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risen during the years 1881-84, attaining its maximum inthe latter year. The means of sewer ventilation and flushingstill remain defective ; that which has been carried out

being insufficient to keep down even obvious nuisance asregards the state of some of the sewers, and locally a verystrong belief obtains that the prevalence of diphtheria andenteric fever has been due to these faulty conditions.Then, again, in the matter of house drainage Tottenham isin a very backward state ; and in 65 per cent. of the housesattacked with diphtheria defects were noticed. Frequently,also, a single cistern affords water both for domestic use andfor flushing the closet, and the common cistern is often soplaced as to favour the impregnation of the containedwater with closet emanations. The scavenging arrange-ments, too, are quite inadequate to the needs of the district.There are, also, no means for the isolation of the infectioussick, but it may be hoped that the sanitary authority haveat last decided to provide a proper isolation hospital. Withall the defects mentioned, there has been some noteworthysanitary progress; and in so far as defects of house con-struction are concerned, the authority have now an excellentcode of bye-laws, and they have taken the very necessarystep of appointing a building inspector to see that the regu-lations are properly carried out.

VITAL STATISTICS,

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5622 birthsand 3011 deaths were registered during the week endingOct. 10th. The annual death-rate in these towns, which hadbeen equal to 15’9 and 17’6 per 1000 in the preceding twoweeks, was again 17’6 last week. During the thirteen weeksof last quarter the death-rate in these towns averaged only18’8 per 1000, which was 2’6 below the mean rate in thecorresponding periods of the nine years 1876-84. The lowestrates in these towns last week were 13’8 in Leicester and inWolverhampton, 14’0 in Derby, and 14’1 in Bristol. Therates in the other towns ranged upwards to 22-6 in Cardiff,32’7 in Manchester, 23’3 in Plymouth, and 28’1 in Preston.The deaths referred to the principal zymotic diseases in thetwenty-eight towns, which had steadily declined in thepreceding nine weeks from 930 to 366, further fell last weekto 303, and were considerably fewer than in any previousweek of this year ; they included 97 from diarrhoea, 51 fromwhooping-cough, 49 from scarlet fever, 42 from " fever "

(principally enteric), 38 from measles, 24 from diphtheria,and 2 from small-pox. These zymotic diseases caused thelowest death-rates last weekin Hull, Brighton, and Blackburn,and the highest in Portsmouth and Preston. Diarrhoea causedthe greatest mortality in Portsmouth and Preston; " fever

"

in Halifax and Cardiff ; scarlet fever in Birkenhead andPreston; and measles in Salford. Of the 24 deaths fromdiphtheria in the twenty-eight towns, 14 occurred inLondon and 2 in Salford. Small-pox caused 3 deaths inLondon and its outer ring (including 1 in the metropolitanasylum hospital ship off Dartford), and not one in any ofthe twenty-seven provincial towns. The number of small-pox patients in the metropolitan asylum hospitals situatedin and around London, which had declined in the pre-ceding eighteen weeks from 1389 to 131, had furtherfallen to 112 on Saturday last; the admissions, which hadbeen 47, 27, and 18 in the preceding three weeks, furtherdeclined last week to 15. The deaths referred to diseasesof the respiratory organs in London, which had been 159and 205 in the preceding two weeks, further rose last weekto 231, but were 23 below the corrected weekly average.The causes of 55, or 1’8 per cent., of the deaths in thetwenty-eight towns last week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in Bristol, Leicester,Newcastle-on-Tyne, Sunderland, and in nine other smallertowns. The largest proportions of uncertified deaths wereregistered in Halifax, Sheffield, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 17’4 and 16’4 per 1000 in the preceding twoweeks, was again 16’4 in the week ending the 10th inst.,and was 1’2 below the mean rate during the same weekin the twenty-eight English towns. The rates in the Scotchtowns last week ranged from 10’6 and 11’4 in Leith and

Paisley, to 17’6 in Greenock and 19-5 in Glasgow. The 400deaths in the eight towns included 18 which were referredto diarrhoea, 12 to scarlet fever, 8 to whooping-cough, 7to diphtheria, 4 to "fever" (typhus, enteric, or simple),and not one either to small-pox or measles; in all, 49deaths resulted from these principal zymotic diseases,against 59 and 41 in the preceding two weeks. These49 deaths were equal to an annual rate of 2-0 per 1000,which was 0’2 above the mean rate from the same diseasesin the twenty-eight English towns. The 18 deaths attri-buted to diarrhoeal diseases showed an increase of 5 uponthe number in the previous week, but were 38 below thenumber returned in the corresponding week of last year;they included 9 in Glasgow, 4 in Dundee, and 3 in Aberdeen.The 12 fatal cases of scarlet fever exceeded the numberreturned in any recent week ; 7 occurred in Glasgow and 2in Aberdeen. The deaths from whooping-cough, which hadbeen 9, 8, and 9 in the previous three weeks, were again 8last week, all of which occurred in Glasgow. The 7 fatalcases of diphtheria exceeded the number in recent weeks,including 3 in Glasgow and 3 in Edinburgh. The deathsreferred to "fever," which had been 7 and 6 in the previoustwo weeks, further declined to 4 last week, of which 2occurred in Glasgow and 1 each in Edinburgh and Greenock.The deaths referred to acute diseases of the respiratoryorgans in the eight towns, which had been 59 and 58 in thepreceding two weeks, rose to 64 last week, and exceeded thenumber returned in the corresponding week of last year by12. The causes of 64, or 16 per cent., of the deaths in theeight Scotch towns last week were not certified.

HEALTH 010 DUBLIN.’

The rate of mortality in Dublin, which had declined inthe preceding four weeks from 26’7 to 21’1, was again 21’1 inthe week ending the 10th inst. During the thirteen weeksof last quarter the death-rate in the city averaged 22’9 per1000; the rate during the same period did not exceed 18’1 inLondon and 15’5 in Edinburgh. The 143 deaths in Dublin lastweek corresponded with the number in the previous week,and included 4 which were referred to diarrhcea, 3 to " fever "

(typhus, enteric, or simple), 3 to scarlet fever, 1 to whooping-cough, and not one either to small-pox, measles, or diph-theria. In all, only 11 deaths resulted from the principalzymotic diseases, against numbers declining from 27 to 14in the preceding four weeks, and were equal to an annualrate of 1’6 per 1000. The rate from the same diseases lastweek was 1’8 in London and 1’0 in Edinburgh. The 4 deathsattributed to diarrhoea showed an increase of 1 upon thenumber in the previous week, while those referred to " fever

"’

were fewer by 2. The fatal cases of scarlet fever exceededthe number in the previous week by 1. Nine deaths fromviolence and 8 inquest cases were registered; and 40, or morethan a quarter of the deaths, occurred in public institu-tions. The deaths of infants showed a decline, while thoseof elderly persons were more numerous than in either ofthe previous two weeks. The causes of 19, or more than 13per cent., of the deaths registered during the week were notcertified.

THE SERVICES.

A DISTINGUISHED service reward has been bestowed uponSurgeon-General J. H. Innes, C.B., Honorary Surgeon to HerMajesty.ARMY MEDICAL STAFF.-Surgeon-Major Richard William

Berkeley, to be Brigade Surgeon, vice Edwin Jas. Hopwood,granted retired pay ; Surgeon-Major James Martin has beengranted retired pay, with the honorary rank of BrigadeSurgeon ; Surgeon-Major Valesius Skipton Gouldsbury,M.D., C.M.G., from the Seconded List, to be Surgeon-Major;Surgeon-Major Valesius Skipton Gouldsbury, M.D., C.M.G.,is granted retired pay, with the honorary rank of BrigadeSurgeon. The under-mentioned Surgeons-Major are grantedretired pay, with the honorary rank of Brigade Surgeon :-William S. Hedley, M.D., and Joseph Eustace Fishbourne.The under-mentioned Surgeons to be Surgeons-Major:—George Thomas Langridge; Breame Weston Fowler; WilliamEdward Webb, M.B. ; Reginald William Mapleton, 1I.B.;Wm. Launcelotte Gubbins, M.B.; Richd. Gillham Thomsett;Peter John McQuaid, M.D., and James Ring, M.D.

ADMIRALTY. — The following Surgeons have been pro-moted to the rank of Staff Surgeon in Her Majesty’s Fleet :-

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Theodore Julian Preston, William Pearson, M.D., and CharlesLymVasey. The following appointments have been made:-Staff-Surgeon William Pearson, M.D., to the Raven; SurgeonAlfred H. Miller, to the Vernon, additional; and SurgeonGeorge Bate, to the Boscawen.

Correspondence.THE TITLE OF "DOCTOR" FOR LONDON

MEDICAL STUDENTS.

14 Audi alteram partem."

To the Editor of THE LANCET.SIR,—Mr. C. St. J. Wright, M.B. Aberd., in his recent letter

to you ignores the point of the grievance of London studentsagainst the English Royal Colleges. Were the point at issuereally what he states it to be-viz., that it is proposed togive students who have undergone an inferior course ofstudy, and who have obtained the diplomata of the conjointColleges, the title of " doctor," which " is given to those whohave taken the extra trouble, and gone to considerable extra- expense, to gain a university degree in addition to the

membership of the College,"-there would be some justgrounds for the Colleges declining to accede to the proposal,originally, I believe, put forward by myself, and since soably advocated by Mr. Hickman, M.B. Lond., for them to- obtain a charter granting the right of giving degrees instead.of diplomata. The truth is, the men on whom the Col-leges inflict a serious loss of status are many; while themen who have been driven to incur " extra trouble" and’" considerable extra expense," in order to obtain a mediocre’Scotch or Irish degree, are a small minority of those who- obtain these qualifications. The great majority of thesegraduates have passed the whole of their studentship at theuniversity selected; they have paid much in small class, hospital, and examination fees; they have found living much- cheaper; and if all one sees, hears, and gathers from experienceis to be relied on, they have found the work easier andthe terms shorter than in London. Even in Edinburgh theterm of study is four months shorter than in London, sincefour academical years only equal the period of forty-fivemonths required by the College of Physicians, while inScotland the winter session commences on November Ist,.a month later than the English session. We haveit on the authority of Dr. Arthur Jacob of Dublin that

’degrees can be obtained after two years and nine months’study. The men who, having already passed four years in- study in England, go over the border or across the Channel,and who then (after undergoing an extra course of studyto keep the terms required by the regulations) obtain adegree, are in a small, though unfortunately an increasing,minority. They are not the men against whom the publicgenerally, and the Royal Colleges in particular, have tomeasure the professional calibre of the English diplomats.Any man, no matter how well read he may be, must neces-sarily increase his knowledge by an extra course of study.My complaint is that men who have not undergone thisextra course, nor indeed a period of study equivalent tothe English course, pose themselves before the world as menof superior education simply because they have studied in aschool, often but little known to fame, where they give a,certificate, form X, while men who have been the pupils ofthe first surgeons and physicians of the day, and who arealumni of the grand old English hospitals, only obtain acertificate, form Z.

I should like to ask Mr. Wright whether it was not thefact, when he was at Aberdeen, that the London hybridsheld themselves aloof from the true Aberdonian students, onwhom they looked down, and by whom they were propor-tionally revered and looked up to as men who, knowing athing or two, and who had seen something of the profes-sional world. If it was not so, his experience was peculiar;and if it was, what then becomes of his argument thatgraduates of most of the British universities are, as such,superior in acquirements to the diplomats of the EnglishColleges ? In Trinity College, Dublin, there is an approachto the academical systems of Oxford and Cambridge, whichEnglishmen, the University of London notwithstanding,usually include in their idea of a university; but elsewhere,

the undergraduates appear to live in lodgings, or withfriends, just as the English students do; indeed, studentsliving in hall, as some do at Bart’s, Ring’s, University, St.Mary’s, and Queen’s, Birmingham, are following the idealuniversity curriculum more closely than are most Scotchand Irish undergraduates.What London students require is a University-i.e., after

all, only a union of Colleges, so styled by Royal Charter-which shall grant them degrees after undergoing a cur-

riculum of study and after passing examinations equal instringency to those of most of the British Universities. TheEnglish Colleges should not be permitted to put up theirstandard unduly. London students hold that the examina-tions of the English Colleges are now at least equal as testsof professional acquirements to those of most of the existinguniversities in the three kingdoms.To attempt to lower the London University standard to

that of the Scotch and Irish universities, which would alonemeet the wants of London students (and which must, 1contend, affect the standards of the Intermediate and SecondM.B. Examinations quite as much as it does those of theMatriculation and the Preliminary Scientific Examinations),would be a grave misfortune. To do so would inflict aserious injury on many men who have worked hard for sixor seven years to obtain what is now rightly esteemed theblue ribbon in medicine. It would be as reasonable to askthe College of Surgeons to make all members Fellows onpayment because the Edinburgh College has thought fit tomake gentlemen who have attained its L.R.C.S. Fellowsafter having been nominated and after having paid extra fees.London students, then, demand not only that they shall

obtain a degree for the same amount of work that Scotchand Irish students do, but that the new arrangements to bemade by the conjoint Colleges shall have a retrospectiveeffect, and that all existing members and licentiates shall beincluded in the benefits of the scheme : Licentiates andMembers of the Royal College of Physicians to be grantedthe degrees of Doctor and Bachelor of Medicine, andFellows and Members of the Royal College of Surgeons thedegrees of Master and Bachelor of Surgery respectively inthe University of England or St. George-ambiguity shouldbe avoided in selecting a title.The gist of the whole matter lies in a nutshell. Unless

the English schools, metropolitan and provincial, are pre-pared to see their students minish from among the childrenof men, they must be prepared to take action on the linesI have indicated, and that without further delay. It issimply monstrous that all our lunacy and hospital physiciansappointments are practically handed over to Scotch andIrish students, all but some 3 per cent. of English studentsbeing practically disqualified to hold them. At BethlemHospital, I believe, it was recently the rule that a M.D. Q.U.I.,

, who might have obtained his degree with less than three.

years’ study, was eligible for an appointment on the staff,. while a M.B. of the Universty of London was not, a doctor’s, degree being an essential. English students are surely: strong enough to see themselves righted in this matter. Let. them remember that union is strength, and I shall be glad. to co-operate as long as I am in England with any gentle-- men who will aid the formation of an association (if no. existing organisation can undertake the duty) having for

its object the granting of degrees for English students on) similar condition to those on which Scotch and Irish students

obtain them. I am. Sir. vours. &c..

Southsea, Sept. 25th.SHIRLEY DEAKIN, F.R.C.S. Eng.,

Surgeon, I.M.S.

POOR-LAW MEDICAL OFFICERS’ SUPERANNUA-TION AND MEDICAL MEMBERS OF

PARLIAMENT.To the Editor of THE LANCET.

SIR— At the meeting of the Council of the Poor-lawMedical Officers’ Association, held at their rooms, 3, Bolt-court, Fleet-street, on Thursday, the 8th inst., the case ofMr. Isaac Flower (inter alia), until recently medical officerof the Codford St. Peter’s district of the Warminster Cnion,Wilts, was taken into consideration, and a resolution wascome to that I should lay the facts before the medical

public through the columns of THE LANCET, and, in accor-dance therewith, I have respectfully to request insertion ofthe following in this week’s issue:-