1515THE SERVICES.

1000. The 358 deaths from all causes in the 22 towndistricts last week showed an increase of 14 upon thenumber in the previous week, and included 27 which werereferred to the principal epidemic diseases, against 42, 33,and 28 in the three preceding weeks ; these 27 deaths wereequal to an annual rate of 1.2 per 1000, and corre-

sponded with the rate from the same diseases last weekin the 77 towns, the rate in the eight Scotch towns

being 1-3. The 27 deaths from these epidemicdiseases in the Irish towns last week included 11 from

diarrhoea, 6 from whooping-cough, 5 from diphtheria,3 from measles, and 1 each from scarlet feverand enteric fever,but not one from small-pox. The deaths attributed to diar-

rhcea, which had been 20 and 14 in the two precedingweeks, further declined to 11 last week, of which 3 occurredin Dublin, 4 in Belfast, and 2 in Londonderry. Of the 6fatal cases of whooping-cough 4 were returned in Dublinand 2 in Wexford ; and the 5 deaths from diphtheria included2 in Dublin and 2 in Dundalk. Two of the 3 fatal casesof measles and the death from scarlet fever occurred inLurgan. The death referred to enteric fever was registeredin Drogheda. The deaths in the 22 towns last week included88 which were referred to pneumonia and other diseases ofthe respiratory system, against 66 and 60 in the two pre-ceding weeks. The causes of 17, or 5.1 per cent., of thedeaths registered last week in the Irish towns were notcertified ; in the 77 English towns the proportion of uncertifieddeaths last week did not exceed 0’8 per cent., while inthe eight Scotch towns it was equal to 3 - 7 per cent.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

THE following Staff-Surgeons have been promoted to therank of Fleet-Surgeon in His Majesty’s Fleet: WilliamBernera Macleod, Arthur Harry Hingston Vizard, HarrySpicer, Edward Thomas Philip Eames, John AlexanderLanford Campbell, Harold Paget Jones (dated Nov. 14th,1910).The following appointment is notified :—Staff-Snrgeon :

P. H. M. Star to the Leander, additional, for destroyers.ROYAL ARMY MEDICAL CORPS.

Captain Robeit B. Black, from the Seconded List, isrestored to the establishment (dated Nov. 1st, 1910).The undermentioned Lieutenants are confirmed in their

rank :-Frederick R. Laing and John T. Simson.Colonel T. J. R. Lucas, C.B., principal medical officer of

the First (Peshawar) Division, has been transferred as

Principal Medical Officer to the Jubbulpore and JhansiBrigades. Lieutenant-Colonel G. E. Hale, D.S.O., has beenposted to the Southern Army in India and appointed to theFifth (Mhow) Division. Lieutenant-Colonel L. W. Swabey,at present on leave from Aden, has been transferred to thehome establishment pending his retirement. Lieutenant-Colonel 0. T. Blackwell has been appointed to the Ninth(Secunderabad) Division. Lieutenant-Colonel R. H. Hall,from Colchester, embarks for Bermuda on Nov. 25th,to take up the appointment of Senior Medical Officer

recently vacated by Lieutenant-Colonel J. C. Culling onpromotion. Lieutenant-Colonel G. G. Adams has been

appointed to command the station hospital at Colaba,in succession to Lieutenant-Colonel G. F. Gubbin, whosetour has expired. Major T. B. Beach has embarked for

Egypt. An exchange on the roster for foreign service hasbeen approved by the War Office between Major W. W. 0.Beveridge, D.S.O., and Major W. G. Beyts. Major H. V.Prynne has arrived home for duty from Gibraltar. MajorH. A. Waring, on the expiration of his tour of service inIndia, has been transferred to the home establishment andhas been appointed to the Southern Command. MajorG. A. T. Bray has been transferred from the SouthernCommand to the Eastern Command. Major H. A. L.Howell, on arrival home from Gibraltar, has been appointedMedical Officer in Charge of the Royal Army ClothingFactory at Pimlico. The undermentioned officers, on con-clusion of their course of instruction for promotion at the RoyalArmy Medical College, Grosvenor-road, have been posted asfollows : Captain J. P. J. Murphy and Captain A. H. Hayesto Dover ; Captain A. McMunn, Captain J. M. H. Conway,Captain W. D. C. Kelly, and Captain A. T. Frost to Dublin ;

Captain J. McKenzie, Captain M. D. Walker, and CaptainH. W. Russell to the London District. Captain G. A. D.Harvey, from Khartoum, has been appointed to the EasternCommand for duty. Captain R. C. Hallowes has arrivedhome for duty from Egypt. Captain J. H. Gurley has beentransferred to the home establishment from Egypt, byexchange. Captain G. A. K. H. Reed has been appointedSpecialist in Physical Training to the Aldershot Command.Captain P. H. Henderson has joined at Portsmouth from

Ibsley Camp. Captain W. F. Tyndale, C.M.G., has beentransferred from Dublin to the Curragh Camp. CaptainJ. C. G. Carmichael, from Fleetwood, has joined for duty atChester. Lieutenant D. H. C. MacArthur, from the LondonDistrict, has embarked for a tour of service in India.Lieutenant T. W. Stallybrass has been transferred fromTidworth Park to Hamilton Camp.ROYAL ARMY MEDICAL CORPS SCHOOL OF INSTRUCTION.

Major Claude K. Morgan, R.A.M.C., to be an Instructor,vice Major C. C. Fleming, D.S.O., who has vacated thatappointment (dated Oct. 29th, 1910).

INDIAN MEDICAL SERVICE.Lieutenant-Colonel A. L. Duke, administrative medical

officer of the North-West Frontier Province, has been

appointed under the Foreign Department of the Governmentof India to be Agency Surgeon of Baluchistan, vice Lieutenant-Colonel J. Sykes, who is proceeding on combined leave inDecember. Lieutenant-Colonel A. J. Macnab, on returnfrom leave, has been appointed Residency Surgeon, Srinagar,Kashmir, vice Lieutenant-Colonel W. R. Edwards, appointedAdministrative Medical Officer, North-West Frontier Province.Lieutenant-Colonel R. H. Castor, Bombay, has received anextension of his leave. Major A. W. R. Cochrane, oncompletion of a course of special duty at the CentralResearch Institute, Kasauli, has taken over the dutiesof Superintendent of the Lunatic Asylums at Agra. MajorB. I. Singh, inspector-general of prisons in the Province ofEastern Bengal, has been granted privilege leave for threemonths. Major E. J. Perry has been selected by the CentralCommittee for Malarial Fever Investigation for special dutyto study the prevalence of malaria in the Jeypur Agency inNorthern Madras. Major F. H. Watling has taken over theMedical Charge of the 48th Pioneers at Allahabad. MajorJ. A. Black, chemical examiner of Bengal, has beenselected to officiate as Chemical Examiner of the PunjabProvince, vice Lieutenant- Colonel D. Grant. Major S.Hunt has received one year’s extension of his leave.The services of Captain J. B. Christian have been

placed permanently at the disposal of the Governmentof Eastern Bengal and Assam. Captain W. W. Jeudwine,district plague medical officer of Gurdaspur, has beengranted three months’ privilege leave. Captain W. H.Hamilton has been appointed Specialist in Ophthalmology tothe Second (Rawal Pindi) Division. Captain S. Whitworth-Jones has received six weeks’ extension of his leave home.

Captain M. J. Quirke has been mentioned in despatches for"exceptionally good work" done in Somaliland. CaptainC. A. Gourlay has been confirmed as Civil Surgeon under theGovernment of Eastern Bengal and Assam. Captain R. M.Carter, from the Pasteur Institute at Kasauli, has been grantedeight months’ leave home from India. Captain T. F. Owenshas been appointed to officiate as Professor of Chemistry atthe Medical College, Calcutta.

TERRITORIAL FORCE.

Royal Army Medical Corps.2nd South-Western Mounted Brigade Field Ambulance,

Royal Army Medical Corps : John Robinson Benson, lateLieutenant, Army Motor Reserve, to be Lieutenant (datedSept. 16th, 1910).

SOCIETY OF TROPICAL MEDICINE AND HYGIENE.-A meeting of this society will be held at 11, Chandos-street,Cavendish-square, London, W., to-day (Friday) at 8 30 P.M.,when Sir Rubert Boyce will read a paper (with lanterndemonstration) on Yellow Fever in West Africa, and the

following papers, which have been approved by the council,will be presented to the society:—(a) Autochthonous OrientalSore in Panama, by Dr. S. T. Darling, chief of the laboratory,Ancon. (b) Tropical Diseases in British New Guinea, by Dr.R. Fleming Jones, Samurai.

1516 PLAGUE AMONG EUROPEANS.

Correspondence.

PLAGUE AMONG EUROPEANS.To the Editor of THE LANCET.

I’ Audi alteram partem."

SIR,—There seems to be a general impression that plaguecould not possibly become epidemic among Europeans. Asthis is likely to lead to viewing the spread of plague-infected lower animals over different parts of the countrywith comparative complacency, I send you the figures whichI submitted to the Colonial Office in May of 1901 regardingthe plague outbreaks in Cape Town two months before thelast case.

Cape Town with its suburbs is a comparatively small town.Rats had died a very considerable time before the outbreak,and when the epidemic began there were very few ratsto be seen. The close connexion between rat plague andhuman plague was only accepted in a half-hearted manner-until there was a succession of cases in which dead rats werefound in the houses, and in one particularly which was badlyinfected where 105 dead rats were found under the floor andbehind the wainscot and panelling. There is also another

impression that plague behaves always in the same way, andthat because there was a small percentage of pneumoniccases in India and Cape Town, whilst in Sydney untilrecently there were no pneumonic cases at all, thereforea small percentage of pneumonic cases is a law of thedisease. In 1908 on the Gold Coast there were both bubonicand pneumonic cases of plague, and instead of 4 to 8 percent. of pneumonic cases there was over 50 per cent.

Until England can deal effectively with her influenza

epidemics she cannot afford to sit down and not deal

vigorously with the plague-infected lower animals in Suffolkin the hopes that nothing may happen. She may be right ;on the other hand, she may be wrong. And the wisest courseis to treat the rat plague as the plague, and bring everyavailable force to bear to get it out of the land.

I am, Sir, yours faithfully.King’s College, Nov. 15th, 1910. W. J. SIMPSON, M.D.

VOLUNTARY AID DETACHMENTS.’

To the Editor of THE LANCET.SIR,—Lieutenant-Colonel A. C. Yate in his communica-

tion on the above subject is not fortunate in his commentsupon the British Red Cross Society. He says that almost allthe members of the voluntary aid detachments raised by thesociety hold the St. John Ambulance Association certificate.That is true ; but he omits to add that until August 8th,1910, that certificate was, by an existing arrangement nowabandoned, the only one available for the purpose. Thedetachments referred to were for the most part raised beforeAugust, 1910, as Lieutenant-Colonel Yate must be aware.Since that date the War Office has recognised a large seriesof certificates in first aid and among them the certificatesof the county councils. It will follow from this that the

preponderance of the St. John certificate will be much lessconspicuous in the future.Your correspondent states that the society has undertaken

to provide two things-viz., a manual of instruction and aninspecting staff. The manual employed by the society is the"Manual of the Royal Army Medical Corps," which can beobtained for 9d. A special manual has been prepared forthe society by Mr. Cantlie and is ready for the printers assoon as it has received the sanction of the War Office. The

society never undertook to provide an inspecting staff, noreven contemplated such a provision. The organisingsecretary of the society, Colonel J. Magill, C.B., undertakesto advise as to the formation of detachments in any districtand has done a great deal of work under that head.Your correspondent complains of the " prodigious " number

of forms issued by the society. The form dealing with thewhole subject under notice is one in number-viz., Form D.The work of the British Red Cross Society, in raising

detachments throughout the country, is proceeding rapidlyand with an enthusiasm worthy of so humane and patriotic a

movement. For the success of this work the society has tothank many, and above all the medical men of the country,who have so generously given their assistance.

I am, Sir, yours faithfully.FREDERICK TREVES,

Chairman of the Executive CommitteeVictoria-street, London, S.W., Nov. 10th, 1910.

MEDICAL ETHICS AND MEDICALETIQUETTE

To the Editor of THE LANCET.SIR,—In a book on the subject of " Medical Etiquette," by

Dr. Surbled of Paris, which has just been translated by Dr.W. P. Grant, and for which, by desire of the author, I wrotea brief preface, I find to my great regret that the excellentlectures of my friend Professor Saundby, which he publishedin 1902 (second edition in 1907), had quite escaped mymemory when I referred to the absence of any recent Englishliterature on the subject. Dr. Saundby’s book on " MedicalEthics " is an admirable one.

T am- Sir. vonrs fait.hfnllv.

Grosvenor-place, S.W., Nov. 12th, 1910. DYCE DUCKWORTH.

THE FERTILITY OF THE UNFIT.To the Editor of THE .LANCET.

SIR,—Many writers and speakers take an unfavourable,and some an alarmist, view of the prospects of maintainingthe vigour of our race. This is illustrated by a discussion atthe recent Church Congress. The unfit, we are told, are

increasing faster than the fit elements of the population.Mrs. Pinsent of Birmingham is reported to have said thatefforts to improve the race by ameliorating the environmentare futile. They only serve to perpetuate the evil conditionswhich they aim at removing. Heredity, it is averred, willalways beat environment into a cocked hat. A journalisticplacard announces The Fatal Fertility of the Poor." Thebirth-rate among mentally defective persons is declared to behigh, whilst that of the middle and upper classes is artificiallylimited. The last statement rests unhappily on a solid basisof statistics and of common experience, and I do not dealwith it here.But statistics on the fertility of the mentally and physically

defective portion of the population are not easy to obtain.Those who have watched the working of natural laws havereason for believing that Nature is always trying to improvethe breed and to eliminate defects. From a study of

pedigrees and long observation of families I am inclined too

agree with this view. Such improvement is effected partlyby mixing with healthier stocks, partly by sterilising thosewhich are defective below a certain standard. The sterilisa-tion must be looked for, not in one generation only, but intwo or three ; that is to say, that if the pedigree of adefective person is traced, then either by combining withbetter strains the succession is maintained and the defect

gradually eliminated, or, if the defect is too great or thenew stocks are also defective, the progeny dies out in one,two. or three generations. In the words of Dr. F. W. Mott,dealing with the inheritance of a tendency to insanity, "Asa rule, there is either a regression to the normal or the stockdies out." Thus the unfit disappear, and the fit prevail. It will be

said these are only general impressions. Yet are they notconsistent with the experience of breeders of animals, withthe conditions of the struggle for existence, and with atendency to be traced all through vital phenomena for thesurvival of the fittest ? But it is said that we have alteredthe conditions in whicb Nature is working by preserving alivemany unfit who would have died, and by so caring for theirwelfare as to enable them to increase in the community, andthat in this manner the efforts of philanthropy and the kind-ness of modern civilising agencies in reality tend to thedeterioration of the race. This is a serious statement, andcan only be fully met by facts and statistics whichare not as yet available, but to some of which Iwill allude presently. In the meantime, two considera-tions may be advanced. In the first place, the sumtotal of modern efforts to improve the welfare of allclasses of the community, by which the unfit are made lessunfit and the fit made fitter, should surely tend to help andnot to hinder the progress of the race as a whole. Secondly,to enter into more detail, with regard to those who were born