VITAL STATISTICS.-THE SERVICES. 1869

- London during the week were duly certified, while in cases of scarlet fever showed no appreciable variation from Edinburgh the proportion of uncertified causes of death was the average number ; this disease was proportionally most fatal 7’ 0 cent. in Fulham, Lambeth, and Camberwell. per - Poplar, Bermondsey, The 31 deaths from diphtheria were 14 below the corrected VITAL STATISTICS OF LONDON DURING MAY, 1908. average; among the metropolitan boroughs the highest IN the accompanying table will be found summarised death-rates from this disease were recorded in Paddington, complete statistics relating to sickness and mortality in Hackney, Stepney, Poplar, Southwark, Bermondsey, and the City of London and in each of the metropolitan Lewisham. The 85 fatal cases of whooping-cough showed boroughs. With regard to the notified cases of infectious a decline of 70 from the average number in the correspond- disease it appears that the number of persons reported to be ing periods of the five preceding years ; whooping-cough was most fatal last in suffering from one or other of the nine diseases specified in proportionally month Hackney, Stepney, and Battersea. The six the table was equal to an annual rate of 6’ 2 per 1000 of Poplar, Southwark, Lambeth, the population, estimated at 4,795,757 persons in the deaths from enteric fever were equal to only half the average of these six two to St. Pancras middle of the year; in the three preceding months the number ; deaths, belonged and one each to and rates were 7’ 8, 6’ 8, and 6’1 per 1000 respectively. Hackney, Poplar, Southwark, Deptford. The fatal cases of diarrhoea were below The lowest rates last month were recorded in Kensington, 43 26 the : corrected number ; this disease showed the Hammersmith, Chelsea, Stoke Newington, and Finsbury ;, average and the highest rates in Hackney, Bethnal Green, greatest proportional fatality in Hammersmith, Hackney, Stepney, Poplar, and Deptford. A slight increase in Stepney, Poplar, Battersea, and Lewisham. In conclusion, . it be stated that the in London last the prevalence of scarlet fever was recorded last month ; may aggregate mortality month from these infectious diseases was 6 among the various metropolitan borcughs this disease; principal 39’ per below the was proportionally most prevalent in Hackney, Bethnal cent. average. Green, Stepney, Poplar, and Deptford. The Metro-. Infant mortality, measured by the proportion of deaths children under one of politan Asylums hospitals contained 2707 scarlet feverr among year age to registered births, at the end of last month, against 3591, 3150, was equal to 86 per 1000. No death’ at this age was. patients in the of the and 2868 at the end of the three preceding months ; thee registered City London ; among metropolitan weekly admissions averaged 342, against 410, 336, and 319 boroughs the lowest rates of infant mortality were recorded in St. Stoke in the three preceding months. Diphtheria was less preva.6- Chelsea, Marylebone, Newington, Holborn, . and and the rates in Ken- lent in May than in any previous month of this year ; Finsbury, Lewisham ; highest the greatest proportional prevalence of this disease wasts sington, Fulham, Stepney, Poplar, Bermondsey, Battersea, and recorded last month in the City of London, Bethnal Green, Deptford. ______Waridsworth, Lewisham, and Woolwich. The number ofr diphtheria patients under treatment in the Metropolitan THE Asylums hospitals, which had been 1184, 1081, and 872 SERVICES. at the end of the three preceding months, had further de- clined to 804 at the end of last month; the weekly admissions averaged 105, against 149,131, and 107 in the three preceding ROYAL ARMY MEDICAL CORPS. to be months. The prevalence of enteric fever also was less than, Captain William K. Steele Major (dated April 6tb,. that recorded in any other recent month ; among the several 1908). boroughs the greatest proportional prevalence of this disease; Colonel M. W. Kerin has been appointed Administrative last month was recorded in Westminster, Finsbury, Shore.- Medical Officer at Tidworth, vice Colonel W. J. R. Rainsford, ditch, Stepney, Bermondsey, and Wandsworth. There werE; C.I.E., appointed to Plymouth. 45 enteric fever under treatment in the Metro patients THE TERRITORIAL politan Asylums hospitals at the end of last month, againstL FORCE. 79, 73, and 45 at the end of the three preceding months; thl3 Nursing Service. weekly admissions averaged seven, against ten, ten, an( The Army Council has decided to establish an Advisory seven in the three preceding months. Erysipelas was pro Council which will frame rules for the admission portionally most prevalent in Shoreditch, Bethnal Green of nurses into a nursing service for the general Stepney, Bermondsey, Battersea, and Deptford. The 1,4 hospitals of the Territorial Force and make recom- cases of puerperal fever notified during the month include,d mendations for the administration of the service and three in St. Marylebone, two in Hampstead, and two in for the appointments of matrons and sisters. Her Poplar. Of the ten cases notified as cerebro-spinal meningitiis Majesty has become President of the Nursing Service and two belonged to Bethnal Green, two to Lambeth, and on has approved of the appointment of the Duchess of to each of six other boroughs. Montrose as Vice-President. The council will consist of The mortality statistics in the table relate to the deatl Surgeon-General Sir Alfred Keogh, K.C B., K.H.P., Director- of persons actually belonging to the various borough General, Army Medical Service (chairman), and the follow- the deaths occurring in institutions having been distI ing members : The Duchess of Montrose (Vice-President), the buted among the boroughs in which the deceased personns Countess of Derby, the Countess of Jersey, the Lady had previously resided. During the four weeks endirIg Grenfell, the Lady Helen Munro Ferguson, Miss Haldane,. May 30th the deaths of 4486 persons belonging to Miss Cox-Davies, matron, Royal Free Hospital; Miss London were registered, equal to an annual rate of 12 ’ 2 Hamilton, matron, St. Thomas’s Hospital; Miss Hughes, per 1000; in the three preceding months the rates were Queen’s Jubilee Institute; Miss McCall Anderson, matron, 17’4, 16-1, and 14’ 9 per 1000. The death-rates lalose St. George’s Hospital; Miss Ray, matron, King’s College month in the several boroughs ranged from 8’4 in Stoe Hospital; Miss Vernet, Middlesex Hospital; Miss Sidney Newington, 9’1 1 in Hampstead, 9’2 in Lewisham, 9.3 in Browne, R.R.C., late matron-in-chief, Q.A.I.M.N.S. Wandsworth, and 10 ’ 3 in Camberwell, to 14’ 1 in Shoredit,ch (secretary). and in 14’ 7 in 14 9 in 15 Stepney, Finsbury, Bermondsey, C. London in Southwark, and 15-6 in Poplar. The 4486 deaths frc Sanitary Company for R.A.M. (2nd Division). all causes included 332 which were referred to the princil At a meeting held on Thursday, June 18th, at the offices infectious diseases; of these, 132 resulted from measles, 35 of the Metropolitan Asylums Board of the medical officers. from scarlet fever, 31 from diphtheria, 85 from whoopirIg- of the hospitals of the Board it was resolved, if 1 os sible, to. cough, six from enteric fever, and 43 from diarrhaea, raise a sanitary company of the Royal Army Medical Oorpa but not any from small-pox, from typhus fever, or frlom for the 2nd London Division. ill-defined No death from of these diseal pyrexia. any The London General was registered last month in the City of London ; among tthe 4th County of Hospital. metropolitan boroughs they caused the lowest death-ratesi in Colonel Atwood Thorne, V.D., is organising the 4th Paddington, Chelsea, St. Marylebone, Hampstead, a County of London General Hospital with temporary head- Islington ; and the highest rates in Hackney, Finsbury, quarters at 148, Harley-street. There are vacancies for non- Stepney, Poplar, Southwark, Lambeth, and Battersea.Che commissioned officers and men. Applications should be 132 deaths from measles were 103 fewer than the corrected made to Colonel Thorne at 148, Harley-street, London, W. average number in the of the J corresponding periods DEATHS IN THE SERVICES. preceding years ; the greatest proportional mortality ft.’Omfive this disease last month was recorded in Hackney, Finsbttry. Deputy Inspector-General Henry Ashlin Close, R N. Shoreditch, Stepney, Poplar, and Battersea. The 35 ftal (retired), on June 13th at Bedford. He entered the Navy in. 1870 THE STUDY OF TWINS AND DOUBLES.

July, 1859, was promoted staff-surgeon in 1872, and fleet- -Instances of one disease or, if possible, of several diseases. surgeon in 1881, retiring with the rank of deputy inspector- (d) Husband and wife.-Like, the likeness consisting in general of hospitals and fleets ten years later. He was in similar eye colour, similar aomplexion, similar height medical charge of the seamen and Royal Marines of the Clio characteristics, allowance being made for the fact that landed at Panama during a revolutionary attack on the city women are about four to five inches shorter than men. in September, 1860. Unlike in above particulars. (e) Parents and children- and Unlike. THE KING’S BODYGUARD FOR SCOTLAND. Like. Unlike. (f) Brothers sisters.-Like. DISSIMILAR DISEASES as The has been to His IN :-(a), (b), (c), (d), (e), (f), King graciously pleased signify above. of the on the staff Majesty’s approval following appointment I should be as the evidence is often difficult to of officers of the of Archers glad, Royal Company (King’s Body to have as in each case as Guard for made at the annual of interpret rightly, many particulars Scotland) general meeting I cannot find satisfactory evidence for the state- the on 21st last :-To be Dr. possible. Royal Company May Surgeon : ment that true uniovular twins are of the same sex. William Allan vice Mr. Thomas always Jamieson, Annandale, If of readers could me with references to deceased. any your supply detailed series of observations on this point I should be still Dr. William Robert Smith, V.D., Brigade-Surgeon- further obliged.-I am, Sir, yours faithfully, Lieutenant-Colonel (Honorary Surgeon-Colonel) 3rd London J. LIONEL TAYLER. Volunteer Infantry Brigade, has been appointed Ddputy- 8, Adys Lawn, Willesden-green, London, N. W., June 8th, 1908. Lieutenant of the County of London (dated June l8th, 1908). THE SOLECISMS OF OPHTHALMIC TERMINOLOGY. Correspondence. To the Editor of THE LANCET. SIR,-I have elsewhere several occasions directed " upon Audi alteram partem." attention to the absurdity of the continued use of the antiquated expression "ophthalmia" as applied to the THE STUDY OF TWINS AND DOUBLES. purulent conjunctivitis of infants. Such a Grasoo Latin as I neonatorum " is unscientific, To the Editor of THE LANCET. hybridity ophthalmia pathologically inaccurate, and a relic of the days of SiR,-Will you kindly allow me once again to appeal to bacteriological ignorance. The defence in favour of its your readers for additional information on the above subject, retention is that custom, as it has been said, has "sanctified" which the consideration of my present evidence has rendered its use-an argument somewhat lacking in strenuousness in advisable. My object is to determine the greater or lesser view of the continued progress of the science of our art. importance of the constitutional factor in disease and while If ophthalmic surgeons neglect to teach their students that still relying mainly on data derived from information the term ’’ ophthalmia " neonatorum is obsolete, the present- respecting twins and doubles I wish to draw upon all sub- day students are likely to inform the ophthalmic surgeons sidiary sources so as to obtain as complete an outline of the that bacteriologically they had been taught that the disease subject as is possible. in question was not "ophthalmia" but purulent conjunc- I have now evidence, though I should be glad of more, tivitis. Bat this is only one of the many solecisms still on the following points :-(a) Similar particular diseases and prevalent and conservatively adhered to in ophthalmic definite constitutional conditions in true twins like and unlike practice. Presumably they are all "sanctified by use." in respect to melancholia, bronchopneumonia, chorea, splenic Perhaps the most glaring instance is that of the term " ansemia, diabetes, hernia, influenza, quinsy and tonsillitis, "sympathetic ophthalmia. To describe an inflammation as conjunctivitis, bronchitis, convulsions, thrush, typhoid due to sympathy might usefully have supplied a want fever, scarlet fever, measles, cyclical vomiting, pulmonary in the unscientific days of old. But to speak of sym- tuberculosis, peritonitis, and caries of similar teeth. From pathetic inflammation in these days is equivalent to asking the literature of the subject instances of suicidal insanity, students to believe in a tradition which has ceased to have exalted delusions, melancholia, mania, idiocy, imbecility, any foundation in fact. If ophthalmic surgeons still persist congenital deformities, conjunctivitis, and most of the in teaching students that sympathetic ophthalmia correctly commoner specific fevers. (b) Cumulative evidence of describes that disease which is really an infective cyclitis several similar diseases contracted nearly or quite simul- then the students should press for an answer to the question taneously, sometimes in twins not living together. Con- "What is the pathology of sympathy ? " It is wonderful, firmatory evidence from literature of the subject. (o) Cumula- too, how the word "lenticular" " enjoys such a vogue in tive evidence in triplets. (d) Reference to insanity in ophthalmic literature. Obviously when the ophthalmic triplets. (e) Other characteristics shared in common in surgeon refers to "lenticular" débris he means "lental" twins and triplets. Confirmatory evidence from literature of débris ; it is difficult to understand how the remains of a the subject. (f) Twins not of the same sex. Much less lens can be described as part of a little lens. Again, the similarity but not unlikeness of constitution. (g) " Doubles." term "crystalline lens " is undeniably high-sounding, magni- ’Two cases of particular diseases. Diabetes ; tetanus. ficent, impressive, but the adjective is nevertheless un- (h) "Doubles." One case of cumulative evidence. (i) Dis. necessary and superfluous. The ancient anatomists spoke of similar diseases in twins, one doubtful case. the crystalline humour to distinguish it from the vitreous For help in collecting these instances together I wish humour and the aqueous humour. In each of the latter specially to thank Mr. D Biddle, Mr. C. Campbell, Dr. H. instances the term " humour " has, for brevity, ceased to be Campbell, Dr S. Davies, Dr. R. Glass, Dr. C. Goring, Dr. R. used, and yet the adjective "crystalline" is still applied to Hutchison, Mr. A. D. Lewis, Dr. H. Maudsley, Mr. George the lens as if to show that it were peculiar to a lens, and Murray, Dr. H. Rayner, Dr. W. J. Rutherfurd, Dr. W. C. especially to the ocular lens, to be "crystalline." This Sullivan, Mr. F. W. Twort, Dr. A. R. Urquhart, and others of calls to mind the solecism so frequently observed in obituary Great Britain, and Dr. B. M. J. Conlin, Dr. C. Hedger, Dr. H. notices, wherein, say, Mrs. Smith is described as the widow Lyons Hunt, Dr J. Ratcliffe, Dr. Milton Sturgis, Dr. J. M. or relict of the late John Smith, thus suggesting the problem Trigg, and Dr. H. Yoder of America, and Mr. H. Rugg of of how a woman can be the widow of a living husband. Australia for useful suggestions and valuable particulars Then there is that fearsome monstrosity, phthisis bulbi, kindly given and all others who replied to my inquiries. employed to describe an atrophic condition of the globe. I am also much indebted to the various medical journals Pathologically, perhaps, the term may be correct. But that which kindly afforded me space for my inquiries. is not the point. I particularly draw attention to it for the Further data required. 1. SIMILAR DISEASES IN :- purpose of showing the confusion to which terms sanctified _(a) Twins and triplets of the same sex.-Like twins and by use" can lead. Phthisis, which only means wasting, triplets. Instances of one disease or, if possible, of several has by custom come especially and exclusively to mean diseases. Unlike twins and triplets. Instances of one disease tuberculosis of the lungs. On this showing, therefore, or, if possible, of several diseases. (b) Twins and triplets ’’ phthisis bulbi can only imply tuberculosis of the globe, not of the same sex.-Like twins and triplets. Instances of whereas the atrophic condition of the globe in question has one disease or, if possible, of several diseases. Unlike twins nothing whatever to do with the tubercle bacillus. It is and triplets. Instances of one disease or, if possible, of somewhat remarkable that throughout the domain of the several diseases. (c) " Doubles " same sex, preferably adults. nomenclature of disease the only instance in which the term