1246 VITAL STATISTICS.-THE SERVICES. ’weeks; of these, 297 resulted from measles, 231 from 19-2 in and 17-6 in . The 156 deaths ’whooping - cough, 64 from diphtheria, 40 from scarlet registered in Dublin during the week under notice showed fever, 33 from diarrhoea, 33 from "fever" " (principally an increase of 18 upon the number in the preceding week, and enteric), and 1 from small-pox. The lowest death-rates included 4 which were referred to the principal zymotic from these diseases were recorded in Preston, Halifax, diseases, against 10 and 6 in the two preceding weeks; , and ; and the highest rates in. of these, 3 resulted from whooping-cough and 1 from scarlet London, Oldham, , , and Sunderland. fever, but not one either from small-pox, measles, diphtheria, The greatest mortality from measles occurred in London,, "fever," or diarrhoea. These 4 deaths were equal to ’ Birkenhead, Manchester, Oldham, and Sunderland; from an annual rate of 06 per 1000, the zymotic death- whooping-cough in London, Croydon, , Bolton, andL rate during the same period being 4-3 in London and - Manchester ; and from "fever" " in . The mortality 1’3 in Edinburgh. The 3 fatal cases of whooping-cough - from scarlet fever showed no marked excess in any of thea exceeded the number in any of the six preceding weeks, large towns. The 64 deaths from diphtheria included 41 in while the mortality from scarlet fever was below that London, 5 in , 3 in Liverpool, 3 in Manchester,, recorded in any recent week. The 156 deaths in Dublin last :and 3 in . One fatal case of small-pox was registeredl week included 30 of infants under one year of age, and in , but not one in any other of the thirty-three large 45 of persons aged upwards of sixty years; the deaths towns. There were 16 cases of small-pox under treatment ini both of infants and of elderly persons showed an increase ’the Metropolitan Asylum Hospitals and in the Highgate Small-- upon the numbers recorded in recent weeks. Five inquest on pox Hospital Saturday last, the 20th inst., against 23.. cases and 6 deaths from violence were registered; and 63, ’ 21, and 16 at the end of the three preceding weeks; 83 or more than a third, of the deaths occurred in public new cases were admitted during the week, against 2,, institutions. The causes of 14, or nearly 9 per cent., of the : 5, and 4 in the three preceding weeks. The number off deaths in the city last week were not certified. : scarlet fever patients in the Metropolitan Asylum Hospitalss ,and in the London Fever Hospital at the end of the week was 2534, against 2676, 2587, and 2527 on the three pre- ceding Saturdays; 236 new cases were admitted during the THE SERVICES. week, against 186, 226, and 201 in the three preceding weeks. The deaths referred to diseases of the respiratory organs in London, which had risen in the three preceding weeks from MOVEMENTS OF THE MEDICAL STAFF. ’.?0 to 328, declined again last week to 287, and were 79 SURGEON - CAPTAINS SKERRETT and Kearney have below the corrected average. The causes of 50, or 1-2 per embarked with the reinforcements for the Cape. Surgeon- ’ cent., of the deaths in the thirty - three towns were not Preston has arrived from Hong-Kong and pro- certified either by a registered medical practitioner or by a ceeded to Dublin as Principal Medical Officer in Ireland. coroner. All the causes of death were duly certified in Surgeon-Lieutenant-Colonel Wolseley has resumed his duties , , , Salford, Leeds, and in at Wadley on return from Ashanti. twelve other smaller the of un- towns ; largest proportions ARMY MEDICAL STAFF. - certined deaths were registered in Birmingham, Liverpool, and Hull. Brigade-Surgeon-Lieutenant-Colonel John Peter Hamilton Boileau, M.D., F.R.C.S.I., is placed on retired pay. Sur- geon-Major Arthur M. Kavanagh, from half-pay, to be Sur- HEALTH OF SCOTCH TOWNS. geon-Major, vice A. H. Morgan, D.S.O., retired, with pre- cedence next below Surgeon-Major J. D. Day, M.B. The annual rate of mortality in the eight Scotch towns, which had been 197 and 19’0 per 1000 in the two pre- AND THE INDIAN MEDICAL SERVICES. rceding weeks, rose again to 19.9 during the week The Queen has approved of the following promotions - ending April 25th, and slightly exceeded the mean rate among the officers of the Indian Medical Service:—To during the same period in the thirty-three large English be Surgeon-Colonel: Brigade - Surgeon- Lieutenant- Colonel towns. The rates in the eight Scotch towns ranged from Terence Joseph McGann, Madras Establishment. Sur- .16’! in and 17.1 in to21’0 in Greenock and geon-Lieutenants to be Surgeon-Captains: Bengal Estab- :.22’5 in Leith. The 580 deaths in these towns included lishment:: Charles Milne, Vivian Godfrey Drake - Brock- ’,30 which were referred to whooping-cough, 12 to diarrhoea, man, William Young, John Joseph Bourke, George 10 to scarlet fever, 9 to measles, 4 to " fever," 2 to diphtheria, Yeates Cobb Hunter, Bernard Robert Chatterton, Cedric .and not one to small-pox. In all, 67 deaths resulted from Barkley Prall, Charles Edward Williams, John Norman these principal zymotic diseases, against 91 and 56 in the MacLeod, Walter Holland Ogilvie, Thomas Alfred Ollivant two preceding weeks. These 67 deaths were equal to an Langston, Richard Heard, Edgar Rowe Parry, Walter ’.annual rate of 2-3 per 1000, which was 1’1 below the Hood Orr, and Paxton St. Clair More. Madras Establish- mean rate last week from the same diseases in the ment:: George Bidie and John Plowden Morton. Her ’thirty-three large English towns. The fatal cases oi Majesty has also approved of the retirement from the whooping-cough, which had been 29 and 21 in the twc Service of the undermentioned officers : -Surgeon-Major- preceding weeks, rose again to 30 last week, of which 21 General Peter Stephenson Turnbull, Bombay Establish- occurred in and 4 in Aberdeen. The deaths ment ; Brigade-Surgeon-Liutenant-Colonel Colin William : referred to scarlet fever, which had increased from 5 to 7 ir MacRury, Bombay Establishment ; Surgeon-Lieutenant- the three preceding weeks, further rose to 10 last week, anc Colonel Benjamin Evers, Bengal Establishment; and Sur- -included 4 in Glasgow, 2 in Edinburgh, and 2 in Dundee geon-Lieutenant-Colonel John O’Neill, Bengal Establish- The 9 fatal cases of measles corresponded with the number ment.-London Gazette. ; in the preceding week, and included 5 in Glasgow and 3 ir The following promotions are made, subject to Her Dundee. The deaths referred to different forms of "fever,’ Majesty’s approval :-Bengal Medical Establishment: Sur- which had been 12 and 7 in the two preceding weeks geon-Majors to be Surgeon - Lieutenant - Colonels: Arthur further declined to 4 last week, of which 2 occurred ii Tomes, M.D., William Arthur Mawson, Sorabshaw Hor- Of the 2 fatal cases of diphtheria 1 was recorde( Dantra, Bernard Robert Glasgow. ’ masji Henry Hamilton, Doyle, f in Dundee and 1 in Leith. The deaths from diseases o Cobb, Augustus Edward Stephens, and William Hotson the respiratory organs in these towns, which had been 111 Cadge. Surgeon-Captains to be Surgeon-Majors : John and 109 in the two preceding weeks, rose again to 121 Henry Tull Walsh, Harold Hendley, Hormasjee Edaljee last week, but were 25 below the number in the corre . Banatvala, George Herbert Fink, and William George sponding period of last year. The causes of 36, or mor Patrick Alpin. Madras Medical Establishment : Surgeon- than 6 per cent., of the deaths in these eight towns las ; Majors to be Surgeon-Lieutenant-Colonels : John Maitla]2d, week were not certified. Lemon Charles and ____ George Walker, Lethbridge Swaine, Maurice Henry Smith. Bombay Medical Establishment:: HEALTH OF DUBLIN. Surgeon-Majors to be Surgeon-Lieutenant-Colonels: John Alexander Kenneth William The Macgegor, Stewart, George death-rate in Dublin, which had declined in the thre Hume Henderson, Kharshedji Ardeshir Dalal, and Henry preceding weeks from 25.5 to 20-6 per 1000, rose again to 23- Walker Butler Boyd. during the week ending April 25th. During the past fou r weeks of the current quarter the death-rate in the city ha NAVAL MEDICAL SERVICE. .averaged 23-7 per 1000, the rate during the same period bein ; The following appointments are announced :-Surgeons: THE SERVICES. 1247

H. Elliot to the Marathon: J. A. Keogh to the . assembled at the works of the Military Equipment Stores ’Surgeons and Agents: J. H. Spreate at Llanwit; C. M. and Tortoise Tents Company at Battersea on April 23rd Kemp at Shoreham and South wick ; M. A. Lyden at Costello to inspect a collection of tortoise army hospital wagons and Bay and Spiddal ; S. Killen at Carrickfergus ; J. H. McAuley tents which the company has just completed for the Argentine at Ringsend. Government. The South American Republic Medical In- Dr. was also On one ARMY MEDICAL RESERVE OF OFFICERS. spector, Albert Costa, present. side of the the firm’s of Frederick H. to be grass plot adjoining manufactory thirty Surgeon-Captain Appleby Surgeon- these tortoise army hospital wagons were drawn up in line, Major. and on the other eighteen of their tents were pitched, while YEOMANRY CAVALRY. " the centre of the ground was occupied by the Congo (Southern Nottinghamshire) : Surgeon- and military stoves, their utility, weight, and component Captain J. F. D. Willoughby resigns his commission, parts being severally described by the officials present. VOLUNTEER CORPS. The hospital wagons appeared good, serviceable vehicles, but little from the in use in our Artillery : lst Ayrshire and Galloway : Alexander John differing pattern own service. Their covering, however, instead of being a Mackintosh, M.B., to be Lieutenant. : Surgeon - Rifle: fixture from the sides of the wagon, consisted of a 5th (, Princess Beatrice’s) Volunteer Battalion loose the sides folded in K. W. I. tortoise-shaped tent, being the Regiment : Surgeon-Lieutenant and strapped to the top rail of the vehicle. When Mackenzie to be Surgeon-Captain. required, by just disengaging the straps the folds THE HEALTH OF THE DUTCH INDIAN ARMY. can be carried outward, and by means of half-inch In the April number of the Archives de Médecine Navale et ropes and pegs form a serviceable and water-proof tent. There were in addition two metal water Coloniale Dr. H. Gros supplies an interesting resunze of the elongated cylindrical to one of which was carried medico-statistical for the year 1894 the receptacles every wagon, report 1 compiled by beneath and behind the shaft of the cart. Each of medical of the Dutch army stationed in the East just department these water barrels contained of fluid. On India islands, otherwise known as Insulinde and Malaysia. sixty pints the lid of one of them a was noticed In his paper Dr. Gros enters considerably into detail. but removing partition about three or four inches from the rim, in the centre of with a view to exhibit at a glance the principal facts which was a hole for the and of the barrel, and contrasts adduced we have constructed the subjoined filling emptying and into the was screwed a metal for use when tables :- aperture cup required. There was also a metal lip soldered on to the side Vital Statistics of the Dutch Troolros serving in Insulinde. of the cylinder to prevent waste of water when pouring it out. Two sizes of camp ovens were shown, the larger pair weighing some 500lb., and they could only be carried in a wagon or on a camel’s back. The smaller size, two in number, weighed when complete some 851b., and these appeared by far the most useful, as they could be borne on the heads of men and were capable of being put together in some two and a half minutes and of cooking food for fifty men. As regards the tortoise tents, with their sombre green-coloured water- proof texture, they are no doubt handy and very serviceable erections, but they are to a certain extent dark and gloomy within, and their poles, though admirably finished as far as workmanship is concerned, appear too fragile for the rough work incidental to campaigning ; it may perhaps be doubted whether these tortoise tents are in any way superior to our own well-ventilated, square, roomy tents made on the old Indian principle. MEDICAL AFFAIRS IN INDIA. The Indian papers received by the last mail are pretty full of matters medical, including Surgeon-Lieutenant-Colonel Lawrie’s address on the Malarial Parasite at the Causes Grant Chief of Mortality. Medical College, Bombay, and the discussion that followed its reading, references to subjects embodied in the late report of the Sanitary Commissioner with the Government of India, correspondence regarding M. HafEkine’s methods of vaccination against cholera, and articles on the state of the medical services. Adverting to one of these subjects we may say that Surgeon-Lieutenant-Colonel Lawrie is endowed with great energy and powers of work as well as the courage of his opinions. If he is able to establish his view as to the alleged mistaken notions entertained by European observers in regard to Laveran’s parasite he will assuredly obtain all the credit he deserves. Shortly put, he contends that the microscopic appearances discoverable in the blood are not really due to the presence and metamorphoses of a but to about No deaths from tetanus, hydrophobia, or diphtheria occurred parasitic element, changes brought in the normal of the blood the .during the year; and, unlike our experience in India, the ingredients through per- verted function of a diseased His address consists ravages of typhoid fever were comparatively slight. Under spleen. of two one of destructive in which he diseases of the nervous system are included five cases of parts: criticism, sunstroke in Europeans. Two Asiatics suffered from leprosy alleges that the observations of histologists in respect of the Laveran bodies are founded in error and are of a and two more from cholera, the latter cases fatal. susceptible proving different to that and the other Dr. Gros concludes his article with graphic charts repre- explanation given by them, in which he sets forth his views as to the senting the march of the chief causes of disability during constructive, part the past five years-namely, malaria, beri-beri, and venereal played by the spleen in malarious subjects, in the production and of blood cells which in their career and affections. That referring to the beri-beri shows a lamentable development state of affairs. appearances deviate from the normal and healthy standard and give rise, he alleges, to those appearances which micro- TORTOISE TENTS FOR THE ARGENTINE GOVERNMENT. scopists have mistaken for those caused by a parasite-the A number of interested persons, including Surgeon-General malariae. We have just received the address Sir plasmodium Guyer Hunter, Surgeon-Major-General Jameson, Surgeon- and hope to publish it in an early issue of THE LANCET. and Major-General Taylor, Surgeon-Colonel Gubbins, ROYAL UNITED SERVICE INSTITUTION. 1 Geneeskundig Tijdschrift voor Nederlandsch Indie. Lord Knutsford presided at a meeting held in the Royal 1248 THE MIDWIVES REGISTRATION BILL.

United Service Institution on April 24th to hear an address recognition of his services while actually and entirely from Mr. J. Furley on the Convention of Geneva and the, employed beyond Her Majesty’s dominions in the service of Care of Sick and Wounded in War. In the course of his the Congc Free State. lecture Mr. Furley said that the badge was undoubtedly The National for Aid to Sick and Wounded in War but this the of the Society abused, only proved necessity making has, as mentioned in another column, sent two surgeons to powers conferred by the Convention of Geneva universally South Africa for service in connexion with the troubles in known, and also placing some restriction on the assumed Matabeleland. neutrals. It was essential that the rights of benevolent Surgeon-Major-General James Jameson will take up the Red Cross should be equally respected by soldiers as well as appointment of Director-General of the Army Medical civilians. He considered that we in the, possessed Department on May 7th. means, personnel and matériel, out of which an effective sup- plement to the Army Hospital Corps could be formed to a, degree that had never been attained in any other country,, much as we could learn from other countries in regard to its organisation and extension to the requirements of war. Correspondence. THE SPREAD OF SMALL-POX. We commend the following letter to the consideration of "Audi alteram partem." the authorities. has suffered severely, and if its sins are not to be visited on other towns the which danger THE MIDWIVES REGISTRATION BILL. our correspondent refers to must be dealt with immediately. ’ To the Editors of THE LANCET. To the Editors of THE LANCET. SIRS,-The dates fixed for assembling of " old hands "for Militia train- SIRS,—We would not trouble you did it not appear that now at hand, is it too much to ask what if ings being precautions, any, those who are this of midwives fail have been taken to prevent the importation of small-pox into hitherto supporting registration healthy districts by men coming from Gloucester or the neighbour- to grasp the seriousness of its meaning. Moreover, the hood ? Might I suggest that where any man’s last-known address was second reading of the Bill is fixed for an early day in May. in or near Gloucester he should be given leave off this training unless The actual aim of the of midwives is to establish he can produce a certificate of recent vaccination. The assembling of registration the county Militia has been abandoned, but there may well be men in a semi-educated class of midwifery practitioners to attend other regiments who reside in the infected district and whose coming women in their confinements, on their sole responsibility and thence into a fresh be a source of not to their place might danger, only without the direct of a medical If comrades, but to the population of the place where the training is held. supervision practitioner. this were enacted it would the I am, Sirs, yours faithfully, proposal repeal Medical Act, SANITAS. 1886, which enacts that if any person wish to lawfully branch of or even PORTRAIT OF SURGEON-GENERAL SIR JOSEPH FAYRER, practise any medicine-say, midwifery, BART., K.C.S.I. affections of the eye or skin-such person must study for at least five the three of and The subscribers to the fund will be to years subjects medicine, surgery, portrait pleased examinations in and be hear that the committee have invited Sir Joseph Fayrer to midwifery, pass stringent them, sit for his to Mr. Hall. It is that registered. portrait Sydney expected This education is the minimum the will be finished in when it will be requirement. Section 2 (2; picture early July, I of the Medical enacts: " The standard of in the officers’ mess at This is a Act, 1886, pro- placed Netley. portrait from candidates at the said testimonial to Sir his brother ficiency required qualifying presented Joseph Fayrer by shall be such as to the officers of the medical services and other friends and examinations sufficiently guarantee army of the and skill for the effi- admirers as some of the services he has possession knowledge requisite recognition great cient of medicine, and and it rendered his and official life to the army and to practice surgery, midwifery, by writings shall be the of the Medical Council to secure the the Medical School, of the Senate of which he was duty Army anB maintenance of such standard of as aforesaid." active member for many years. proficiency This period of study being necessary in the public interest, DEATH IN THE SERVICES. the action of those who propose to establish an inferior order Inspector-General Arthur Anderson, C.B., M.D., on the of midwife practitioners threatens to repeal the Medical Act 26th ult. He entered the Army in October, 1835, as Assist- and to revert to the death-dealing system associated with a life- ant Surgeon, and was appointed Surgeon in December, 1845. early midwifery practice. This Act is and health- He attained the rank of Surgeon-Major in 1854, of Deputy saving Act. To practise midwifery with efficiency and with Inspector-General in 1858, Inspector-General in 1862, and the least possible danger to the public the practitioner retired on half-pay in 1867. - He served in the Eastern must possess a full and perfect training in medicine and campaign of 1854, and was present at the battles of Alma, surgery as well as in midwifery. A large proportion of Balaclava., and Inkerman, and at the siege of Sebastopol. women about to be confined and many newly-born infants He was Principal Medical Officer, 4th Division of Balaclava suffer from complaints which require medical and surgical and Inkerman (medal with four clasps, Turkish medal). He skill. This inseparable unity of the three branches of was also created a Knight of the Legion of Honour. He was medicine is one of national import and was recognised as present at the capture of Canton in 1857 (medal with clasp). such by the Royal Commission (1882) on the Medical Acts. among whom were the late Bishop of , Earl THE MATABELE RISING. Camperdown, Sir G. Jessel, Sir W. Jenner, Sir J. Simon, Public attention has been absorbed by the state of affairs’ Mr. Huxley, Sir W. Turner, and others. This Commission in South Africa and the exciting news about the results of reported as follows : "Another grave defect of the licensing the Pretoria trial and the sharp fighting in the vicinity of, system lies in the fact that nearly all the medical corpora- Bulawayo. The garrison of that place was not only holding tions grant diplomas in medicine alone or in surgery alone. its own, but had made some very successful sorties. The There is no point of medical reform on which there is so number of killed and wounded on the part of those defending general an agreement as that the holding of a licence ought to Bulawayo is, compared with the losses inflicted on the imply the possession of a complete qualification for practice;-, Matabeles, small ; but we know relatively nothing about the that is to say, the attainment of a sufficient standard of pro- hospital arrangements in Bulawayo itself. It is believed ficiency in all the three essential branches of medical ’ that the place can be successfully held until relieved. practice-medicine, surgery, and midwifery. It is our that the of a licence be HONG-KONG. opinion holding ought to conclusive evidence of sufficient proficiency in medicine, surgery, and According to telegraphic intelligence received at the midwifery." Colonial Office the Governor of Hong-Kong reports seventy- To understand the meaning of this life-saving recom- five fresh cases of bubonic in the the plague colony during mendation we would state that to the above date week the 28th and the number of rlenths previously ending ult., during the Medical Act (1858) recognised three classes of prac- the same period as also seventy-five. titioners-viz., those educated in and who practised medicine The Queen has granted to Mr. Sidney Langford Hinde, only, or surgery only, or midwifery only. As practitioners L.S. A. Lond., Medecin, Service d’Etat du Congo, Boma, Her who were educated and licensed to practise only one of these Royal licence and authority to accept and wear the Medal for three branches were called upon to treat patients suffering from the Campagne Arabe, 1892-94, L’Etoile du Service, and the complaints which they had neither been educated nor licenced Cros of the Royal Order of the Lion, conferred upon him by to treat, this condition of affairs constituted a grave danger His Majesty King Leopold 11., King of the Belgians, in to the public health. Hence the final abolition of what was