856 invited by the corporation to notify to the medical officer of showed a slight decrease from the number in the preceding health all cases of this disease occurring in milch cattle included four in Glasgow and two in Leith. The within the borough, and for every such notification the week,deaths andfrom scarlet fever occurred in Edinburgh, Glasgow, corporation will pay a fee of ls. It is also provided by the and Greenock. The deaths referred to diseases of the corporation that where there is doubt as to the nature of the respiratory organs in these towns, which had been 83 and 54 disease they are prepared to supply the veterinary in the two preceding weeks, rose to 68 last week, and were with the necessary tuberculin and to pay him a fee ofsurgeon 2s. 6d. equal to the number in the corresponding period of last year. for performing the operation. The causes of 30, or 5 per cent., of the deaths in these towns were __ _ __ eight last week not certified.

VITAL STATISTICS. HEALTH OF DUBLIN. The death-rate in Dublin, which had been 30-6 and HEALTH OF ENGLISH TOWNS. 37 4 per 1000, in the two preceding weeks declined IN 33 of the towns 6877 births and 4617 igain to 35-1 during the week ending Sept. 16th. During largest English ;he four weeks the death-rate in the has deaths were registered during the week ending Sept. 16th. past city averaged The annual rate of in these towns, which had 33 5 per 1000, the rate during the same period being mortality 21.8 in London and 210 in The 235 deaths decreased from 26 8 to 25-2 per 1000 in the three preceding Edinburgh. the week under notice were weeks, further declined to 21-1 last week. In London the ’egistered in Dublin during L6 below the number in the and included rate was 18 1000, while it averaged 22-6 in the 32 pro- preceding week, 8 per were the vincial towns. The lowest death-rates in these towns were 30 which referred to principal zymotic diseases, 10-6 in Norwich, 13 5 in 15.7 in Derby, and 16’8 against 58 and 72 in the two preceding weeks; of these, 45 Croydon, resulted from 23 from nine in Cardiff; the highest rates were 30-9 in Liverpool, diarrhoea, measles, from "fever," 31-0 in Preston, 31-7 in Wolverhampton, and 32-5 in one from scarlet fever, one from diphtheria, one from Salford. The 4617 deaths in these towns included 1185 whooping-cough, and not one from small-pox. These 80 deaths were to an annual rate of 11-9 the which were referred to the principal zymotic diseases, equal per 1000, zymotic against 1743 and 1588 in the two preceding weeks ; death-rates during the same period being 3 5 in London and 5.1 of these, 931 resulted from diarrhoea, 69 from diph- in Edinburgh. The deaths from diarrhoea, which had been theria, 61 from "fever’’ (principally enteric), 55 from 36 and 42 in the two preceding weeks, further rose to whooping-cough, 39 from measles, 27 from scarlet 45 last week. The 23 fatal cases of measles exceeded by fever, and three from small-pox. The lowest death- six the number recorded in the preceding week. The deaths rates from these diseases occurred in London, Croydon, referred to different forms of "fever" which had been Bristol, Norwich, Derby, and Birkenhead, and the highest four and eight in the two preceding weeks, further rose last rates in Wolverhampton, Salford, Burnley, and Preston. week to nine. The mortality from scarlet fever and from The greatest mortality from measles occurred in Burnley ; whooping-cough was below, while that from diphtheria from scarlet fever in Bradford ; from "fever" in Sheffield, corresponded with, the mortality in the preceding week. The Halifax, and Birkenhead; and from diarrhoea in Brighton, 235 deaths in Dublin last week included 74 of infants under ’Wolverhampton, Bolton, Salford, Burnley, and Preston. one year of age, and 32 of persons aged upwards of 60 The 69 deaths from diphtheria included 22 in London, 10 years ; the deaths of infants exceeded the number recorded in Leeds, six in Leicester, and five in Birmingham. Three in the preceding week, while those of elderly persons showed a decline. Two cases and five deaths from fatal cases of small-pox were registered last week in Hull, but inquest violence were and or more than a of the deaths not one in any other of the 33 large towns ; and no small-pox registered, 83, third, occurred in institutions. The causes of or more patients were under treatment in any of the Metropolitan public 10, Asylums Hospitals. The number of scarlet fever patients in than 4 per cent., of the deaths in the city last week were not certified. these hospitals and in the London Fever Hospital on Saturday, Sept. 16th, was 2640, against 2538 and 2549 at the end of two 336 new cases were admitted the preceding weeks; THE during the week, against 225, 252, and 298 in the three pre- SERVICES. ceding weeks. The deaths referred to diseases of the respiratory organs in London, which had been 131 and 170 ROYAL NAVY MEDICAL SERVICE. in the two preceding weeks, declined again last week to 133, FLEET SURGEON ALEXANDER GEORGE PEMBERTON GIPPS .and were 18 below the corrected average. The causes of 28, has been placed on the Retired List of his rank at his own or 0’6 per cent., of the deaths in the 33 towns were request ; Fleet Surgeon Horace E. F. Cross has also been not certified either by a registered medical practitioner or by placed on the Retired List at his own request, with the rank a coroner. All the causes of death were duly certified in of Deputy Inspector-General of Hospitals and Fleets. and in 16 other Leicester, Salford, Bradford, Leeds, Hull, ROYAL ARMY MEDICAL CORPS. smaller the of uncertified deaths towns ; largest proportions Lieutenant-Colonel Blennerhassett is nominated for service were registered in Bristol, Birmingham, Nottingham, Liver- and Sheffield. in the Bombay Command. Lieutenant-Colonel E. J. Fair- ,pool, - land (retired list) is selected for duty with the troops at Maidstone. Major G. W. Brazier-Creagh joins at Woolwich. HEALTH OF SCOTCH TOWNS. Lieutenant G. J. S. Archer is placed under orders for service The annual rate of mortality in the eight Scotch towns, in India. Colonel W. F. Stevenson, Professor of Clinical which had been 24.1 and 22-6 in the two preceding weeks, Military Surgery at Netley, who completed his period of declined to 20-2 the week again per 1000, during ending service on August 10th, is reappointed for a further term. Sept. 16th, and was 0-9 per 1000 below the mean rate INDIA AND THE INDIAN MEDICAL SERVICE. during the same period in the 33 large English towns. The rates in the eight Scotch towns ranged from 11-7 in Aber- The services of Major E. A. W. Hall (Bengal) are placed deen and 13’5 in Perth to 22-5 in Glasgow and 22-8 in Leith. permanently at the disposal of the Chief Commissioner of The 616 deaths in these towns included 136 which were Assam. The services of Major H. D. Rowan, R.A.M.C., are referred to diarrhœa, 15 to 11 fever," eight to whooping-cough, replaced at the disposal of the Military Department. Dr. seven to diphtheria, five to measles, and three to scarlet Dhingra is temporarily engaged for plague duty and his fever. In all, 174 deaths resulted from these principal services are placed at the disposal of the Government zymotic diseases, against 217 and 225 in the two preceding of India in the Foreign Department. Dr. F. W. Twidale, weeks. These 174 deaths were equal to an annual rate doing temporary plague duty in Sutna, Central India, is of 5-7 per 1000, which almost corresponded with the mean transferred on the same duty to Ajmir, Rajputana. rate last week from the same diseases in the 33 large Captain W. Henvey is appointed to officiate as Super- English towns. The fatal cases of diarrhoea, whicli intendent of the Central Jail, Raipur. On being relieved had increased from 70 to 193 in the five preceding weeks, by Major W. L. Price Captain P. F. Chapman, Officiating declined last week to 136, of which 69 occurred in Civil Surgeon, Bilaspur, is transferred in the same capacity - Glasgow, 24 in Edinburgh, 17 in Dundee, and nine in to Seoni. Leith. The deaths referred to different forms of "fever," VOLUNTEER CORPS. which had been nine and 10 in the two preceding weeks, rose; Rifle: 3rd Volunteer Battalion the King’s (Liverpool again last week to 15, of which nine were recorded. Regiment) : Surgeon-Lieutenant J. McMullen to be Surgeon- in Glasgow. The eight fatal cases of whooping-cough Captain. 2nd Volunteer Battalion the Duke of Cambridge’s 857

Own (Middlesex Regiment) : Surgeon-Lieutenant E. Farr 1 , us, it is likely that the error will be repeated of be Surgeon-Captain. under-estimating the enemy. A very large military force will be with, of course, a correspond- VOLUNTEER MEDICAL STAFF CORPS. required, ing provision of hospitals and medical service. If we may The London Companies : Alexander Granville to be Su; judge from the reports published in the daily press it is geon-Lieutenant. probable that the Boers may speedily assume the aggressive. There must be in this, as in all campaigns conducted on a. VITAL STATISTICS IN THE AUSTRIAN NAVY. large scale, periods of some anxiety to be passed through. In the year 1896 the average strength of the Austrian nav It is highly probable that there will be a good deal of hard was 9871 officers and men, of whom 3728 were employed o: fighting betore the war is ended and quite possible that the land and 6143 afloat. The admissions to hospital, invaliding enemy may be more or less successful in their encounters atf out of the service, and deaths were at the rate of 682, 21’36 the beginning of the campaign, but there cannot be a doubt- and 9-30 per 1000 respectively, but if seven suicides, eigh as to what will be the final end of the struggle which is really accidental deaths, and four casualties in an affray with the one for maintaining our supremacy in that part of the world. natives at Guadalcanar (one of the Solomon Islands) be We can only trust that an ample supply of medical officers, deducted the death-rate falls to 7 36 per 1000. In 1897 thl hospitals and hospital stores will be forthcoming. We suspect average strength was 10,058 (3775 ashore and 6283 afloat) as in all wars the difficulty will be mainly one of while the admissions to hospital and invalidings were at thf transport,that in this and we are glad to see that orders on a considerable rate of 579 and 2404 per 1000. Deducting seven deaths by scale have already been issued for the purchase of transport suicide-and 14 by accidents the death-pate for the year was animals in America and in South Africa. 5’06 1000. the extent of their only per Judged by hospitalisa- DEATHS IN THE SERVICES. tion the health of the men in sea-going ships was better than Fleet Robert on in his that of their comrades on land, the admissions per 1000 Surgeon Willcox, Sept. 5th, of strength having been 577 afloat against 708 ashore. eighty-fifth year, at Southsea. He joined the service as assistant in 1841. He was of the During the biennium 604 cases of typhoid fever were treated, surgeon surgeon Spitfire the Crimean War and was landed at the battles of but of these no fewer than 560 occurred at Pola in Istria, during between the beginning of November, 1896, and the end of Alma and Inkerman, and assisted the army medical service in the care of the wounded on the field. He was also at February, 1897. Early in the former year some sporadic the of of cases showed themselves, and others continued to bombardment Sebastopol. the taking Kertch, the appear bombardment and of and the destruction during the summer and autumn until the end of October capture Kinburn, of Sulina and medals with when the disease burst forth in epidemic form all over the (Turkish Crimean Sebastopol He was Fleet in 1863 and retired town. In the military portion of the garrison there were clasp). appointed Surgeon in 1870. He was the Greenwich in 725 cases, and the number officially reported among the granted Hospital pension civilian population was 1148. By general consent the June, 1896. Caroline from which the central is Surgeon-Major-General Stewart Aaron Litbgow, C.B., spring, water-supply D.S.O. of the derived, was incriminated as the cause of the epidemic. (retired), A.M.S., Superintendent Edinburgh on in his From a bacteriological investigation which was insti- Royal Infirmary, Sept. 20th, sixty-seventh year, tuted and received subsequent confirmation at at Melrose. He entered the army .in 1855, served at the locally and in the Indian wounded at the both Gratz and Vienna it appears that in dry weather Cape Mutiny, being siege of Delhi. He also served in in the Nile this water remains wholesomely free from germs, but Egypt Expedition of as Medical Officer on the lines of com- that after rain unmistakable traces of fæcal con- 1884-85 Principal munication medal and Khedive’s bronze tamination are always present. Considering that a great (Egyptian star). part of the watershed from which the spring is fed is thickly He retired in 1893. inhabited this is not to be wondered at; and further The Jelunga (chartered troopship) sailed from South- evidence of the water-borne character of the disease is ampton on Sept. 20th’ with 55 officers, three ladies, 1047 furnished hv t.hp fact that, in thf -nrcKpnf, itiatH.Tlf.R as wpll of all ranks, 64 soldiers’ wives, and 63 children, for Malta, as on several previous occasions, the typhoid outbreak was Port Said, and Natal. Major H. 0. Trevor, R.A.M.C., is in preceded by a heavy rainfall. When the epidemic first medical charge of the troops. showed itself excavations for a new series of water-pipes were in progress in most of the streets, but that the typhoid fever was not owing to the disturbance of the subsoil thus occasioned seems to be proved by the immunity of the excavators, of whom only two out of a total of 150 were attacked. Correspondence. In combating the outbreak dependence was at first upon water-boiling and after that upon sterilisa- placed "Audi alteram partem." tion by means of chloride of lime and hyposulphite of soda, but in neither case were the results satis- factory. It was not until water from the Tivoli spring SYPHILIS OF THE STOMACH. was substituted for that from the Caroline that the disease To the Editors of THE LANCET. showed any signs of abatement. Amongst other points of interest it may be mentioned that in 1896 there were 261 SIRS,-The descriptions of cases diagnosed as syphilis of cases of sunstroke or heat apoplexy without a death, whereas the stomach which have appeared in THE LANCET 1 are in 1897 out of 24 cases two proved fatal. Almost the whole very interesting to me because of a case I had which, I of the first series occurred on land at Pola during July and thought, came under the same heading. August, 1896, the compiler’s remarks in this connexion being My patient was a thin pale individual, aged 40 years. I to the following effect: "The very large number of cases had treated him previously for a tubercular syphilide over the that in 1896 were diagnosed as heatstroke or sunstroke sacrum which cleared well away under potassium iodide. shows that persons whose work keeps them on shore are He came to me in August, 1897, with a troublesome cough, more liable to suffer from a high temperature than their which was accentuated while on his back in bed. He com- congeners afloat." plained of a pain in the pit of the stomach. Examination THE TRANSVAAL CRISIS. of the chest revealed nothing, so that a simple cough mixture was sufficient to relieve the It must be obvious to everyone, even to the least thought symptoms. thoughtful, that affairs in South Africa have reached A fortnight later after a heavy day in the harvest field, while from his work and a thrown such a state of tension that, unless the Transvaal Govern- walking having heavy tarpaulin over his he felt an acute in his ment gives way, war is imminent. No one can now shoulder, suddenly pain stomach as of He was tell whether it can be averted or not. There is, as something having given way. uneasy might be expected, much difference of for the rest of that night and early the next morning he began opinion-should to vomit blood and to it rectum. The con- a be inevitable the Boers pass per vomiting unfortunately campaign against and until the on the part of this country-as to the difficulties that will tinued at intervals during the day following when I saw him. I found him in bed have to be overcome before any final settlement can be morning lying utterly with cold sweat and reached. Where both sides are brave and determined prostrate, his body covered well-nigh and well armed with the most modern of weapons precision 1 An annotation on a case by Dr. Dubuc in La France Médicale is to the of the task is not to be under-estimated gravity likely be found in THE LANCET of July 16th, 1898, p. 164, and the case is any more than, with our previous experience to guide described by Dr. Dalgliesh in THE LANCET of August 12th, 1899, p. 410.