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from all causes in the eight towns last week, 148, or 30 percent., were recorded in public institutions, and 28 were attri-buted to different forms of violence. The causes of 22, or

4’5 per cent., of the deaths in the eight towns last weekwere not certified or not stated ; in the 77 English townsthe proportion of uncertified causes of death during the weekdid not exceed 07 per cent.

HEALTH OF IRISH TOWNS.

In the 22 town districts of Ireland, having an estimatedpopulation of 1.149,495 persons in the middle of this year,581 births and 369 deaths were registered during the weekending July 15th. The annual rate of mortality in these

towns, which had been equal to 17’0 and 14’2 per 1000in the two preceding weeks, rose again to 16-7 inthe week under notice. During last quarter the annualdeath-rate in these towns averaged 17. 9 per 1000; themean rate during the same period in the 77 Englishtowns did not exceed 13-8, and in the eight principalScotch towns was 16 7 per 1000. The annual death-rate

during the week under notice in the 22 Irish towns was

equal to 20’9 in Dublin (against 11-3 in London),16’6 in Belfast, 11-6 in Cork, 19’2 in Londonderry,10-9 9 in Limerick, and 5’ 7 in Waterford; in the 16smallest of these Irish towns the mean annual death-rate last week did not exceed 12-1 per 1000. The 369deaths from all causes in the 22 towns last week showedan increase of 57 upon the low number in the previous week,and included 35 which were referred to the principal epidemicdiseases, against 21 and 22 in the two previous weeks ; these35 deaths were equal to an annual rate of l’ 6 per 1000,exceeding the mean rate from the same diseases in the 77English towns by 0’ 6. These 35 deaths in the Irish townslast week from the principal epidemic diseases included 15from infantile diarrhoea, 7 from measles, 4 from scarlet fever,4 from diphtheria, 3 from enteric fever, and 2 from whooping-cough, but not one from small-pox. The 15 deaths frominfantile diarrhcea exceeded by 7 the number in the previousweek, and included 5 in Dublin and 9 in Belfast. The fatalcases of measles, which had been 9 and 6 in the two previousweeks, were 7 last week, all of which occurred in Dublin.The 3 deaths referred to enteric fever, 3 of the 4 fatal casesof scarlet fever, and 3 of the 4 deaths from diphtheria,were recorded in Dublin. One death from scarlet feveroccurred in Belfast, and one from diphtheria in Dundalk.The deaths referred to diseases of the respiratory system inthe 22 towns, which had been 54 and 46 in the twoprevious weeks, rose again to 52 last week. Of the 369deaths from all causes in the 22 towns last week, 132, or36 per cent., were recorded in public institutions, and 12were referred to different forms of violence. The causes of

12, or 3’3 per cent., of the deaths registered in the 22 townslast week were not certified either by a registered medicalpractitioner or by a coroner after inquest ; the proportion ofuncertified causes of death during the week under notice didnot exceed 0-7 per cent. in the 77 large English towns,and was equal to 4’ 5 per cent. in the eight principal Scotchtowns.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments have been notified

Fleet-Surgeons : F. J. A. Dalton to the Prince George,on recommissioning ; Edward C. Cridland to the 1llustrious,on recommissioning. Staff-Surgeons : C. C. Macmillan,D.S.O., to the Gtbroltar and to the Pt/?’allws, on recom-

missioning; Godfrey Taylor to the Naiad; C. E. C. Stanfordto the New Zealand, on commissioning ; J. H. Lightfoot tothe Crescent and to the Psyche on recommissioning ; G. E.Duncan to the Crescent and to the Paoneer, on recommission-ing ; Thomas H. Vickers to the King Edward Y1I.,additional, on transfer of flag ; C. B. Fairbank to the -F?o:,on recommissioning ; and R. Kennedy to the 8p7iinx. Sur-geon : J. S. Orwin to the Clio.

ROYAL ARMY MEDICAL CORPS.

Colonel L. E. Anderson, principal medical officer of theAllahabad Brigade, has been appointed Principal MedicalOfficer of the Bareilly, Garhwal, and Dera Dun Brigades in

succcession to Colonel M. Kerin, C. B. Lieutenant-ColonelR. W. Wrigbt, at present serving at Shoeburyness, has beenplaced under orders for a tour of duty in the Northern Army,India. Lieutenant-Colonel W. W. Pike, D.S.O., from themilitary hospital at Tidworth Park, Salisbury Plain, has takenup duty as Senior Medical Officer at Cairo. Lieutenant-Colonel H. L. E. White has arrived home on leave from-Malta. Lieutenant-Colonel M. O’Halloran has been appointedin charge of the Military Hospital at Canterbury. Lieu-tenant-Colonel J. H. Daly, at present serving at Limerick,has been detailed by the War Officer for a tour of duty inSouth China. Lieutenant-Colonel L. T. M. Nash, com-manding the Station Hospital at Karachi, has been

granted six months’ leave of absence home from India.Lieutenant-Colonel C. T. Blackwell has taken up dutyat Rangoon in command of the Station Hospital. MajorE. C. Anderson, D.S.O., has been transferred from Kuldannato the Fourth (Quetta) Division for the temporary commandof the Station Hospital at Karachi. Major B. Watts, atpresent serving at Campbellpore, has been granted three anda half months’ general leave. Major H. B. G. Walton hasbeen appointed Specialist in Advanced Operative Surgery tothe Seventh (Meerut) Division of the Southern Army. MajorG. St. C. Thom has been granted one year’s extension of hisIndian tour of service by H.E. the Commander-in-Chief.Major A. W. Bewley, from the Station Hospital at MeerutCantonment, has taken up duty as Senior Medical Officer atLandour. Major G. J. A. Ormsby has been transferred fromFyzabad to Dinapore. Major J. F. Burke, from Falmouth,has been appointed to the Medical Charge of the troops atLancaster. Major J. McD. McCarthy, from Chester, on

arrival in India has been appointed for duty at Multan.

Major C. F. Wanbill, assistant professor of militaryhygiene at the Royal Army Medical College, London,has been placed under orders for a tour of service inIndia. Major C. W. R. Healey has arrived home on leave ofabsence from Nasirabad. Captain J. F. Whelan fromManchester has taken up duty at Nowgong. Captain A. B.Smallman has been transferred from the military hospital atColchester to Woolwich. Captain W. McConaghy fromBirmingham has been appointed to Tidworth Park, SalisburyPlain. Captain M. Dunbar Walker has been appointedSpecialist in Physical Training at the Royal Army MedicalCollege, London. Captain F. J. Stuart has been appointedSpecialist in the Prevention of Disease with charge of theBrigade Research Laboratory at Fyzabad. Oaptain C. J.

Coppinger has taken up duty in the Irish Command. The

following officers have been detailed by the War Office toproceed abroad for duty with the Southern Army in India oCaptains J. Tobin, A. R. Greenwood, P. C. Douglass, J. L.Jones, H. A. Bransbury, and A. W. Sampey. Lieutenant A.

Shepherd from Agra has joined for duty at Landour.Lieutenant D. S. Buist, from the Royal Victoria Hospital atNetley, has been appointed to the Station Hospital at Quetta.

INDIAN MEDICAL SERVICE.

The King has approved of the following promotions:-Lieutenant-Colonel Harold Hendley to be Colonel (datedApril 7th, 1911). Lieutenant-Colonel Robert Bradley Roe tobe Colonel (dated April 30th, 1911). Colonel Roe’s tenureof appointment will reckon from May 6th, 1911.The promotion of Major T. S. Novis is antedated from

July 27Lh, 1910, to Jan. 28th, 1910.The King has approved of the retirement of Colonel

William O’Hara (dated June 7th, 1911), and Lieutenant-Colonel John William Rogers (dated July 5th, 1911).

Colonel H. Hendley has been appointed Principal MedicalOfficer of the Sirhind and Jullundur Brigades, Third (Lahore)Division, in succession to Colonel A. M. Cofts, appointedPrincipal Medical Officer of the Second (Rawal Pindi)Division. H.E. the Governor of Bombay in Council hasappointed Lieutenant-Colonel J. G. Hojel to officiate as

physician to St. George’s Hospital at Bombay during theabsence on leave of Lieutenant-Colonel M. A. T. Collie.Lieutenant-Colonel W. Ronaldson Clarke has taken up dutyat Lahore Medical College as Civil Surgeon and Professor ofForensic Medicine in succession to Colonel Hendley. Lieu-tenant-Colonel A. H. Nott, Bengal Presidency, has arrivedhome on leave of absence from India. Major A. F. Stevens,civil surgeon of Murshidabad, has been appointed CivilSurgeon at Hazaribagh. Major H. F. Knapton has beengranted 35 days’ privilege leave. Major R. H. Maddox has

250

been selected to succeed Captain E. P. O’Connor as Civil

Surgeon at Gaya. Major B. R. Chitterton, civil surgeona.t Muzaffarpur, has been granted seven months and nine

days’ leave of absence home from India. Major J. A.Black has been confirmed in the appointment of ChemicalExaminer, Punjab, and Professor of Chemistry in theMedical College, Lahore, by the Home Department, Govern-ment of India. Major C. A. Lane, on return from leave, hasbeen appointed Civil Surgeon at Murshidabad, in successionto Major J. G. P. Murray. Captain W. G. Hamilton hasbeen succeeded as Superintendent of the Central Jail at

Midnapore by Captain F. H. Salisbury. Captain H. M.Inman has been appointed to officiate as Civil Surgeon atJacobabad. Captain S. J. Bathena has taken up duty underthe Jail Department in the Bombay Presidency. CaptainN. S. Simpson has been selected to succeed Captain L.Reynolds as Medical Officer of the Lawrence MilitaryAsylum, Sinaway, Punjab. Captain E. Bisset has beenplaced on plague prevention duty in the Meerut District.’j.ptain E. P. Wernicke has arrived home on leave of absencefrom India.

SPECIAL RESERVE OF OFFICERS.

Royal Army medical Curps.Major Elward C. Thompson relinquishes his commission

(dated July 15th, 1911).TERRITORIAL FORCE.

Royal Army Medical Corps.Yorkshire Mounted Brigade Field Ambulance, Royal Army

Medical Corps : Thomas Edmund Lister to be Lieutenant

da.ted June 1st, 1911).NAVAL MEDICAL SUPPLEMENTAL FUND.

At the quarterly meeting of the directors of the Naval’Medical Supplemental Fund, held on July llth, Inspector-General W. H. Lloyd, R.N., in the chair, the sum of B35was distributed among the several applicants.

UNITED SERVICES MEDICAL SOCIETY.

The annual general meeting of this society was held at theRoyal Army Medical College under the chairmanship ofColonel Sir David Bruce, C.B., F. R. S. The secretaries

:Mpor6ei that the balance credit of the society had increasedlby ;S5, but that owing to increased expenditure on the.’publication of the Transactions it would be necessary toobtain more members to keep the society on a sound footing.During the past year there had been nine meetings, at which.3.7 papers were read, and the policy of the secretarieshad been to emphasise the military character of the

society, since it was felt that there was already an

abundance of purely medical societies. The followingoncers were elected :-President : Major E. B. Waggett,.:R A.. M.. (T.). Treasurer : Major S. Lyle Cummins, R.A.M.C.Members of Council: Staff-Surgeon Dudding, R.N., MajorC. E Pollock, R.AM.C., Lieutenant-Colonel P. J. Freyer,I.M.S. (R.), and Lieutenant-Colonel E. Lloyd Williams,,R.A.M.C. (T.). On the motion of Lieutenant-Colonel SirWilliam Leishman, R. A.M. C., a hearty vote of thanks waspassed to the retiring officers, especially the President,--Colonel Sir David Bruce, and the treasurer, Lieutenant-. Colonel J. B. Wilson, R.A.Al.C. Colonel Sir David Bruce,in reply, referred to the work on preventive medicine as themost important part of the duties of service medical officers.As instances of the value of such work he pointed to thealmost complete abolition of Mediterranean fever from thegarrison at Malta; 9 this represented a saving which,.capi.ta.Hsed, amounted to a gain of something like 1millions sterling for an expenditure of about..E5000.The work on enteric fever had resulted in a reductionof the incidence in India from 15-6 6 per 1000 five years agoto a present rate of 4 6 per 1000. This was due to inocula-tion, segregation of carriers, and improved methods of

disposal of excreta, all of which had been indicated largely-as a result of researches by medical officers. The saving oflives alone in India must represent a capitalised value of morethan 1 millions. Such economies as these could be obtainedin no other sphere of work, and he urged medical officers to- devote more and more of their time to prevention andresearch. At the present time the problem of the preventionof malaria in our tropical garrisons was a subject callingmrgently for solution. I

Correpsondence."Audi alteram partem."

THE NATIONAL INSURANCE BILL.To the Editor of THE LANCET.

SIR,-What is adequate remuneration ? 7 The question willhave to be asked, and its reply will contain the future ofthe profession, which is a matter of more vital moment tothe nation than the fate of any Bill, howsoever beneficent,and which should be the first care of the State. Muchirrelevant discussion of impossible terms might have beenavoided had that inevitable question been asked in legitimatecourse of our accredited authorities. Would the Church or theLaw ever have been offered the slur of a commandeering ofthe services of their irresponsible units at a wage not

previously discussed with their constituted governing bodies ? 7In principle the State cannot negotiate matters of professionaland public interest with individuals or on the basis of indi-vidual circumstances. Any attempt, both unbusinesslikeand, with all reservation for the best intentions, inequitable,to enter into any such irregular conversations should not havebeen entertained, but referred to the proper quarter. Muchcredit and much time have been lost. At any rate, a shortrespite has been gained-to ponder upon the significance ofthat official manoeuvre and over the error of our tactics inmeeting it.

Is the future health advantage of the masses, for whichhitherto we alone have toiled and paid, to be constructedupon the basis of our past charities to them and to theState ? Where does our own future come in, which shouldbe the State’s first concern ? And what, too, of therepayment of those long arrears, when we stood vicariouslyfor it in loco parentis towards them, and in a unique positionamong all professions, as contributing to the State unlimitedtreasure in lives, in efficient health, and in productivelabour? 7 Shall we put our own seal to a deed of perpetualsweating, presented to us ingeniously in belated acknowledg-ment of a long course of free giving ? The State has forgotten,it could hardly repudiate, its obligation ; and the rank andfile of the profession are being mesmerised into forgetfulnessover the Chinese puzzles which have been cast at them.Meanwhile we are still waiting for the main answer from theappointed guardians of our status as a profession.What is the irreducible minimum compatible with the

claims of our great past and with the greater claims ofour future ? 7 It belongs to the honour of the profession notto recognise any of the baser coinage. The WestminsterDivision of the British Medical Association was the first toassert that essential principle in a resolution passed twomonths ago as the only safeguard against the official debase-ment threatening an order which had hitherto been free topity rather than to resent. In practical terms of the situa-tion, free scope should be afforded to the discussion of figureswith any Local Health Committee in those districts which

may opt for a basis of " remuneration for services rendered " ;the profession cannot be committed by any individual

negotiations special to localities. But in others, where itwould become irretrievably committed, on the basis of a

capitation fee, under a direct compact with the State, theirreducible minimum should be half-a-guinea, with faculty toclaim more, if justifiable, but under no condition less. Thatresolution, which has been adopted by other divisions, stands,and any settlement on meaner terms could not receive thesanction of a unanimous profession.

I am, Sir, yours faithfully,WILLIAM EWART,

Formerly President of the Westminster Division of the BritishMedical Association.

The Athenæum, July 13th, 1911.

To the Editor of THE LANCET.SiR,-I desire to bring to the notice of the profession the

paramount importance of the Local Medical Committees.Their importance unfortunately seems to be improperlyappreciated. Thus with regard to Clause 14, the amend-ment agreed upon by the British Medical Association readsas follows :-Every approved soiety and Local Health Committee shall ...... make

arrangements with duly qualified medical practitioners in accordancewith regulations made by the Insurance Commissioners.