348 GEOGRAPHY OF MORTALITY FROM BRONCHITIS, ETC.

In the same situations actinomycosis may be thecausative factor.

Malignant Disease.Malignant disease is one of the rarest causes of

sinus, but it must be borne in mind. In thisconnexion it is as well to mention that sinuses of longduration, perhaps usually associated with very deep-seated and chronic bone disease, may eventuallythemselves become engrafted with epithelioma,although this is a very rare event.

The Indications for Treatment.A sinus should never be allowed to persist without

an attempt at its diagnosis and cure. It is not onlyan annoyance, but a potential source of danger,because it may be a focus for continuous septicabsorption and it is liable to outbursts of acuteinfection. Chronic absorption may lead to a wholetrain of evil symptoms, sometimes even culminating inlardaceous disease. Tetanus has been known to ariseand malignant disease may certainly follow. For thesereasons every, sinus requires careful investigation :—

1. By ascertaining the history accurately and bycritical consideration of all the circumstances.

2. By ordinary examination with the object ofascertaining its relation to surrounding parts.

3. By X ray examination, in some cases with theaid of opaque injections.

4. By cautious use of the probe.5. By noting the effect of treatment.6. By reconsideration from time to time.From what has been said it is clear that the most

important indication is to discover and remove thecause, and if this is done the great majority will soonheal.

G. GREY TURNER, M.S. Durh., F.R.C.S. Eng.,Professor of Surgery in the University of Durham ;

Surgeon, Royal Infirmary, Newcastle-on-Tyne.

The Services.ROYAL NAVAL MEDICAL SERVICE.

Surg. Lt.-Comdr. (D) T. A. B. Corless is placed on Retd.List at own request.

Surg. Lt.-Comdr. A. W. Gunn to be Surg. Comdr.Surg. Lt. A. H. Harkins to be Surg. Lt.-Comdr.The following appointments are notified :-Surg.

Comdr.: C. H. M. Gimlette to President, addl., forthree months’ post-graduate course. Surg. Lt.-Comdrs.:A. W. McRorie to President, addl., for three months’ post-graduate course ; F. C. Hunot to y’oM’)M<M<<A,’ and W. E.Heath to Fisgard ; L. S. Goss to Suffolk; and J. C. Brownto Vivid, for Rodney. Surg. Lts. : N. A. Dickinson to Hermes ; ;and L. P. Spero to Adamant.

ROYAL NAVAL VOLUNTEER RESERVE.

Proby. Surg. Sub-Lts. F. T. Doleman and A. R. Thomasto be Surg. Sub-Lts.

ROYAL ARMY MEDICAL CORPS.Lt.-Col. J. H. R. Winder retires on ret. pay.Capts. to be Majs. : T. Menzies, D. H. Murray, E. Under-

hill, R. A. Mansell, and J. T. Scrogie.Lts. to be Capts. : C. R. Christian, C. W. Greenway,

R. J. Rosie, J. Huston, and E. G. Dalziel.

ROYAL HOSPITAL, CHELSEA.

Physician and Surgeon: Maj. E. A. Strachan, viceMaj. E. T. Potts, C.M.G., D.S.O., who has vacated the appt. I,

REGULAR ARMY RESERVE OF OFFICERS.

Col. T. C. MacKenzie, late R.A.M.C., having attainedthe age limit of liability to recall, ceases to belong to theRes. of Off. ’

TERRITORIAL ARMY.

Lt. A. H. Macklin to be Capt.E. J. G. Glass (late Offr. Cadet, Edinburgh Univ. Contgt.,

Sen. Div., O.T.C.), F. Lishman, J. N. Russell, F. Heywood-Jones, and M. S. Scott to be Lts.The King has conferred the Territorial Decoration upon

Lt.-Col. Andrew Johnstone Brown and Majs. Henry NevilleBurroughes and Ronald Ogier Ward.

ROYAL AIR FORCE.

Squadron Leader F. C. Jobson relinquishes his com-

mission on completion of service.

Special Articles.THE GEOGRAPHY OF MORTALITY FROM

BRONCHITIS AND PNEUMONIA.

NEARLY one-seventh of deaths from all causes

come under the two rubrics of bronchitis and pneu-monia, and a study of the incidence of these diseases,which the Registrar-General’s report! renders possible,is therefore of great importance. Such a study leadsinevitably to the conclusion that a large part ofmortality from these diseases is avoidable. A partof the teaching of Tables XLVI. and XLVII. in thereport can be seen graphically displayed in Figs. 1and 2. These diagrams show for three divisions ofEngland the male and female death-rates for theyears 1921-25 from bronchitis and pneumonia respec-tively at each of seven age-periods, in proportion tothe mortality for the same ages in England andWales stated as 100.

FIG. 1.

AGES 0 5 5 25 45 65 75 0 5 15 25 45 65 75Death-rates from bronchitis showing topographical variations.

County boroughs and rural districts in each of threesections of England-north, midland, and south-are contrasted in each instance for males and females.separately. Wales has been omitted from the com-parison, but it may be stated broadly that it is onlysurpassed in its unfavourable mortality by thenorth of England. It will be seen that in county

1 The Registrar-General’s Statistical Review of England andWales for the year 1925. Text. H.M. Stationery Office. 5s.