1426 VITAL STATISTICS OF LONDON DURING OCTOBER, 1905.-THE SERVICES.

increased during October ; among the various metropolitanboroughs this disease was proportionally most prevalent inShoreditch, Bethnal Green, Stepney, Poplar, Bermondsey,Battersea, and Ctmberwell. The Metropolitan Asylumshospitals contained 4187 scarlet fever patients at the endof last month. against 2527, 2860, and 3567 at the endof the three preceding months; the weekly admissionsaveraged 509, against 338, 368, and 487 in the three pre-ceding months. Diphtheria was considerably more prevalentlast month than in either of the two preceding months ;the greatest proportional prevalence of this disease occurredin Stoke Newington, Holborn, Finsbury, Poplar, Wands-worth, and Dptford. The Metropolitan Asylums hospitalscontained 796 diphtheria patients at the end of last month,against 785, 665, and 730 at the end of the three precedingmonths; the weekly admissions averaged 123, against 118,83, and 114 in the three preceding months. The pre-valence of enteric fever showed a slight decline last

month; this disease was proportionally most prevalent inFulham, Hackney, Holborn, Finsbury, Stepney, and South-wark. There were 157 enteric fever patients under treat-ment in the Metropolitan Asylums hospitals at the end oflast month, against 94, 12L, and 143 at the end of the threepreceding months ; the weekly admissions averaged 26,against 17, 20, and 24 in the three preceding months.Erysipelas was proportionally most prevalent in Paddington,Hackney, Finsbury, Stepney, Poplar, Bermondsey, Camber-well, and Deptford. The 30 cases of puerperal fevernotified during the month included three in Wandsworthand two each in Chalsea, St. Pancras, Islington, Poplar,Lambeth, Battersea, Camberwell, and Lewisham.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various boroughs, thedeaths occurring in public institutions having been distri-buted among the boroughs in which the deceased persons hadpreviously resided. During the four weeks ending Oct. 28ch5028 deaths of persons belonging to London were registered,equal to an annual rate of 14’ 0 per 1000 ; in the three pre-ceding months the rates had been 11 - 9, 16 ’ 2 and 13’ 6 per1000. The death-rates last month ranged from 8’ 7 in Hamp-stead, 9 5 in Woolwich, 11 ’1 in Stoke Newington, 11’ 3 inWandsworth, 11’5 5 in Chelsea, and 12’ 0 in Fulham and inLewisham, to 16 0 in Stepney, 16’ 5 in Finsbury, 16 7 in Ber-mondsey, 18 - 7 in Holborn, 18 ’ 8 in Bethnal Green, and 19’ 7in Southwark. The 5028 deaths from all causes in Londonlast month included 426 which were referred to the prin-cipal infectious diseases; of these, 94 resulted from

measles, 45 from scarlet fever, 36 from diphtheria, 55 fromwhooping-cough, 24 from enteric fever, and 172 fromdiarrhoea. The lowest death-rates from these diseases wererecorded in Hampstead, Stoke Newington, Holborn, the Cityof London, and Woolwich ; and the highest rates in Kensing-ton, Finsbury, Bethnal Green, Stepney, Poplar, Southwark,and Bermondsey. The 94 deaths from measles were sevenin excess of the average number in the corresponding periodsof the ten preceding years ; this disease was proportionallymost fatal in Kensington, St. Pancras, Bethnal Green,Stepney, Southwark, Bermondsey, and Lambeth. The 45fatal cases of scarlet fever were nine below the correctedaverage number; among the various metropolitan boroughs thegreatest proportional mortality from this disease was recordedin the City of Westminster, St. Pancras, Islington, Shoreditch,Stepney, and Poplar. The deaths from diphtheria numbered36, last month, against a corrected average of 162 in thecorresponding periods of the ten preceding years ; thisdisease was proportionally most fatal in Hammersmith,Stoke Newington, Bethnal Green, Poplar, Southwark, andGreenwich. The 55 fatal cases of whooping-cough wereslightly below the corrected average number ; among thevarious metropolitan boroughs the greatest proportional mor-tality from this disease was recorded in Fulham, Finsbury,Shoreditch, Bethnal Green, Stepney, Poplar, and Bermond-2iey- The 24 deaths from enteric fever were only one-thirdof the average number in the corresponding periodsof the ten preceding years ; of these 24 deaths, five

belonged to Stepney, three each to Hammersmith, Finsbury,and’ Southwark, an two each to Hackney and Wandsworth.The 173 fatal cases of diarrhoea were 70 below the correctedaverage number; among the various metropolitan boroughsthe greatest proportional mortality from this disease wasrecorded in Chelsea, St. Marylebone, Finsbury, BethnalGreen, Southwark, and Bermondsey. In conclusion, it maybe stated that the aggregate mortality in London last monthfrom the principal infectious diseases was more than 36 percnt. below the average.

Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 110 per 1000. The lowest rates of infant

mortality were recorded in Hammersmith, St. Marylebone,Hackney, Holborn, the City of London, Lambeth, and

Woolwich ; and the highest rates in Fulham, the Cityof Westminster, Sboreditch, Bethnal Green, Southwark,Bermondsey, Battersea, and Greenwich.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.IN accordance with the provisions of Her late Majesty’s

Order in Council of April 1st, 1881, Fleet Surgeon ArchibaldMcKinlay has been placed on the Retired List at his ownrequest, with permission to assume the rank of DeputyInspector-General of Hospitals and Fleets.The following appointments are notified :-Fleet Sur-

geons : J. E. Coad and J. Lloyd Thomas to the President, forthree months’ course at West London Hospital, and J.Andrews to the Vengeance. Surgeons E. S. Reid to theVictury, for disposal, and C. R. Sheward to the Pembroke,temporary.

ROYAL ARMY MEDICAL CORPS.

Captain H. R. Bateman is appointed for duty with thetroops in London. Lieutenant R. B. Hole is transferredfrom the 5th (Mhow) Division to the 6th (Poona)Division, and appointed officer commanding Station Hos-pital, Khandalla.The undermentioned Captains to be Majors (dated

Oct. 29th, 1905): Harold V. Prynne, Alfred E. Master,George Dansey-Browning, Ernest S. Clark, Kennet B.Barnett, Kenneth M. Cameron, Arthur C. Fox, Sebert F.St. D. Green, and Walter Tibbits.

INDIAN MEDICAL SERVICE. .

To be Surgeon-General : Bombay: Colonel (temporarySurgeon-General) John Philip Greany (dated June 20th,1905). To be Colonels : Bengal : Lieutenant-ColonelCharles Henry Beatson (dated June 16Gh. 1905), and Lieu-tenant-Colonel Thomas Elwood Lindsay Bate, C.I.E. (datedJuly 12th, 1905). Bombay : Lieutenant-Colonel (temporaryColonel) James McCloghry (dated June 20th, 1905), andLieutenant-Colonel Harry Beecham Briggs (dated July 10th,1905). Captain to be Major : Bjmbav : Patrick PercyKilkelly (dated Jaly 29th, 1905). Lieutenants to be

Captains (dated July 26th, 1905): Frederick AdolphusFleming Barnardo, James McPherson, George Denne

Franklin, Charles Aikman Gourlay, William Charles Ross,Robert Archer Lloyd, John Conrad Gie Kunhardt, ErnestAlexander Walker, Lwis Cook, Leonard Bodley Scott,Gerard Irvine Davys, Robert Hallilay, George Cook IrvineRobertson, Alfred John Vernon Betts, Frederick Ernest

Wilson, Walter Scott Patton, William Leigh Trafford,Behramji B.ujorji Paymaster, Norman Walter Mackworth,Henry Ross. John Forrest, Howard Crossle, Leonard Hirsch,Laurence Runoall, E iward Chailes Cecil Maunsell, HerbertErnest Jardine Batty, John Warwick Illius, Daniel StanislausAloyius O’Keefe, and John Philip Cameron. To be Lieu-tenants (dated Feb. 1st, 1905) : Arthur Francis Hamilton,Arthur Denham White, Michael Fo,ter Reany, Ralph KoperWhite, Hugh Clive Buckley, Norman Methven Wilson,John Stevenson O’Neill, Matthew Robert Cecil MacWatters,William Herbert Boalth, George Alick Soltau, WilliamHaywood Hamilton, John Cunningham, Herman Falk, andCharles Joseph Coppinger.

C,

The King has approved of the transfer to the TemporaryHalf-pay Ust of the undermentioned officers: -MajorWilfred Ernest Arbuthnet Armstrong (dated March 12th,1905), and Captain George Cook Irvine Robertson (datedSept. 17th, 1905).The King has also approved of the retirement from

the service of the following officers :-Surgeon-GeneralWilliam McConaghey (dated June 20th. 1905) ; Lieutenant-Colonel Patrick Fenelon O’Connor, C.B (dated July 13th,1905) ; Lieutenant-Colonel John Henry Tull Walsh (datedJuly 21st, 1905) ; Lieutenant-Colonel George Tucker Thomas(dated June 26th, 1905) ; Lieutenant-Colonel John Lancaster(dated April 1st, 1904) ; Major George Thomas Mould(dated July 28th, 1905) ; and Daniel Grove Marshall (daed.Tnnp 24dl. 1905).

1427ENTERIC FEVER IN THE ARMY.

IMPERIAL YEOMANRY.

Derbyshire: Surgeon-Captain R. M. Wilson resigns hiscommission (dated Nov. 4th, 1905).

VOLUNTEER CORPS.

Royal Garrison Artillery ( Volunteer): 1st Argyll and Bute :Surgeon-Captain J. Banks resigns his commission (datedNov. 4th, 1905). 3rd Middlesex : Surgeon-Lieutenant C. G.Watson to be Surgeon-Captain (dated Oct. 16th, 1905).Royal Engineers (Volitnteers) : lst Sussex: Surgeon-

Lieutenant R. M. Johnston to be Surgeon-Captain (datedNov. 4th, 1905).

Rifle: 8th Volunteer Battalion, the Royal Scots (LothianRegiment) : Surgeon-Major R. Kirk to be Surgeon-Lieu-tenant-Colonel (dated Nov. 4th, 1905).

Infantry: : 3rd Volunteer Battalion, the Duke of Welling-ton’s (West Riding Regiment) : Alexander Waugh (late Cap-tain) to be Surgeon-Lieutenant (dated Nov. 8th, 1905).-ThePrince of Wales’s Own, 12th Middlesex (Civil Service) Volun-teer Rifle Corps : Surgeon-Captain T. H. Dickson to be

Surgeon-Major (dated Oct. 23rd, 1905).-lst Volunteer Bat-talion, the Durham Light Infantry : The under-mentionedgentlemen to be Surgeon-Lieutenants : Henry Carden Pearson(dated Nov. 8th, 1905), Duncan Alexander Cameron (datedNov. 8th, 1905), and Arthur James Dale (dated Nov. 8th,1905) ; the under-mentioned Surgeon-Lieutenants are borneas supernumerary whilst doing duty with the Bearer Com-pany of the Durham Light Infantry Volunteer InfantryBrigade : H. C. Pearson (dated Nov. 8th, 1905) and D. A.Cameron (dated Nov. 8th, 1905).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Scottish Command: Glasgow Companies: Captain A. J.

MacDougall, R.A.M.C., to be Adjutant, vice Major C. C.Fleming, D.S.O., R.A.M.C., whose tenure of that appoint-ment has expired (dated Oct. 16th, 1905).SIR FREDERICK TREVES ON THE ARMY MEDICAL SERVICE.In a leading article last week on Sir Frederick Treves’s

address at Brighton on the Army Medical Service it was onlypossible to deal with some of its more salient points. Speak-ing generally, Sir Frederick Treves adopted an optimistictone, in which he was no doubt justified having regard tothe many striking changes for the better which have takenplace in that service since the date of the South Africanwar. But he carefully guarded himself against being sup-posed to hold the view that the Army Medical Service wasin a position to cope with the emergency of an importantwar. On the contrary, he very forcibly dwelt upon thenecessity of further changes being introduced so as to

give the Army Medical Department a more free, inde-

pendent, and influential position than it possesses at presentand he indicated at the same time many directions in whichsuch changes are most required. There is no need to

recapitulate all that he said in this respect but we

may take one point. No country could stand the expenseof a medical service maintained on a war footing ; con-

sequently there must be a medical reserve organised intime of peace to meet the contingency of war but at

present there is no such reserve, at any rate, not on anyadequate scale. In connexion with this subject and thatof some future scheme of Imperial defence, of which itreally forms part, we think that the statement in the reporton the war in South Africa by the Royal Commission whichwas presided over by the Duke of Norfolk, may be referred tohere. The Commissioners expressed the opinion that "nomilitary system will be satisfactory which does not containpowers of expansion outside the limit of the regular forces ofthe Crown." This principle is capable of an even more

extended application than was perhaps contemplated. Withthe means and material at the disposal of the British empireit is . surely not beyond the power of some statesman todevise an organised and unified scheme of Imperial defenceand of cooperative medical aid in which this country and hercolonies can take part in case of our being engaged in somebig war in the future. With the recollection of what hap-pened in South Africa on account of our unpreparedness andof all that has since taken place in the Far East we cansurely form a very good idea of the amount of medical aidof all sorts and properly organised that will be required.

MR. ARNOLD-FoRS1ER’S EXPLANATORY LETTER.We advise all those who are interested in the subject of

the present state and progress of army affairs to read Mr.ATnold-Forster’s letter to Sir Gilbert Parker which appeared

in the daily journals of Nov. 7th. It is explanatory of thedifficulties connected with the supply of drafts to the IndianArmy and of the measures taken to meet or to overcome them.It is only fair to the War Minister, when so much doubt andmisgiving exist in regard to his army scheme, that what hehas to say thereon should be duly read and considered. Hecondemns the alarming and mysterious allusions" thathave been made to the subject, says that there is nothingto conceal, and refers at length to the clear and consistentpolicy which he has pursued at the War Office and itssuccess. It has yet to be seen, however, what will be theEffect of running a short service system of enlistment along-side a long service one; it may be that one will starve theother.

MEDICAL OFFICERS OF HEALTH AND THE ADMIRALTYREGULATIONS.

At the meeting of the West Penwith rural district councilheld at Penzance on Nov. 2nd the medical officer ofhealth (Mr. J. R. M. Richmond) reported that twocases of enteric fever had occurred at Tennen CoveCoastguard station. He visited the station but was re-

fused admission under a clause in the coastguard regu-lations. Mr. Richmond added that he had written tothe Local Government Board and in reply had beeninformed that in Section 327 of the Public Health Act, 1875,it was stated that he had no right to interfere with Crownproperty, but under another section of the Act he could, ifhe thought fit, exclude the children of the affected districtfrom the public elementary schools. After a considerablediscussion it was decided to write to the Admiralty and callattention to the great disadvantage which the council

experienced through their medical officer of health not beingallowed to inspect the coastguard station.

THE ROYAL ALBERT HOSPITAL, DEVONPORT, AND THEADMIRALTY.

For the convenience of naval officers in the West of

England the Admiralty has decided to hold a war course atDevonport on Nov. 27th. The Admiralty will convert the " lockwards " at the Royal Albert Hospital, which have not beenused for many years, into lecture rooms. The building willbe subsidiary to the Royal Naval College, Greenwich, andwill be under the direction of a professorial staff from thatestablishment.

Surgeon G. Gibson, R.N., of the Assistance, has beenawarded a bronze medal by the committee of the RoyalHumane Society for his gallantry in jumping overooard fromthat vessel on August 18th and saving a seaman.

Correspondence.I I Audi alteram partem." "

ENTERIC FEVER IN THE ARMY.To the Editors of THE LANCET.

SIRS,-In THE LANCET of Oct. 21st, in an annotationunder the above heading (p. 1201), you refer to therecent letter in the Times by the Principal MedicalOfficer in India apropos of the assumed possibilityof extirpating this disease in the army through thesterilisation of the water for drinking purposes ; and asone who in bygone days has done his "little best" toelucidate and put on record the nature of the disease abroad,especially in India, its associations and causation, I wouldlike to add my support to that given in the letter and by you,Sirs, in the annotation above mentioned, to the view " thatwater is by no means the one and only source of entericinfection " and that the mere boiling of it before usage is noguarantee against the disease. So far as the army is con-cerned the position taken by Sir Thomas J. Gallwey is, Itake it, essentially the right one, based as it is on the evi-dence furnished by the troops as a whole, whether at home orabroad, in barrack or camp, each country occupied givingits quotum in support of the conclusions as a whole derivedfrom the study of the disease and from practical experi-ence, the cause being the same throughout the world, thesurroundings varying.

This water-borne theory of enteric diffusion was brought tvery prominently forward many years ago by the late editor