre- sponding period of last year. The causes of 63, or nearly 11 per cent., of the deaths in the eight towns last week were not certified. HEALTH OF DUBLIN. The death-rate in Dublin, which had increased from 194 to 28 ’5 per 1000 in the preceding three weeks, declined again to 23’9 during the week ending Nov. 12th. During the first six weeks of the current quarter the death-rate in the city averaged 23’1 per 1000, against 17’8 in London and 21’6 in Edinburgh. The 160 deaths in Dublin during the week under notice included 5 which were referred to different forms of " fever," 2 to measles, 2 to diarrhoea., and not one either to small-pox, scarlet fever, diphtheria or whooping- cough. In all, 9 deaths resulted from these principal zymotic diseases, equal to an annual rate of 1’3 per 1000, the zymotic death-rate during the same period being 1’8 in London and 5’7 in Edinburgh. The deaths referred to different forms of "fever," which had increased from 2 to 10 in the preceding three weeks, declined again to 5 during the week under notice. The 2 fatal cases of measles ex- ceeded the number recorded in any recent week. The 160 deaths registered in Dublin last week included 25 of infants under one year of age and 45 of persons aged upwards of sixty years ; the deaths of infants showed a marked decline, while those of elderly persons showed a further in- crease upon those recorded in recent weeks. Six inquest cases and 4 deaths from violence were registered; and 41, or rather more than a fourth of the defths, occurred in public institutions. The causes of 19, or nearly 12 per cent., of the deaths in the city last week were not certified. THE SERVICES. MOVEMENTS OF MEDICAL STAFF. SURGEON-COLONEL JAMESON has re-embarked for Egypt on return from sick leave of absence. Brigade-Surgeon- Lieutenant-Colonel Comerford has arrived in Bermuda and assumed the duties of Senior Medical Officer. Brigade- Surgeon-Lieutenant-Colonel Scott has embarked for India on a tour of foreign service, and Brigade-Surgeon-Lieutenant- Colonel Barrett, whose promotion was recently gazetted, has arrived home in the Tamar on completion of a tour. Surgeon-Captains Lynden Bell and Gubbin have arrived at Bermuda for duty, and Surgeon-Captain Reilley has obtained leave from there. The following officers have embarked for India in the Cyccoa!:—Surgeon-Captains Tate, Watson, Mumby, Brogden, Birch and Kelly. Surgeon-Captain Carr has arrived home in the Serapis. Surgeon-Captain Risk has
Transcript of THE SERVICES.
1194
benefit, especially to this neighbourhood, and shows the
urgent necessity for the maintenance and development of the’hospital. "
The Hon. Conrad Dillon, in submitting a resolution to theeffect that, "although those patients who have paid only aproportion of their cost have contributed according to theirmeans, the receipts have fallen short of the expenditure andprevented the hospital from being self-supporting, and there-fore it is expedient that a sum of at least E2000 should beraised forthwith to prevent its being closed," spoke of theenergetic labours of Canon Erskine Clarke, who had foundedthe hospital and who had for the past twelve years suppliedthe funds. He said that the finances were now in such astate that if the hospital were to cease its work to-morrowthey would be exactly solvent.
Both resolutions being carried, Mr. T. Bryant, Presidentof the Royal College of Surgeons, testified to the excellenceof the hospital arrangements. In all nearly 200 large opera-tions had been performed with very little mortality, andthis he attributed to the airy wards, good nursing and goodfood.The meeting having recorded its appreciation of the
services of the committee of management and the staff incarrying on the institution, a vote of thanks to LordBattersea terminated the proceedings.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN thirty-three of the largest English towns 6375 births and3817 deaths were registered during the week ending Nov. 12th.The annual rate of mortality in these towns, which hadincreased from 17 3 to 19 6 per 1000 in the preceding fourweeks, declined to 19 last week. In London the death-rate was 18 ’8 per 1000, while it averaged 20 ’1 in the thirty-*two provincial towns. The lowest rates in these towns were13 -0 in Leicester, 13’1 in Wolverhampton, 152 in Norwich,and 16’1 in Derby ; the highest rates were 25 1 in Bolton,26-7 in Hull, 28 0 in Salford, and 29 6 in Preston. The3817 deaths included 434 which were referred to the
principal zymotic diseases, against 407 and 434 in the pre-ceding two weeks; of these, 139 resulted from measles,81 from diphtheria, 74 from scarlet fever, 55 from
whooping-cough, 46 from diarrhoea, 34 from "fever" (prin-cipally enteric), and five from small-pox. These diseasescaused the lowest death-rates last week in Derby, Halifaxand Norwich, and the highest rates in Plymouth, Hull,Croydon, Preston and Salford. The greatest mortality frommeasles occurred in West Ham, Oldham, Brighton, Croydon,Portsmouth, Hull and Salford ; from scarlet fever in Croydon,Cardiff, Plymouth, Salford and Preston ; from whooping-cough in Croydon, Salford and Preston ; from "fever" inPortsmouth, Birkenhead and Wolverhampton ; and fromdiarrhoea in Preston, Leicester and Oldham. The 81 deathsf!rom diphtheria included 51 in London, 4 in Sheffield, 3 inCardiff, 3 in Manchester and 3 in Leeds. Three fatalcases of small-pox were registered in Sheffield, one
in Halifax and one in Huddersfield, but not one inLondon or in any other of the thirty-three large towns ;3 cases of this disease were under treatment in the MetropolitanAsylum Hospitals and 2 in the Highgate Small-pox Hospitalon Saturday last. The number of scarlet fever patients inthe Metropolitan Asylum Hospitals and in the LondonFever Hospital at the end of the week was 4063,against 3936, 4012 and 4067 on the preceding three Satur-days ; 403 new cases were admitted during the week,against 410 and 462 in the preceding two weeks. The deathsreferred to diseases of the respiratory organs in London,which had been 267, 296 and 319 in the preceding threeweeks, further rose last week to 357, but were 39 belowthe corrected average. The causes of 75, or 2’0 per cent.,of the deaths in the thirty-three towns were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in Portsmouth,Cardiff, Bolton, Preston, Newcastle-upon-Tyne, and in nineother smaller towns ; the largest proportions of uncertifieddeaths were registered in West Ham, Birmingham, Leicester,Liverpool and Sheffield.
-
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in eight of the largest Scotchowns, which had increased from 19’0 to 22 9 per 1000 in the
preceding three weeks, declined again to 20-6 during theweek ending Nov. 12th, but exceeded by 1-1 per 1000 themean rate during the same period in the thirty-three largeEnglish towns. The rates in the eight Scotch towns rangedfrom 14-5 in Paisley and 14-9 in Greenock to 224 in Glasgowand 26 ’0 in Leith. The 574 deaths in these towns included61 which were referred to measles, 19 to scarlet fever,9 to whooping-cough, 9 to "fever," 6 to diarrhoea, 5 to
diphtheria, and one to small-pox. In all, 110 deathsresulted from these principal zymotic diseases, against 80and 108 in the preceding two weeks. These 110 deathswere equal to an annual rate of 4’0 per 1000, which exceededby 1’8 the mean rate last week from the same diseasesin the thirty-three large English towns. The fatal cases ofmeasles, which had increased in the preceding seven weeksfrom 12 to 69, declined last week to 61, of which 23occurred in Edinburgh, 19’ in Aberdeen, 11 in Leith,and 7 in Glasgow. The deaths referred to scarlet fever,which had been 14 and 13 in the preceding two weeks, roseagain last week to 19, and included 14 in Glasgow, 3 inEdinburgh, and 2 in Leith. The 9 fatal cases of whooping-cough exceeded by 4 the number in the preceding week, andincluded 8 in Glasgow. The deaths referred to differentforms of "fever " which had been 2 and 5 in the previoustwo weeks, further rose to 9 last week, of which 6 occurredin Glasgow. The 5 fatal cases of diphtheria showed a markedfurther decline from those recorded in recent weeks, and in-cluded 2 in Edinburgh and 2 in Glasgow. The death fromsmall-pox was registered in Glasgow. The deaths referred todiseases of the respiratory organs in these towns, which hadbeen 138 and 142 in the preceding two weeks, were again 142last week, and were 120 below the number in the corre-sponding period of last year. The causes of 63, or nearly11 per cent., of the deaths in the eight towns last week werenot certified.
HEALTH OF DUBLIN.
The death-rate in Dublin, which had increased from 194to 28 ’5 per 1000 in the preceding three weeks, declined againto 23’9 during the week ending Nov. 12th. During the firstsix weeks of the current quarter the death-rate in the cityaveraged 23’1 per 1000, against 17’8 in London and 21’6 inEdinburgh. The 160 deaths in Dublin during the weekunder notice included 5 which were referred to different formsof " fever," 2 to measles, 2 to diarrhoea., and not one
either to small-pox, scarlet fever, diphtheria or whooping-cough. In all, 9 deaths resulted from these principalzymotic diseases, equal to an annual rate of 1’3 per1000, the zymotic death-rate during the same period being1’8 in London and 5’7 in Edinburgh. The deaths referredto different forms of "fever," which had increased from 2 to10 in the preceding three weeks, declined again to 5 duringthe week under notice. The 2 fatal cases of measles ex-ceeded the number recorded in any recent week. The 160deaths registered in Dublin last week included 25 of infantsunder one year of age and 45 of persons aged upwardsof sixty years ; the deaths of infants showed a markeddecline, while those of elderly persons showed a further in-crease upon those recorded in recent weeks. Six inquestcases and 4 deaths from violence were registered; and 41,or rather more than a fourth of the defths, occurred in publicinstitutions. The causes of 19, or nearly 12 per cent., ofthe deaths in the city last week were not certified.
THE SERVICES.
MOVEMENTS OF MEDICAL STAFF.SURGEON-COLONEL JAMESON has re-embarked for Egypt
on return from sick leave of absence. Brigade-Surgeon-Lieutenant-Colonel Comerford has arrived in Bermuda andassumed the duties of Senior Medical Officer. Brigade-Surgeon-Lieutenant-Colonel Scott has embarked for India ona tour of foreign service, and Brigade-Surgeon-Lieutenant-Colonel Barrett, whose promotion was recently gazetted, hasarrived home in the Tamar on completion of a tour.
Surgeon-Captains Lynden Bell and Gubbin have arrived atBermuda for duty, and Surgeon-Captain Reilley has obtainedleave from there. The following officers have embarked forIndia in the Cyccoa!:—Surgeon-Captains Tate, Watson,Mumby, Brogden, Birch and Kelly. Surgeon-Captain Carrhas arrived home in the Serapis. Surgeon-Captain Risk has
1195
been posted to Aldershot, and Surgeon-Major Drury has’ obtained sick leave from that station. Surgeon-Captain
Barton has rejoined at Holme. The death of Surgeon-Captain Waller has been reported from Bengal.
ARMY MEDICAL STAFF. ,
Brigade-Surgeon-Lieutenant-Colonel John Ross Murray,M.D., F.R.C.S. Edin., has been placed on retired pay.
ARMY VETERINARY SCHOOL.
Veterinary-Captain Seaward Longhurst, Army VeterinaryDepartment, has been appointed Professor, vice Veterinary-Captain Fred Smith, whose period of service in that appoint-ment is about to expire.
INDIAN MEDICAL SERVICE.
The following appointments have been made :-Surgeon-Captain A. H. Nott, Officiating Second Resident Surgeon ofthe Presidency General Hospital, to act as Civil Surgeon ofBirbhum. Surgeon-Captain B. D. Basu, I.M.S., has beentransferred from general duty, Scinde District, to general duty,Bombay, Deesa, and Aden Districts. Brigade-Surgeon-Lieutenant-Colonel R. P. Ferguson, A.M.S., having been
appointed an Army Medical Officer in the Bengal Command,has been directed to proceed to Allahabad in order to takeover the administrative medical charge of that district.Surgeon-Major B. Doyle has been posted to Ferozepore. Mr.H. A. Hall and Surgeon-Lieutenant-Colonel S. M. Salaman,M.D., have respectively delivered over and received charge ofthe Yerrowda Central Gaol. Surgeon-Captain A. V.Anderson, M.B., has been appointed to act as Deputy Sani-tary Commissioner for the Western Registration District. Thefollowing promotions are made subject to Her Majesty’sapproval:-To be Surgeon-Lieutenant-Colonel from Oct. lst,1892: Surgeon-Major A. N. Rogers-Harrison, M. P. L. Beech,and H. P. Esmonde-White. To be Surgeon-Majors fromOct. 2nd, 1892 : Surgeon-Captain J. L. Van Geyzel, H. N. V.Harington, G. M. F. McKee, J. A. F. Burton, and F. J. Doyl.
NAVAL MEDICAL SERVICE.The following appointments have been made Fleet
Surgeon J. Lyon, M.D., to the Impregnable. Staff Surgeons :T. E. H. Williams to the Peliean and G. F. Watts to theBeagle. Surgeons : William R M. Young to the lvildfire,for Sheerness Dockyard; R. Hickson to the Bermuda Hos-
pital ; 0. S. Fisher to the A lac7,ity; J. Lowney to the Redpole;E. E. P. Tindall to the Plove7-; E. C. Lomas, M.B., to thePig1ny,. J. Dawson to the Pemb2,o7ze; B. S. Mends, to thePortsmouth Division, R.M.A.; A. Kidd to the Cccroline ;E. E. Bray to the -/?’eK ; ; E. J. Swan to the Arclaer; F. W.Parker to the Cambridge,. and E. A. Shaw, B.A., M.B., tothe Bearty.
VOLUNTEER CORPS.
Artillery: 2nd Hampshire (Southern Division RoyalArtillery): Surgeon-Captain B. J. Guillemard, M.D., hasresigned his commission. The Volunteer Officers’ decoratiorhas been conferred upon the following : - Surgeon-Lieu-tenant-Colonel Thomas Henry Moxon, 1st Norfolk ArtilleryBrigade-Surgeon-Lieutenant-Colonel Stephen Moulton Hopson,3rd Volunteer Battalion, the Norfolk Regiment ; BrigadeSurgeon-Lieutenant-Colonel Geo. Sampson Elliston, 1st Volunteer Battalion, the Suffolk Regiment; Surgeon and HonorarySurgeon-Major John William Harper, retired, 2nd Voluntee:Battalion, the Suffolk Regiment ; Surgeon-Major Danie
Bailey Balding, lst (Hertfordshire) Volunteer Battalion, thiBedfordshire Regiment; Surgeon-Major (ranking as Lieutenant-Colonel) Alfred T. Brett, M.D., retired, 2nd (Hertfordshire) Volunteer Battalion, the Bedfordshire RegimentHonorary Assistant Surgeon William Gimson, M.D., retired3rd Volunteer Battalion, the Bedfordshire Regiment; Surgeoiand Honorary Surgeon-Major Theophilis Wm. Trend, M.D.retired, 2nd Volunteer Battalion, the Hampshire RegimentBrigade-Surgeon-Lieutenant-Colonel Henry Robert Smith an<Surgeon and Honorary Surgeon-Major John Robert KealyM.D., retired, 3rd Volunteer Battalion, the Hampshire Regiment ; Brigade-Surgeon-Lieutenant-Colonel Fredk. FawsorLee, M.B., lst Wiltshire Rifle Volunteer Corps.—Te2nd (Westmoreland) Volunteer Battalion, the Border Reg’ment : Surgeon-Lieutenant R. W. Leeming has resigned hicommission.-4th Volunteer Battalion, the King’s (LiverpocRegiment) : Surgeon-Captain W. J. Fleetwood, M.D., habeen appointed Surgeon-Major.
EXAMINATION.A medical examination has been ordered by the War Offie
of candidates for the Royal Military College, Sandhurst, t
be held at the Offices, King-street, Westminster, on the 28tband 29th inst.
SICKNESS IN THE ROYAL WELSH FUSILIERS.
According to the Indian papers the Peshawur Valley hasbeen very unhealthy this year. The Royal Welsh Fusiliers have’lost many men during the hot weather and rains, and have a,large number of sick in hospital with fever. The regiment isstated to be under orders for Nowshera. The whole valley i5well known as a malarious locality, and the form of feverwhich occurs there has certain features which have given rise-to the name of " Peshawur fever"; and it is alleged that theunusually heavy rains which occurred a few months ago gaverise to a considerable increase of that disease. Removal frorstthe locality and complete change of climate is recognised asthe only remedy where it is at all intractable and does notyield to treatment.The usual Report on the Sanitary Measures in India in
1890-91, " for presentation to both Houses of Parliament has-just been issued. It contains chapters on the health of theEuropean and native, with which we have already dealt, onthe health of prisoners in gaols and on that of the generalpopulation, together with chapters on medical institutions,including medical schools and lunatic asylums, and on sani-tary works. Appended to the report are abstracts of reports.by the Sanitary Commissioners in India, and memoranda bythe Army Sanitary Commission in England. We hope soonto deal more fully with this blue-book.
Correspondence.
THE BRADSHAW LECTURE.
"Audi alteram partem."
To the Editors of THE LANCET.
SIRS,-Dr. Gee in his recent Bradshaw Lecture, which ispublished in the current number of THE LANCET, told us.among other things that he had sometimes found the scalpin tuberculous meningitis too tender to bear shaving and com-mended this observation, among others, to the considerationof "those who find a difficulty in believing that leeches orblisters applied to the skin can possibly affect a deeply seatedpart with which the skin has no obvious connexion." I donot know whether Dr. Gee meant his admonition for me, oronly whether the consciousness of coming within its scopemade me suppose so ; but when something is commended to’my consideration by a person in a place of authority, and onewhom I respect so much as Dr. Gee, it behoves me togive my respectful consideration to it. As it is not easy to
say what is possible I will be content with what is pro-bable, and I will deal in especial with the subject ofmeningitis, to which he has given prominence. The casestands thus, if I may try to expand Dr. Gee’s statementof it without misrepresentation. The scalp may becometender in meningitis, though there is no obvious connexion,between the seat of the tenderness and the seat of the dis-ease ; therefore I am to consider whether irritation of a
neighbouring but unconnected surface may not act beneficiallyupon a subjacent region of inflammation. Now I deny the majorand dissent from the conclusion which is implied. Ifthe scalp become tender under meningitis I presume it is
L because the roots of the fifth nerve, which lie at the base ofthe brain, are irritated by the inflammatory products or theinflammatory condition there present, whereby the branchesof the same nerve which go to the scalp are made hyper-assthetic. This appears to be simple enough, but I do
,
not see how it bears upon counter-irritation or localbloodletting. Does it afford any ground to suppose
. that irritation of the scalp will influence the course
.
of meningitis 7 At most it displays a sensory consent between.
the roots and the branches of the same nerve, a condition of
l which we have many other examples. If, by appealing to,
the branches of the fifth nerve, we could influence its roots,’
does it follow that we should thereby lessen the inflammationaround them which is the cause of the irritation, not its con-sequence ? As well might we hope to benefit a case ofrenal stone by applying remedies to the tender or painful
) testicle.
