1796 appears that the number of persons reported to be suffer- l >oplar, and 2 in Wandsworth. The 78 deaths from diphtheria ing from one or other of the ten diseases specified in the were slightly below the corrected average ; this disease was table was equal to an annual rate of 7’8 per 1000 of the >roportionally most fatal in Fulham, Chelsea, the City of population, estimated at 4,522,628 persons in the middle ofWestminster, Hampstead, and Poplar. The 32 fatal cases the year. In the three preceding months the rates were c )f whooping-cough were 26 below the corrected average 4’4, 6-9, and 8’5 per 1000 respectively. The lowest rates lumber, and included 5 in Poplar, 4 in Wandsworth, and 3 last month were recorded in Paddington, Kensington, i n Lambeth. The 20 deaths referred to enteric fever showed Hammersmith, Chelsea, the City of Westminster, Holborn, decline of 8 from the corrected average number ; of these and the City of London ; and the highest rates in Fulham,3 20 deaths 3 belonged to Hammersmith, 3 to Lambeth, and 2 Hackney, Finsbury, Deptford, Greenwich, Lewisham, and i iach to Fulham, St. Pancras, Poplar, and Wandsworth. Woolwich. The prevalence of scarlet fever showed a marked ’ rhe 149 deaths from diarrhoea and enteritis among children decline from that recorded in the previous month ; among the i inder two years of age were less than half the number several metropolitan boroughs the greatest proportional pre-n the previous month ; the greatest proportional mortality valence of this disease occurred in St. Marylebone, Hackney,’rom this cause was recorded in Hammersmith, Chelsea, Lambeth, Wandsworth, Camberwell, Deptford, and Wool-Finsbury, Bethnal Green, Bermondsey, and Wands worth. wich. The Metropolitan Asylums Hospitals contained 2103 In conclusion, it may be stated that the aggregate mortality scarlet fever patients at the end of last month, against.n London last month from the principal infectious diseases 1324, 1656, and 2152 at the end of the three precedingi excluding diarrhoea) was 47 per cent. below the average. months; the weekly admissions averaged 254, against 261 and 317 in the two preceding months. Diphtheria was slightly more prevalent than it had been in the preceding month; this disease was proportionally most prevalent in THE SERVICES. Fulham, St. Pancras, Finsbury, Greenwich, Lewisham, and Woolwich. The number of diphtheria patients under treat- ROYAL NAVY MEDICAL SERVICE. had ment in the Metropolitan Asylums Hospitals, which IN accordance with the of Order in Council of been and 1143 at the end of the three provisions 720, 892, 1881, Hubert William Austin had risen to 1327 at the end of April lst, Fleet-Surgeon preceding months, Burke has been on the Retired List at his own the placed request. last month ; weekly admissions averaged 180, The have been notified :-Fleet. 138 and 168 in the two months. following appointments against preceding Surgeon: G. T. to Malta The of enteric fever showed a considerable Bishop Hospital. Staff-Surgeons: prevalence D. V. Lowndes to the for R.N. and decrease from that recorded in either of the two Pembroke, Barracks; preceding R. R. L. M. and G. H. M. Mills to the the of this Horley, Morris, months ; greatest proportional prevalence disease additional, for A. D. C. occurred in Holborn, and Viotory, disposal. Surgeons : Fulham, Islington, Finsbury, Cummins to the for R.N. Barracks ; W. R. Harrison Lambeth. There were 85 enteric fever under treat- Victory, patients to the for G. Moir to the ment in the at the end of Victory, additional, disposal ; Metropolitan Asylums Hospitals Vivid, additional, for disposal; and G. T. Verry to Haslar last month, against 56, 155, and 160 at the end of the three the admissions Hospital. preceding months; weekly averaged 9, ARMY MEDICAL SERVICE. against 39 and 23 in the two preceding months. Erysipelas Sir Francis W. C.B., was proportionally most prevalent in Stoke Newington, Surgeon-General Trevor, K.C.S.I., Shoreditch, Bethnal Green, K. H. S., is retained supernumerary to the establishment, under Hackney, Finsbury, Stepney, the of Articles 92 and 472 Warrant for Southwark, and Bermondsey. The 40 cases of puerperal provisions Royal Pay fever notified during the month included 5 in Southwark, and Promotion, 1909 (dated Dec. llth, 1911). Colonel 5 in Lambeth, 4 in 4 in 4 in Wandsworth, Thomas M. Corker to be Surgeon-General, vice Sir F. W. Hackney, Stepney, K.H.S. Dec. 3 in Fulham, and 3 in St. Pancras. Of the 20 cases of Trevor, K.C.S.I., C.B., (dated llth, 1911). poliomyelitis notified, 4 belonged to Lambeth, 3 to Shore- Colonel (temporary Surgeon-General) William Babtie, V.C., ditch, and 2 each to and C.M.G., to be Surgeon-General to complete establishment Hackney, Stepney, Poplar, Dec. Lieutenant-Colonel James M. Battersea ; and 2 of the 6 cases notified as cerebro-spinal (dated llth, 1911). meningitis belonged to Finsbury. Irwin, from the Royal Army Medical Corps, to be Colonel, vice T. M. Corker (dated Dec. lltb, 1911). The mortality statistics in the table relate to the deaths of persons actually belonging to the several boroughs, the deaths ROYAL ARMY MEDICAL CORPS. occurring in institutions having been distributed among the Lieutenant Arthur J. 0. Wigmore resigns his commission several boroughs in which the deceased persons had pre- (dated Dec. 16th, 1911). viously resided; the death-rates from all causes are further Lieutenant-Colonel G. G. Adams, commanding the Military corrected for variations in the sex- andage-constitution of the Hospital at Colaba, Bombay, has been selected for the populations of the several boroughs. During the five weeks higher rate of pay under Article 317 of the Royal Warrant. ending Dec. 2nd the deaths of 5827 London residents were Lieutenant-Colonel T. McCulloch has arrived home, tour- registered, equal to an annual rate of 14’1 per 1000 ; in the expired, from India, and has been appointed in charge of the three preceding months the rates had been 18’9, 16 8, and Medical Divisions of the Royal Victoria Hospital at Netley. 15-1 per 1000 respectively. The death-rates last monthLieutenant-Colonel M. J. Sexton, lately in medical charge of ranged from 10 - 7 in Lewisham, 11’ 0 in Kensington, 11’1the Military Hospital at Arbor Hill, Dublin, has embarked in Wandsworth, 11-2 in Hampstead, 11. 3 in Woolwich, for a tour of service in South Africa. Lieutenant-Colonel J. and 11.8 in the City of London, to 16’7 in Bermondsey, Donaldson, in charge of the infectious diseases hospital at 16’8 in Bethnal Green, 17’0 in Poplar, 17.1 in Holborn, Aldershot, has been detailed by the War Office for a tour of 17’7 in Finsbury, and 19.0 0 in Southwark. The 5827 deaths service in India, and on arrival will be posted for duty from all causes included 52 from measles, 19 from scarlet in the Second (Rawal Pindi) Division. Lieutenant-Colonel fever, 78 from diphtheria, 32 from whooping-cough, T. Daly has been selected to hold Medical Charge of 20 from enteric fever, and 149 among children under the Station Hospital at Peshawar. Lieutenant-Colonel two years of age from diarrhoea and enteritis. No death M. P. C. Holt, D.S.O., honorary surgeon to the H.E. from any of these diseases was recorded last month in the Viceroy of India, has been appointed to command the City of London ; among the metropolitan boroughs they the Station Hospital at Kasauli. H.E. the Commander- caused the lowest death-rates in Kensington, Islington, Stoke in-Chief in India has been pleased to grant an exten- Newington, Hackney, and Woolwich, and the highest rates sion of the command of the Station Hospital at Lucknow in Hammersmith, Chelsea, Finsbury, Bethnal Green, South- to Lieutenant-Colonel H. N. Thompson, D.S.O., honorary wark, Wandsworth, Greenwich, Poplar, and Deptford. The surgeon to H.E. the Viceroy. Major G. M. Goldsmith has 52 deaths from measles were less than one-third of the been selected for appointment to command the Station Hos- corrected average number in the corresponding period pital at Lebong. Major T. H. J. C. Goodwin, D.S.O., on of the five preceding years; of these 52 deaths, 20 completion of his Indian tour of service, has been appointed belonged to Deptford, 9 to Southwark, 7 to Camberwell, to the Southern Command. Major F. Harvey, from Devon- 4 to Greenwich, 3 to Battersea, and 2 to Bermondsey. port, has taken up duty at Bodmin. Major L. N. Lloyd, The 19 fatal cases of scarlet fever were 28 fewer D.S.O., on completion of his tenure of appointment as than the corrected average, and included 3 in Finsbury, adjutant of the Royal Army Medical Corps School of 2 in St. Marylebone, 2 in Islington, 2 in Shoreditch, 2 in Instruction at London, has been posted for duty in the 1797 Western Command. Major F. J. C. Heffernan, from the Ri;ht Hon. the Secretary of State for India to extend London District, has taken up duty with the Fifth (Mhow) his leave of absence by four months. Major A. A. Gibbs Division in India. Major S. de C. O’Grady has been has been appointed Medical Storekeeper to the Government transferred from the Military Hospital at Khartoum to of India at Lahore, in succession to Lieutenant-Colonel P. W. Cairo. Major H. E. Staddon, from Shorncliffe, has 0’(jrorman, who has vacated the appointment. Surgeon- been appointed to the Military Hospital at Dover. Captain W. A. Murray, in medical charge of the Assam- Major R. H. Lloyd, lately adjutant of the Royal Army Bengal Railway Volunteer Rifles, has been granted leave of Medical School of Instruction at Exeter, has embarked ab.sence home from India for one year and three months for a tour of service in India, and on arrival will by the General OfBcer commanding the Assam Brigade. be posted to the Third (Lahore) Division. Major E. P. Ca,ptain A. W. Overbeck-Wright, officiating superintendent Sewell, from Belfast, has taken up duty in Oeylon. of the Central Prison at Agra. has been appointed to officiate Major J. V. Forest, in medical charge of the troops as Superintendent of the Lunatic Asylum at Agra, in suc- at Kasr-el-Nil, Cairo, has been transferred for duty ce:ssion to Major A. W. R. Cochrane, granted leave of absence. at the Military Hospital, Khartoum. Major J. D. Captain C. F. Marr, medical storekeeper to the Government McCarthy, from Multan, has taken up duty at Rawal Pindi. of India at Bombay, on relief by Major F. E. Swinton, Captain E. V. Aylen has been transferred from Nowshera to reiturning from furlough, has been detailed to rejoin his regi- Barian. Captain J. M. H. Conway, from the Royal Infirmary, ent. Captain W. Jeudwine has been appointed to officiate Phoenix Park, Dublin, has taken up duty as Adjutant of the as Civil Surgeon of Simla, West, during the absence Royal Army Medical Corps School of Instruction at Leeds in onL deputation to Delhi of Lieutenant-Colonel C. Daer. succession to Major H. S. Roch. Captain F. M. Parry, from aptain J. W. McCay, Bengal Presidency, has been per- Maidstone, has embarked for a tour of service in Mauritius. mitted to extend his leave of absence home from India for Captain J. W. S. Seccombe has arrived home for duty from orie month on the recommendation of a medical board. Nasirabad. His Honour the Lieutenant-Governor of the aptain A. W. Howlett, whose services have been placed United Provinces in India has been pleased to appoint temporarily at the disposal of the Government of the United Captain T. Scatchard to hold Civil Medical Charge of P:rovinces, has been appointed to officiate as Superintendent Ranikhet in addition to his military duties in succession to oi the Central Prison at Agra. Captain N. S. Wells, on Major W. G. Beyts. Captain S. M. W. Meadows has taken reiturn from leave, has been appointed Civil Surgeon at over Charge of the Military Families Hospital at Tidworth Ghazipur. Captain D. Munro has been granted an exten- Park, Salisbury Plain. Captain F. W. W. Dawson, from sion of leave for three months by the Right Hon. the Dublin, has embarked for a tour of service with the Northern Secretary of State for India. Captain H. C. Keates has Army in India. Captain T. J. Potter, at present employed IE;linquished charge of the duties of superintendent of the in the London District on medical recruiting duty, has been Jullundur District Jail. Captain E. T. Harris has been placed under orders for a tour of service in Egypt. Captain granted four months’ extension of his leave of absence. H. G. Sherren, from Colaba, and Captain C. F. White, from Ciaptain G. D. Franklin has taken up duty as Agency Surgeon Jhansi, have been detailed for duty on board the troopship at Gilgit on return from leave. The services of Captain s.s. Dongola, leaving Bombay for Southampton on Dec. 28th. T:. C. C. Maunsell have been placed temporarily at the Captain A. W. Sampey, on relief by Lieutenant-Colonel disposal of the Government of India. Captain J. Cunningham F. W. H. Burton, in charge of the Military Hospital at hias been selected for appointment to the Bacteriological Warley, has been granted six weeks’ leave of absence prior I)epartment. Captain N. S. Sodhi has taken up duty as to embarkation for a tour of service in India. Captain J. I’lague Medical Officer in the Gurgaon District. Powell has arrived home on leave of absence from Egypt. SPECIAL RESERVE OF OFFICERS. Lieutenant H. Gall, from Dagshai, has taken up duty at Simla. Lieutenant A. S. M. Winder, from the Curragh, and Royal Army Medical Corps. Lieutenant M. White, from Bordon, have embarked for a tour Captain and Honorary Major William V. Sinclair of service in India. Lieutenant L. F. K. Way, from Cosham, (Honorary Lieutenant in the Army) resigns his commission, has been transferred for duty at the Military Hospital,vith permission to retain his rank and wear the prescribed Hilsea. Lieutenant H. F. Joynt, from Hounslow, has i.miform (dated Dec. 16th, 1911). embarked for a tour of service in South Africa. Lieutenant G. P. Taylor has been transferred from Irvine to Glasgow for TERRITORIAL FORCE. duty at the Military Hospital. Lieutenant S. S. Dykes, on Royal Army Medical Corps. the closing of the Training Camp at Barry, has been posted to 2nd East Lancashire Field Ambulance, Royal Army Medical Aberdeen. Lieutenant S. W. Kyle, from Jubbulpore, has Dorps( : Lieutenant William F. Munro to be Captain (dated been appointed to the Station Hospital at Jhansi. Lieu-Sept. 23rd, 1911). tenant A. W. Byrne, from Dalhousie, has taken up duty at 1st Wessex Field Ambulance, Royal Army Medical Corps : Lahore Military Hospital. -The undermentioned officers to be Captains (dated Nov. 5th, INDIAN MEDICAL SERVICE.1911) : Lieutenant Thomas Duncan, Lieutenant George P. D. Lieutenant John and Lieutenant Richard The King has approved of the confirmation of the com- Hawker, Miller, missions of the following Lieutenants on probation with Eager. effect from July 29t.h, 1911 :-Edward Slade Goss and Percival Supernumerary for S’ervice with the Officers Training Corps. Sandys Connellan. -The undermentioned officers from the Unattached List for The King has approved of the retirement of Lieutenant- the Territorial Force are appointed, with rank and precedence Colonel D. G. Crawford (dated Dec. 5th, 1911). as on the Unattached List, for service with the medical unit H.E. the Viceroy and Governor-General of India has been of the University of London Contingent, Senior Division, to Colonel J. Smith, Officers Training Corps (dated Dec. 16th, 1911): Captain pleased appoint officiating principal Archibald Lieutenant medical officer of the Secunderabad to be an Hono- Montague Henry Gray, (Provisional Brigade, Robert Lieutenant rary Surgeon on His Excellency’s personal staff, in succession Captain) Davies-Colley, (Provisional to Surgeon-General P. H. Benson, retired. Lieutenant- Captain) Alfred Edward Johnson, Lieutenant John Charlton Thomas Lieutenant Colonel W. R. Edwards has arrived home on leave of Briscoe, Lieutenant Bramley Layton, absence from India. Major F. F. Elwes has been appointed Gordon Olunes McKay Mathison, and Lieutenant William to H.E. the Governor of Madras. Major A. M. Victor Corbett. Surgeon THE MILITARY SURGEON. Fleming, civil surgeon at Raipur, has been granted furlough on medical certificate home from India for one year. Major In the December issue of the Military Surgeon Major H. J. Walton has been selected for appointment as Civil Paul F. Straub, of the General Staff, U.S. Army, Sanitary Surgeon at Saharanpur. The Chief Commissioner of the Inspector, Manoeuvre Division, gives an interesting account of Central Provinces has appointed Captain M. F. Reaney, civil the working of the Medical Department of the division at surgeon at Wardha, to the Executive and Medical Charge of San Antonio, Texan, under the new field service regulations. the Wardha District Jail. On relief by Major T. G. N. The Medical Department was made responsible for the Stokes, of the office of the Sanitary Commissioner of the sanitary service of the division, and was given by the com- Central Provinces, Major W. H. Kenrick has been placed on manding general the necessary authority and means for special duty in connexion with the investigation and preven- it on. The result was that after the lapse of four tion of malarial fevers in the Central Provinces. Major months the sick rate of the division is reported as never J. W. F. has been the carryingexceeded half the sick rate at the Rait, Bengal Presidency, permitted by having average military 1798

posts. General orders defined and prescribed the power and To the Editor of THE LANCET. authority of the chief surgeon and the sanitary inspector, SIR,-The Chancellor of the has stated that .a.nd dealt with the dis- Exchequer water-supply, regimental surgeons, visit is an under the the sale of foods and drinks in and payment per impossibility present posal of wastes, camps, Insurance Bill. The logical conclusions to be drawn are: the oG!1trol of Illustrations are of a sanitary squads. given (1) the Government is dependent for the success of the Bill of incinerator which was as type garbage finally developed upon the ohccrity of the medical profession-which ruins the the result of and was found efficient. experiment, very Bill as a sound financial proposition ; (2) the Government is deliberately sweating the medical profession-a disgrace to the originators of the Bill and an insult to the profession. The" six cardinal points " of the British Medical Associa- tion were loyally accepted even by those of us who were not Correspondence. members, but in view of the way in which the Asssociation has been flouted I feel that the profession should now stand "’ Audi alteram partem." firm and demand payment for work done, and nothing less. The attitude of the profession has been hitherto very passive, but the apathy of its leaders is far from creditable. Does THE NATIONAL INSURANCE ACT. the General Medical Council mean to do nothing ? Can it To the Editor of THE LANCET. without protest allow the profession to be sweated? Is the charity of the profession to be farmed out by the State for SIR,—It is desirable that the action of the medical I profit without some intervention from the General Medical profession with regard to the National Insurance Act should Council, or does it allow the State to do what it forbids to a be based on a clear enunciation of just principles, and on a commercial enterprise ? Let us stop the huckstering and recognition of undeniable facts. The Act is founded on a bargaining that have gone on and remember the dignity of system of contract medical practice. our profession. Now it cannot be denied that (1) contract practice Payment for work done-that and nothing else-should be involves an undertaking by the practitioner to perform what our watchword. Cannot this matter be taken in hand at it is certain that he will not always be able to perform ; once by some influential organisation ? I am confident that (2) contract practice destroys the relation of mutual it would meet with the entire support of the profession. confidence between patient and practitioner, and intro- I am, Sir, yours faithfully, duces an opposition of interests between them ; (3) under Carlisle, Dec. 18th, 1911. RICHARD SEDGWICK, M.D. Cantab. contract practice no patient will ever be satisfied with the amount of attention which he receives from his To the Editor THE doctor, however conscientious and diligent that doctor may of LANCET. be ; (4) under contract practice the medical man is SIR,-Can you or any of your readers inform me why the certain to be grossly overworked, to be subject to un- British Medical Association in its six points insists on a wage- reasonable calls (and at unreasonable hours) for the most limit ? Does it cost more to attend a man earning £22s. a trifling ailments, and to be constantly liable to dismissal for week than a man sitting on the next stool earning only £2? filing to perform what it will be impossible for him to Is there any logical basis for fixing any wage-limit, unless we perform. propose to continue the semi-charitable methods of medical H these facts are undeniable, is it not clearly the duty of attendance that at present characterise club practice ? If the every member of the profession to refuse to work under the pay fixed is adequate I cannot see that a wage-limit is needed. Act so long as it is administered on a basis of contract ? The British Medical Association would have been better I am, Sir, yours faithfully, advised if they had faced the question of adequate pay in the first instance. If they had said 8s. 6d, per annum, to include Dec. 19th, 1911. DAVID B. LEES, M.D., F.R.C.P. drugs and dressings (not appliances)-in fact, the terms now paid for Post Office employees-they would have had practi- cally all the medical men engaged in industrial practice To the Editor of THE LANCET. behind them, and I honestly think the Government would SIR,—The amount of unpaid labour imposed on medical have yielded to these terms. If any general practitioner -men by the services that they are expected to give on the agrees with me that an endeavour should now be made to committees of this Act does not appear to have received the secure these terms from the Commissioners I should be glad attention that their onerous nature demands. The Insurance if he would send me a postcard. (Health) Committees are to consist of from 40 to 80 I am, Sir, yours faithfully, members, their meetings will necessarily be protracted, CHARLES F. SEVILLE, M.B. Lond. - frequent in number, and often distant from the residence of Oulton, Leeds, Dec. 18th, 1911. the medical men serving on them, so that much time and expense will be involved in attendance. To the Editor of THE LANCET. Thi.s, however, would be a portion of the corvee since only SIR,-I have seen during this controversy as to much more work would be entailed interviews and nothing by the attitude that consultants will now that the Bill has with medical co-workers and attendance at take, correspondence passed, towards those members of the who may the of the local or committee. This work profession meetings panel be to work under the Act in its form. will also involve considerable friction and willing present worry, increased In common with other I should be the that the work is useless and many practitioners, by knowledge utterly hope- interested to learn if the consultants will be willing to meet since will be in a on the Insurance ’I less, they always minority them as usual. Is there sort of authoritative to Committees of 1 to 16. any body speak for consultants, or will any senior man among them The time occupied in service on a Health Committee could give his opinion?—I am, Sir, yours faithfully, scarcely occupy less than ten working days of eight hours I FRANK G. WALLACE. per annum and might easily be more. These committees, Earl’s Court-road, London, S.W., Dec. 16th, 1911. allowing for the county subdivisions, will number at least 1fi.ve hundred and the number of medical men employed on them must exceed a thousand. The extent of the medical To the Editor of THE LANCET. corvée can be estimated. The Insurance Committees easily are, SIR,—Dr. Luard, I think, says everything that can be said so far as the is a sham. The profession concerned, Friendly in favour of retention of our time-honoured of pay- societies will dominate them and the system completely profession ment by fee, and has thought of two or three fresh things to will be h&nded over without of resistance to the tender pwer say against the system I am advocating-that of payment mercies of bodies whose are well sweating" proclivities per capita. Several of his are well known. Ef the medical the oorvee by premium points profession accepts imposed thought out and clearly put, and I will essay to meet them on it its members will be reduced to a state of practically later on. He fails, however, to two main socialistic serfdom. approach my standpoints. I will repeat them. 1. In the face of a I am, Sir, yours faithfully, constantly falling sickness rate, payment by fee inevitably Queen Anne-street, W., Dec. 18th, 1911. HENRY RATNNR.RAYNER. means a declining income. I assert that every income