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the Tenterden urban district. Separate reports have reachedus as to several of these districts.—ro?M/e M;’a; jDMi’7’M: :The death-rate for this district was 14’4 per 1000 in 1886, asopposed to an average of 15’2 in the preceding ten years.Two deaths from diphtheria occurred in one house at Chels-:field; but Dr. Butterfield believes no other cases took placein his district. As an instance of the sort of disease thatgets placed under the Registrar-General’s heading " cholera,"a case may be noted that occurred at Farnborough, wherean old lady in her eightieth year died after taking six

aperient pills, followed by a luncheon on cucumber. Unfor-tunately the dearth of water in parts of this districtremains unremedied since the throwing out of the WestKent Company’s Bill in 1885.—Sevenoaks Urban District: :Here the death-rate was 14 8, and the zymotic rate onlyreached 0 7 per 1000 during 1886. But Dr. Butterfield ex-press" the conviction that the lives of infants are sacrificedto the unwillingness of mothers to supply their offspringwith the natural breast milk, and he urges lady visitors toinstruct and advise mothers properly in this respect. No-case was admitted into the tever hospital, simply becauseno cases needed such isolation.-Sevenoaks Rural District:In this portion of Dr. Butterfield’s district the death-ratewas 16 5 per 1000 last year, the zymotic rate being 1-6.Among the latter, small-pox, measles, and diarrhoea weremost prominent; and a special report is appended on thesubject of small-pox at Edenbridge, the workhouse, andHever. At the former place railway works were in pro-gress, and the disease was imported through the navvies .employed.

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VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5208 birthsand 4050 deaths were registered during the week endingAugust 6th. The annual rate of mortality in these towns,which had increased in the preceding six weeks from 17’6to 23’2 per 1000, declined again last week to 22.9. During the,first five weeks of the current quarter the death-rate inthese towns averaged 21’7 per 1000, and was 0’6 above themean rate in the corresponding periods of the ten years1877-86. The lowest rates in these towns last week were13’2 in Brighton, 16’0 in Birkenhead, 17’1 in Halifax, and17’5 in Bristol. The rates in the other towns rangedupwards to 27’8 in Huddersfield, 29’6 in Newcastle-upon-Tyne, 30’3 in Wolverhampton, and 39-3 in Preston. Thedeaths referred to the principal zymotic diseases in thetwenty-eight towns, which had increased in the preceding-five weeks from 486 to 1301, declined last week to 1293;they included 973 from diarrhoea, 125 from whooping-cough,93 from measles, 54 from scarlet fever, 30 from "fever"(principally enteric), 17 from diphtheria, and only one fromsmall-pox. These zymotic diseases caused the lowestdeath-rates last week in Halifax and Cardiff, and thehighest rates in Manchester, Sheffield, Leicester, and Preston.The highest death-rates from diarrhcea occurred in Derby,Portsmouth, Sheffield, Nottingham, Leicester, and Preston;from measles in Bolton, Manchester, and Oldham; fromwhooping-cough in Birmingham; and from scarlet fever inBlackburn. Of the 17 deaths from diphtheria in the twenty-eight towns, 7 occurred in London, 2 in Liverpool, and 2 inPortsmouth. Small-pox caused 1 death in Sheffield, but notone in Greater London, or in any of the twenty-six otherlarge provincial towns. Only one case of small-pox wasunder treatment on Saturday last in the metropolitanhospitals receiving cases of this disease. The deaths re-ferred to diseases of the respiratory organs in London,which had declined in the preceding five weeks from 199to 160, further fell last week to 158, and were 34 below thecorrected average. The causes of 104, or 2’0 per cent., ofthe 4050 deaths in the twenty-eight towns last week werenot certified, either by a registered medical practitioner orby a coroner. All the causes of death were duly certified inPortsmouth, Plymouth, Bolton, Blackburn, and Cardiff ;the largest proportions of uncertified deaths were recordedin Oldham, Norwich, and Halifax.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 20’9 and 19’9 per 1000 in the precedingtwo weeks, further declined to 17’1 in the week ending

August 6th; this rate was as much as 5’8 below the meanrate during the same week in the twenty-eight large Englishtowns. The rates in the Scotch towns last week rangedfrom 10.6 and 15.8 in Aberdeen and Leith, to 21’1 in Perthand 28’2 in Paisley. The 428 deaths in the eight towns lastweek showed a further decline of 59 from the numbers inthe preceding two weeks, and included 28 which were

referred to diarrhoea, 22 to whooping-cough, 9 to "fever"(typhus, enteric, or simple), 7 to scarlet fever, 6 to diph-theria, 1 to small-pox, and not oiie to measles; in all, 73deaths resulted from these principal zymotic diseases, against103 in each of the preceding two weeks. These 73 deathswere equal to an annual rate of 29 per 1000, which was4’3 below the mean rate from the same diseases in thetwenty-eight English towns. The fatal cases of diarrhoea,which had been 39 in each of the previous two weeks,declined last week to 28, of which 13 occurred in Glasgow,6 in Dundee, 3 in Edinburgh, and 2 in Leith. The deathsfrom whooping-cough, which had been 37 and 41 in thepreceding two weeks, declined last week to 22, and included11 in Glasgow and 5 in Dundee. The 9 deaths referred to",fever" exceeded by 5 the number in the previous week; 6occurred in Glasgow and 2 in Edinburgh. The fatal casesof scarlet fever, which had been 5 and 12 in the previoustwo weeks, declined last week to 7, and included 5 inDundee. The 6 deaths from diphtheria showed an increaseof 3 upon the number in the preceding week, and included4 in Edinburgh. The fatal case of small-pox occurred inAberdeen. The deaths referred to acute diseases of therespiratory organs in the eight towns, which had been 82and 65 in the preceding two weeks, were 67 last week, and7 above the number returned in the corresponding week oflast year. The causes of 56, or 13 per cent., of the deathsregistered in the eight towns during the week were notcertified.

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HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had increased inthe preceding four weeks from 26’6 to 30’9 per 1000, declinedto 29’6 in the week ending August 6th. During the firstfive weeks of the current quarter the death-rate in thecity averaged 29’0, the mean rate during the same periodbeing but 22’6 per 1000 in London and 19’0 in Edinburgh.The 200 deaths in Dublin last week showed a decline of 9from the increasing numbers in recent weeks; they included29 which were referred to diarrhoea, 16 to measles, 4 toscarlet fever, 3 to whooping-cough, 2 to "fever" (typhus,enteric, or simple), 1 to diphtheria, and not one to small-pox. Thus the deaths resulting from these principalzymotic diseases, which had been 48 and 49 in the precedingtwo weeks, further rose last week to 55, owing to theincreased prevalence of summer diarrhoea, and were equalto an annual rate of 8’1 per 1000, the rates from the samediseases being 7’4 in London and 2’4 in Edinburgh. The fatalcases of diarrhoea, which had been 21 and 16 in the precedingtwo weeks, rose again last week to 29. The deaths referredto measles, which had been 21 and 22 in the preceding twoweeks, declined to 16, a lower number than has beenrecorded.; in any week since Alay last. The 4 fatal casesof scarlet fever showed a further increase upon recentweekly numbers, while the 3 deaths from whooping-cough corresponded with the numbers in the precedingweek. The deaths of infants showed a decline from thehigh number in the previous week, while those of elderlypersons showed an increase. Two inquest cases and 2deaths from violence were registered ; and 38, or nearlyone-fifth, of the deaths occurred in public institutions.The causes of 28, or 14 per cent., of the deaths registeredduring the week were uncertified.

THE SERVICES.

YEOUÀNRY CAVALRY.-Warwickshire: Surgeon T. W.Bullock is granted the honorary rank of Surgeon-Major(dated Aug. 6th, 1887).

, ARTILLERY VOLUNTEERS.—4th Volunteer (Cinque Ports)Brigade, Cinque Ports Division, Royal Artillery: ActingSurgeon Otho Robert Travers is appointed Second Lieu-tenant (dated Aug. 6th, 1887).RIFLE VOLUNTEERS.—1st Volunteer Battalion, the Prince

of Wales’s Volunteers (South Lancashire Regiment) :Surgeon J. H. Gornall resigns his commission (dated

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Aug. 6th, 1887). -Honorary Assistant Surgeon J. W.

Watkins, M.D., to be Surgeon (dated Aug. 6tb, 1887);Surgeon J. W. Watkins, M.D., is granted the honoraryrank of Surgeon-Major (dated Aug. 6th, 1887).—16thMiddlesex (London Irish): Philip Percival Whitcombe, I

M.B., to be Acting Surgeon (dated Aug. 6th, 1887).

Correspondence.THE SALICYL COMPOUNDS IN ACUTE

RHEUMATISM.

I I Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-In the address in medicine delivered at the meet-ing of the British Medical Association in Dublin the otherday, Professor Gairdner made the remark that "the benefitderived in acute rheumatism from the salicyl compounds isvery satisfactorily established." In the same number ofTHE LANCET, in which this remark appears, Mr. Greene ofWallingford reports a case of acute rheumatism in whichsalicin and salicylate of soda are stated to have " failed toexercise their so-called specific action."Mr. Greene’s case is a type of a number of similar ones

which have been published of late years, all pointing to thesame moral-the mefficiency of the salicyl compounds. Asthe most recent one of the kind, and one of the best re-ported, I shall, with your leave, take Mr. Greene’s case as atext on which to found a few remarks on the subject withwhich it deals; this not for the sake of criticising Mr.Greene’s very interesting case, but solely with the object ofindicating and insisting on a point of much practical im-portance in the treatment of acute rheumatism.On June 18th Mr. Greene’s patient had pains in the limbs

and joints, and some febrile disturbance. Nothing is saidregarding treatment then. On the 21st there was consider-able pain and swelling of the wrists, finger-joints, andankles, and also profuse perspiration, having the charac-teristic rheumatic odour. The temperature was 103° andthe pulse 120. The patient got twenty grains of salicinevery three hours. This was continued for a week, duringwhich time the temperature was fluctuating, but rarely rosehigher than 102°, and the joint complications and rheumaticperspirations continued. On the 28th the temperature roseto 103°, and there was much restlessness. Salicin was givenevery two hours in twenty-grain doses. On the 29th thetemperature rose to 1060, and in a few hours to 107’4°;the pulse was small and irregular, the face livid, and thepatient delirious. The case had become one of rheumatichyperpyrexia, and the patient was in imminent danger.The cold bath and ice to the nape of the neck were hadrecourse to with excellent results, and by judicious manage-ment a very alarming illness was brought to a favourabletermination.Such is a brief summary of the salient points in Mr.

Greene’s case. The special point with which I would dealis his assertion that the salicin failed to exercise " its so-called specific action." The facts as stated by Mr. Greeneapparently quite bear out this assertion. The patient did getsalicin regularly for a week, and the salicin failed to check therheumatic process. "From June 21st to June 29th," says Mr.Greene, "my patient had taken at least 1280 grains of sali-cin, and in spite of this the temperature had risen to 107’40,"That is a perfectly accurate statement, and apparently a verytelling one against the salicin, and quite justifying Mr.Greene’s indictment. But only apparently, for what does it really mean? 1280 grains in eight days are 160 grainsa day, or 6’6 grains an hour, a totally inadequate dose. Aswell might one give a man suffering from intermittentfever one grain of quinine every three hours, and say thatthe quinine failed to exercise its so-called specific action, asit certainly would in that dose. From the time that I firstintroduced salicin to the notice of the profession as a remedyin acute rheumatism in your pages (now more than elevenyears ago), I have never ceased to insist that small dosesare of no use, and that to get its full beneficial action the drug must be given in large and frequently repeated doses.. I,In my book on Rheumatism, published in 1881, this point ’,,is thus referred to (p. 199): " To get its full beneficial effects,

the remedy (salicin) must be given in full and frequentlyrepeated doses....... Twenty to forty grains should be givenevery hour till there is decided evidence of its action. Itwill generally be found that before an ounce has been con-sumed, often before half that quantity has been taken, thereis a marked improvement....... As the symptoms declinethe dose may be diminished ; but it is well not to do thistoo quickly or too early, for if the remedy be omitted toosoon, or given in inadequate dose, the symptoms are aptto recur." The salicyl compounds are very rapidly elimi-nated from the system, and their full beneficial action inacute rheumatism can be got only by frequently repeatedfull doses. Mr. Greene’s patient never had the chance ofbeing under the influence of salicin; the twenty grainswhich he got at 12 o’clock had probably nearly all passedoff from the system before the 3 o’clock dose was given.

1 hope I have said enough to show that Mr. Greene’s facts,do not warrant his charge of failure against the salicyl com-pounds. I do not think that I exceed my right when I askthose who criticise the action of these drugs, with whichmy name is associated, to give them in that dose whichI insist upon as essential to the production of their fullbeneficial effects.One word on rheumatic hyperpyrexia. Hyperpyrexia is

not a part of the rheumatic process. It is to be regarded asan accidental complication which may occur in any form offever, but is most common in acute rheumatism. It is pro-bably due to some idiosyncrasy on the part of the patient-some weakness or unusual susceptibility of the heat regu-lating apparatus in the nervous centres. In rheumatichyperpyrexia the salicyl compounds, so potent in rheumaticpyrexia, are of no use. In that condition cold to the sur-face is the one effectual remedy. It cannot be too clearlystated that it is mere waste of valuable time to have recourseto any other treatment.

T am. Sirs. your obedient servant.T. J. MACLAGAN, M.D.

THE ARMY MEDICAL DEPARTMENT.To the Editors of THE LANCET.

SIRS,—At page 270 of THE LANCET of August 6th, 1887,you say, "The plebiscite of the army medical officers weconsider an unwise and unwarrantable act, it cannot but bean undeserved reflection on its [the department’s] head."As one of the army medical officers who received the paper

you call a plébiscite, I desire to enter my protest againstsuoh a statement. The document was regarded, both bymyself and by all I spoke to on the subject, as a mere requestby the journal to be favoured with individual opinions onthe subjects mentioned. I am sure Sir Thomas Crawfordwould be the last man in the world to consider that an armymedical officer expressing an opinion in a medical journal,even if that opinion were not in accord with his own, couldbe an undeserved reflection on his opinions, it would be areductio ad absurdum. I took care, however, to head myremarks with the statement that these were my opinions,and as such might be right or might be wrong. But I hadthe courage of my opinions, and the editor was quite atliberty to publish my name, which I now subscribe to thisprotest. —I rammin .6’ire yours faithfully ST.—I remain, Sirs,

yours

J. PERCIVAL HUNT, M.D., F.R.C.S.P.,Barrister of Lincoln’s-inn, Lond., Surg. Army Med. Staff, and a

subscriber and contributor to THE LANCET for over 22 years.

SOUTH LONDON AND THE HOSPITAL SUNDAYFUND.

To the Editors of THE LANCET.SIRS,—The subject to which I endeavoured to direct atten-

tion in the letter referred to in your annotation under theabove heading, was that, while valuable institutions like

Guy’s were languishing in South London for lack of funds,the effect of the present mode of distribution of the Hos-pital Sunday Fund is to transfer some S8000 out of £10,000collected on this side of the river, to institutions situatedprincipally at the West-end, where it might be supposedthey were not so urgently required as in the poorer districtsof the south and south-east. It is evidently no answer tothis to quote the dare quam accipere motto, since the sug-gestion is not that those who contribute the money shouldreceive it back, but rather that it should be spent in some-thing like a fair proportion among the institutions which