194 Limehouse and in Bermondsey, 37-3 in Woolwich, and 40 0 R.13.A., for duty. Captain G. A. T. Bray has joined the in Westminster and in St. Olave Southwark. During the Brigade Division Staff (43rd, 86th, and 87th Batteries), four weeks of December 744 deaths were referred to the R.F.A., for service in South Africa. Lieutenant. Colonel principal zymotic diseases in London; of these, 1 resulted W. W. Kenny has joined at Woolwich. from small-pox, 238 from measles, 47 from scarlet fever, 207 Major Arthur E. J. Croly is seconded for service on the from diphtheria, 115 from whooping-cough, 87 from enteric Staff. Major Henry Martin, from the Seconded List, to be fever, 49 from diarrhcea, and not one either from typhus or Major, vice A. E. J. Croly, seconded. Major Fausset M. from any ill-defined form of continued fever. These 744 Baker is placed on temporary half-pay on account of ill- deaths were equal to an annual rate of 2’1 per 1000, against health. 34. 1’8, and 1-9 in the three preceding months. The ARMY MEDICAL RESERVE OF OFFICERS. lowest death-rates from these diseases last month were Surgeon - Lieutenant - Colonel William Harford Glover recorded in Paddington, Kensington, Hampstead, St. Luke, Phelps having attained the limit of age, is removed from the Lee, and Plumstead; and the highest rates in Fulham, List of Officers of the Army Medical Reserve. Surgeon- Bethnal Green, St. Olave Southwark, Rotherhithe, Battersea, Lieutenant-Colonel G. P. Bate having resigned his com- and Woolwich sanitary areas. The fatal case of small-pox mission in the Militia ceases to belong to the Army Medical belonged to Whitechapel sanitary area. The 38 deaths Reserve of Officers. Surgeon-Major Walter Culver James, referred to measles were slightly below the average number Honourable Artillery Company of London, late Army in the corresponding periods of the 10 preceding years; Medical Reserve of Officers, is re-appointed with the rank this disease was proportionally most fatal in Fulham. St. of Surgeon-Major. St. Marh’n-ia-the-Fields, Whitechapel, George-in-the-East, INDIA AND THE INDIAN MEDICAL SERVICES. Nevington, and Battersea areas. The 47 fatali sanitary to be Lieutenant-Colonels : cases of scarlet fever showed a marked decline from the Majors -Bombay Establis7t. ment:: William Patrick John William corrected average number: the fatality of George Dennys, proportional Unthank Macnamara, and John Francis this disease was highest in Fulham, St. James Westminster, Joseph Sykes. Marylebone, Stoke Shoreditch, and St. Olave Tuohy. Jfadras Establis7iment : James Cort Marsden, Newington, Francis Casement Reeves, and John SjuhCamberwell, and Woolwich. The 115 fatal VOLUNTEER CORPS. : The casas of whooping-cough were considerably below the Artillery Tynemouth (Western Division, Royal corrected average number ; this disease showed the highest Garrison Artillery) : Surgeon-Lieutenant J. Cromie to be in St. Surgeon-Captain. Royal Engineers : lst Lanarkshire : John proportional fatality George Hanover-square, Hackney,I Clerkenwell, Bethnal Green, Poplar, and Woolwich sanitary Hammond Teacher to be Surgeon - Lieutenant. Rille: lst Volunteer Battalion the Duke of Cornwall’s areas. The 87 deaths from enteric fever were largely in Light Roberts to be excess of the average number in the corresponding periods Infantry : Harry Surgeon-Lieutenant. lst Volunteer Battalion the South Staffordshire - of the ten preceding years; this disease showed the highest Regiment: ,proportional fatality in Hammersmith, Holborn, Limehouse, I Surgeon-Lieutenant H. S. Hughes resigns his commission: Newington, St. Olave Southwark, and Rotherhithe sanitary Thomas Thompson to be Surgeon-Lieutenant. 6th Volunteer Battalion the Gordon A. a.re,s. The 49 fatal cases of diarrhoea were slightly below the Highlanders: Surgeon-Lieutenant Grant his commission. 19th Middlesex : John Gallie average; among the variou3 sanitary areas this disease was resigns proportionately most fatal in St. James Westminster, Strand, Fraser to be Surgeon-Lieutenant. - St. George Southwark, and Woolwich. In conclusion, it may VOLUNTEER INFANTRY BRIGADE. be stated that the from these aggregate mortality prin- The P. F. Robertson, diseases in London December was Clyde : Surgeon-Lieutenant-Colonel .cipal zymotic during nearly lst Dumbartonshire Volunteer Rifle to be Brigade- 12 per cent. below the Corps, average. on as Senior Infant in London last measured the Surgeon-Lieutenant-Colonel appointment mortality month, by Medical Officer to the proportion of deaths of children under one year of age to Brigade. births registered, was equal to 187 per 1000. The lowest VOLUNTEER MEDICAL STAFF CORPS. rates of infant mortality were recorded in Hampstead, The London Companies : First Class Staff Sergeant St. Lnke, City of London, Mile End Old Town, Camberwell, Edmund William Herrington to be Surgeon-Lieutenant. and Plumstead ; and the highest rates in Westminster, -St. Martin-in-the-Fields, Strand, Clerkenwell, St. Olave TRANSVAAL WAR NOTES. Southwark, and Rotherhithe sanitary areas. There is a movement on foot to use some of the islands off Influenza was certified as the primary cause of 312 deaths the north-west coast of Africa for the wounded to relieve the in Ltudon last month, the corrected average number in the overcrowded and overtaxed depôts in South Africa. In 4,.c)rreip-)niinlg periods of the 10 preceding years being 100. Madeira large numbers could be accommodated by placing Of these 343 deaths. 193, or more than one-half, were regis- them not only in the environs of Funchal but in mountain tered during the last week of the month. Among the various villas as far as 2000 feet above the sea level. The climate of sanitary areas the greatest proportional mortality from infla- Madeira would be specially likely to benefit not only the -enza was registered in Paddington, St. George Hanover-square, wounded, but cases of dysentery, loss of blood, and, oi Marylebone, Islington, St. Martin-in-the-Fields, and Lee. In course, pulmonary affections. The hotel-keepers have addition to the 342 deaths directly attributed to influenza already made definite offers of entertainment. The Canary 3334 were referred to diseases of the respiratory organs Islands, too, might be used in this connexion and we under- during the four weeks ending Dec. 30th last. showing an stand that Messrs. Elder, Dempster, and Co. have offered excess of 1412 over the corrected average number. to place a number of beds in their hotel at Las Palmas, free of expense, at the disposal of the authorities. Mr. Carlo Spaini, proprietor of the Grand Hotel Brunate, Como, has offered a reduction of 40 per cent. on the usual THE SERVICES. charges to all officers of the British army on their return from the seat of war who desire to reside at his hotel. ROYAL NAVY MEDICAL SERVICE. The proprietors of the Grand Hotel, Arenzino, have also offered to six rooms at their hotel free of all cost at THE are notified : place following appointments -Surgeons the of British officers wounded in the Transvaal. H. M. Hart-Smith to the Eitropa for duty on voyage to disposal Major C. R. Woods, R.A.M.C., is reported to have been Malta, and afterwards to the Ram.llePS;" C. to Shepherd wounded in the at on Jan. 6th. the P. H. to the and J. A. L. engagement Ladysmith Vtj- Boylen TVuodlark; The Fund is to the Terno2t. Imperial Yeomanry Hospital receiving support Campbell from all parts of the country. Lieutenant-Colonel A. T. ROYAL ARMY MEDICAL CORPF. Sloggett is to act as military medical superintendent, and Captain P. H. Whiston is appointed to the Medical Staff in we understand that Dr. J. W. Washbourn, Mr. Raymond the Home D.strict. Lieutenant Colonel J. A. Gormley has Johnson, and Mr. Newland Pedley will go out as medical left for South Africa. Major J. M. Irwin is posted to the officers. We understand that the National Fire Brigades 8th Hussars and Captain R. C. Lewis to M Battery Union has offered to provide an ambulance detachment of 195

28 men for the Imperial Yeomanry. This offer has been This extract from Allbutt’s I System of Medicine’ is un- accepted. Towards the .650,000 necessary for carrying out fortunate. I have never written anything about an I abnor- the scheme 30,000 have been subscribed. mally powerful’ contraction of the auricle and cannot help Surgeon-Captain E. W. St. V. Ryan of the City Imperial wishing that Dr. Brockbank had looked up my original paper Volunteers sails to-day (Saturday) in the Gaul. and not argued from a digest which misrepresents me." Such is the serious of which Dr. J. B. Coleman, F.R.C.P. Irel., has been appointed to charge misrepresentation the staff of Lord Iveagh’s Irish hospital. Fifteen orderlies confronts me. Now for my defence. I have before me for the will be selected from the Irish Con- what I take to be the original paper of Dr. Samways. hospital Royal " stabulary. It is a thesis thus dedicated: A mon President de These Mons. le Professeur Potain." It is entitled, Messrs. Oflord and Sons have an con- presented ambulance 11 Le Role de l’Oreillette Gauche notamment dans le Rétré- several novel features to the for taining Imperial Yeomanry cissement Mitral, par D. W. Samways, Docteur en Medecine South Africa. de la Faculte de Paris, M.D., M.A., B.Ch. de Cambridge, Messrs. Maw, Son, and Thompson’s Roentgen ray operator, D.Sc. de Londres, M.R.C.S., L. R. C, P. d’Angleterre, autrefois I " Mr. H. C. W. Meredith, will go to the front with the City of Fellow of St. John’s College, Cambridge.’ The booklet is - London Imperial Volunteers. published in Paris by Steinheil, 1896. The Pavonia arrived at Southampton on Jan. 17th with The first chapter opens with these words : "Dans ce sick and wounded, under the charge of Staff Surgeon chapitre j’essaierai de demontrer que dans le cas de retre- Whelan, from South Africa. Every possible arrangement cissement mitral pur, la compensation est maintenue, dans was made for their comfort. le plus grand nombre de cas, par l’hypertrophie de l’oreillette Major Maurice O’Connor Drury, R.A.M.C., has been gauche associee a une prolongation de la systole auriculaire appointed to the charge of the Langman Hospital. qui se continue durant une partie ou la totalite du temps pendant lequel le ventricule expulse son contenu." In DEATHS IN THE SERVICES. Chapter II. in the first sentence are these words: " Dans Inspector-General Edward Townsend Mortimer (retired), le cas de retrecissement mitral, si la contraction de at Cromwell in his He l’oreillette hypertrophiee et non dilatre empiete sur celle Houses, Southsea, sixty-sixth year. la the medical service of the Navy in March, 1856, and du ventricule elle peut empecher avec succes regurgita- joined tion venant du ventricule." I think that there is no served as Assistant the China War from 1857 Surgeon during I " to mentioned in for his necessity that should quote further-the "conclusions" 1862, being specially despatches these views with certain additions. The services at the of Canton. He was also at (page 71) repeat capture present immediate inferences that I formed were in the the of the Peiho Forts and at the attack on the that, opinion capture of Dr. a mitral stenosis was attended same in on which occasion he was thanked the Samways, compensated 1859, by of the muscle of the left auricle and Commander-in-Chief for his services to the wounded, and by (a) hyperthrophy a of the auricular It promoted to Staff Surgeon (medal with three clasps) for his (b) prolongation (normal) systole. services in the Daphne during the Abyssinian War ; he also seemed to me that the inference was not only legitimate but that there was in the cases mentioned an received a medal and was in 1876 to be Fleet necessary promoted contraction of the left auricle. It is Surgeon for the part he took at the capture on the East abnormally powerful Coast of As Medical in to be remembered that this digest of what I took to be Africa of 18 slavers. Officer charge " of the be Rear-Admiral Gore Dr. Samways’s views was under the heading, The Working Embassy accompanied Jones, of the Heart in Mitral Stenosis." It had whatever on a Mission to the Queen of nothing C.B., Diplomatic Madagascar, to do with the morbid of the disease. This I had and as Deputy Inspector-General in charge of the Royal anatomy Naval Hospital, Hong-Kong, he received the thanks of the discussed in previous paragraphs, and I had given a of the observations of Dr. on this Government of that colony for acting as chairman of a summary Samways part Commission to into the of fever there. of the subject. inquire prevalence The of the muscle in therefore Mr. Robert appearance hypertrophy Collum, M.D. Glasg., M.R C P. Lond., was not under consideration, but its functions were. M.R.C.S. at his Sutherland House, Sur- Surely Eng., residence, there was no other course open to me but to describe the in his He was in biton, eighty-fourth year. formerly muscular contraction of the muscle as ’’abnor- the of the Honourable East India and hypertropied service Company of muscle cannot be normal was to Sir Charles the mally powerful." Hypertrophy Staff-Surgeon Napier throughout and the action of such muscle must be abnor- of Scinde. Dr. Collum rendered valuable services hypertrophied conquest Of course, I mean the war and was mentioned in of the mally powerful. by hypertrophy strictly during despatches a condition in which the muscular elements have been battle of Meanee. nourished more than normally and have consequently in- creased in bulk. So also the protraction of the contrac- tion noted by Dr. Samways can be nothing but abnormal and must indicate a muscular power in excess of the normal. If Dr. Samways contends that in compensated Correspondence. mitral stenosis the hypertrophy of the left auricle, the existence of which he admits, and the prolongation of "Audi alteram partem." its muscular contraction, which he also admits, do not indicate an abnormally powerful contraction of the auricle, then I must confess that I do, not understand "THE MURMURS OF MITRAL STENOSIS." the meaning of his language, whether French or English, To the Editors of THJII LANOET. and I wonder whether there are any other competent observers who would or could understand it. The ab- is a matter of and to me that Dr. SIRS,—It pain grief normally powerful contraction of the left auricle in cases Samways of Mentone considers that I have misrepresented of compensated mitral stenosis is proved by the clinical his views in my article on Mitral Stenosis in the fifth volume researches of many observers. I said in my article, which of Professor Allbutt’s 41 System of Medicine." I have no con- has been stigmatised as a misrepresenting digest by Dr. " He" "shows from mechanical cern with the between Dr. and Dr. E. M. Samways, (Dr. Samways) controversy Samways and data that the force of the These two experimental auricle, seeing Brockbank. excellent observers must fight the that its active contraction is continued until the aortic battle but I have a concern in the of the out, great portion valves are opened and a free outflow is permitted into the letter of Dr. to Samways THE LANCET of Jan. 6th, 1900, aorta, ia adequate to prevent any reflux during the which me the serious page 64, virtually brings against ventricular systole. It seems to me very probable charge that in my article in Professor Allbutt’s System that this view is correct. It affords a " explana- of Medicine I am of good guilty misrepresentation. tion of the post-mortem appearances when a contracted In order to be clear let me quote the exact words which mitral orifice, evidently of slow pathogenesis, is accompanied Dr. "He" Samways employs. (Dr. Brockbank) "states by a very small left ventricle. If mitral regurgitation had rather that or, mis-states, my theory thus : Samways believes occurred in such a case the ventricular cavity would in all the abnormally powerful contraction of the auricle prevents probability have become dilated." Be it well remembered in stenosis regurgitation compensated mitral and, further, that I was then considering the left auricle in the morbid that the auricle may even be strong enough to force blood condition of mitral stenosis. I had nothing in this relation into the ventricle after contraction of the latter haj begun.’ to do with the normal action of the auricle in a state of