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necessary to prevent the editor from being influenced by thepublisher.

After a considerable amount of conversation on thissubject it was ultimately decided that a report should beprepared for the next meeting and the assembly thenadjourned till the morrow.

(To be continued.)

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8332 births and 5250deaths were registered in the week ending April 21st. Theannual rate of mortality in these towns, which had beenequal to 17’ 0 and 17’ 1 per 1000 in the two preceding weeks,further rose last week to 17 3. In London the rate was19’2 per 1000, whereas the mean rate in the 75 otherlarge towns did not exceed 16’5. The lowest death-ratesin these towns during the week were 6.9 in Bournemouth,7.8 in Wolverhampton, 9.3 in Southampton, and 9.6 inTottenham ; the rates in the other towns ranged upwards to23.1 in Tynemouth, 23.2 in Coventry, 23.4 in Middles-brough, 23.6 in Liverpool, and 25.9 in Bromley. The 5250deaths in the 76 towns included 519 which were referred tothe principal infectious diseases, against 457 and 518 in thetwo preceding weeks; of these, 214 resulted from measles,133 from whooping-eough, 58 from diphtheria, 48 fromdiarrhœa, 47 from scarlet fever, 18 from " fever" (principallyenteric), and one from small-pox. The deaths from thesediseases were equal to an annual rate of 1’ 7 per 1000 in the 76towns and to 1’ 9 in London. No death from any of theseinfectious diseases was registered last week in Hastings,Brighton, Bournemouth, Southampton, Rsading, or in eightother large towns ; while they caused the highest death-ratesin Bradford, Bristol, Preston, Liverpool, Walthamstow, andBurnley. The highest death-rates from measles duringthe week occurred in Liverpool, Preston, Walthamstow, andBurnley ; from whooping-cough in Bristol, Aston Manor,Merthyr Tydfil, West Bromwich, Burnley, and Coventry ;from diphtheria in Walthamstow and Halifax ; and fromdiarrhoea in Warrington. The highest death-rates fromscarlet fever occurred in Middlesbrough and Sheffield."Fever" showed no marked fatality in any of the largetowns, and one fatal case of small-pox occurred in Plymouth.The number of small-pox cases remaining under treat-ment in the Metropolitan Asylums Hospitals were stillseven at the end of last week, one new case havingbeen admitted daring the week. The number of scarletfever cases under treatment in these hospitals and inthe London Fever Hospital on Saturday, April 21st, was2225. showing a further decline from numbers decreasingsteadily from 2628 to 2301 in the six preceding weeks ; 288new cases were, however, admitted during the week undernotice, against 270 in the previous week. The deathsreferred in London to pneumonia and other diseases of therespiratory organs, which had been 332 and 357 in the twopreceding weeks, further rose last week to 399 and exceededby 104 the corrected average for the corresponding week inthe four preceding years, 1902-05. The causes of 51, or

rather less than 1 per cent., of the deaths registered duringthe week in the 76 large towns were not certified either bya registered medical practitioner or by a coroner. All thecauses of death were duly certified in West Ham, Bristol,Leicester, Nottingham, Salford, Bradford, Hull, Newcastle-upon-Tyne, and in 48 other large towns; whereas theproportion of uncertified deaths showed a considerable excessin Birmingham, Coventry, Liverpool, Sheffield, Sunderland,and Gateshead.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 19.4 and 19.1 in thetwo preceding weeks, further declined to 17’ 6 during theweek ending April 21st, but exceeded by 0’ 3 the mean rateduring the same week in the 76 large English towns.The rates in the eight Scotch towns ranged from10’ 6 and 13-1 1 in Perth and Aberdeen to 18 5 in

Glasgow, 19’ 6 in Dundee, and 20 ’ 6 in Greenock. The634 deaths in these eight towns included 15 whichwere referred to measles, 14 to whooping-cough, 12 todiarrhoea, seven to diphtheria, four to "fever," one to

scarlet fever, but not one to small-pox. In all, 53 deaths

resulted from these principal infectious diseases during theweek, against 51 and 54 in the two preceding weeks.These 53 deaths were equal to an annual rate of 1’5 per1000, which was 0’ 2 below the mean rate during theweek from the same diseases in the 76 large Englishtowns. The fatal cases of measles, which had been 27,20, and 23 in the three preceding weeks, declined last week t315, of which eight occurred in Glasgow, three in Edinburgh,and two in Dundee. Of the 14 deaths from whooping-cough,which exceeded by two the number returned in each of thetwo previous weeks, ten were recorded in Glasgow. Thedeaths referred to diarrhœa, which had been 15 and 11 inthe two previous weeks, were 12 last week, and includedfive in Glasgow and three in Edinburgh. Four of theseven fatal cases of diphtheria occurred in Glasgow, as didthree of the four deaths referred to fever, which includedtwo attributed to cerebro-spinal fever. The deaths in theeight towns referred to diseases of the respiratory organs,including pneumonia, which had been 142 and 170 in thetwo previous weeks, declined last week to 140, but exceededby 14 the number referred to these diseases in the corre-sponding week of last year. The causes of 13, or rather morethan 2 per cent., of the deaths registered in the eight townsduring the week were not ceitified, the proporliion of un-

certified deaths in the 76 English towns being less than1 per cent. -

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 26 1, 21’1, and23’ 4 per 1000 in the three preceding weeks, further rose to28’1 1 during the week ending April 21st. During the 13 weeksof last quarter the death-rate in the city averaged 22’ 9 per1000, against 16 6 and 17 4 in LO’1don and Edinburgh ; andduring the first three weeks of the current quarter the

Dublin death-rate has further increased of 24 ° 2. The 204deaths of persons belonging to Dublin registered duringthe week under notice showed an increase of 26 upon thenumber returned in the previous week, and included sixwhich were referred to the principal infectious diseases,against four and six in the two preceding weeks ; ofthese, three resulted from measles, two from "fever,"one from diarrhoea, and not one either from small-pox, scarlet fever, diphtheria, or whooping-cough. Thesesix deaths from the principal infectious diseases were

equal to an annual rate of but 0 - 8 per 1000, while therate last week from the same diseases were equal to1. 9 in London and 1. 4 in Edinburgh. The threefatal cases of measles showed an increase upon thenumbers in recent weeks, as did the two deaths referredto "fever," probably enteric. The 204 deaths included 25of infants under one year of age and 78 of persons agedupwards of 60 years; the deaths both of infants and ofelderly persons showed a marked increase upon the numbersin the two previous weeks. Nine inquest cases and fourdeaths from violence were registered; and 87, or 43 percent., of the 204 deaths were recorded in public institutions.The causes of six, or 3 per cent., of the deaths registeredduring the week were not certified, either by a registeredmedical practitioner or by a coroner.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Staff Sur-

geons : E. Sutton to the St. George, on recommissioning,and E. S. Tuck to the President, for three months’ courseat Guy’s Hospital. Surgeons : F. L. de Verteuil to theHogue, on completing ; N. H. Mummery to the Latona; J.Verdon to the Hyacinth and M. T. Male to the Russell, bothon recommissioning.

ROYAL ARMY MEDICAL CORPS.Lieutenant Percy Farrant, from the Seconded List, to be

Lieutenant (dated April lst, 1906),The following have been appointed medical officers,

London Recruiting Area: Lieutenant-Colonel H. Scott,retired pay, and Lieutenant-Colonel R. H. Hall. CaptainA. C. Lupton, from Newcastle-on-Tyne, has been appointedto the lst Life Guards. Lieutenant L. Bousfield has beenselected for employment with the Egyptian Army.

THE ROYAL ARMY MEDICAL (MILITIA) CORPS.The Army Council has decided that it is necessary to

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encourage the non-commissioned officers and men of thE

Royal Army Medical (Militia) Corps to qualify as cooks, bottfor hospital and general purposes, and has directed that a

sufficient number shall be trained at selected military hos-pitals to maintain an establishment of two cooks pelcompany, the period of instruction being three months.

VOLUNTEER CORPS.

Ri fle : lst Volunteer Battalion the NorthumberlandFusiliers: Surgeon-Major J. P. Elliot is granted the hono-rary rank of Surgeon-Lieutenant-Colonel (dated April llth,1906) ; Surgeon-Major and Honorary Surgeon-Lieutenant-Colonel J. P. Elliot resigns his commission, with permissionto retain his rank and to wear the prescribed uniform (datedApril llth, 1906). 5th (Glasgow Highland) VolunteerBattalion the Highland Light Infantry : Surgeon-Major A.Macphee to be Surgeon-Lieutenant Colonel (dated April llth,1906).

THE KING’S BIRTHDAY.Notice is given in the London Gazette that the King’s

Birthday will be celebrated in London and at all HomeStations on Friday, June 29th next. At all other stationsHis Majesty’s Birthday will be celebrated on Friday,Nov. 9th next.

PATRIOTISSI AT THE UNIVERSITIES.In the April number of the University Review Sir William

Ramsay has written an article entitled " Patriotism at theUniversities." It is an earnest plea for a scheme wherebymen while at the university should be able to undertake tofit themselves for service In defence of their country. Hereminds his readers that in Germany those who have passedthe " Abiturientenexamen " of the high schools (gymnasiaor oberrealschulen), which is equivalent to matriculation atour universities, are allowed not only to limit their time ofservice to one year but it is made easy for them to serveduring one of their years of study. Their hours of

compulsory drill are made to fit their hours of study.And further, he asks, "Could we not form the habitof devoting one of our university years to shooting anddrill "We see that the editor of the University/Review invites discussion upon this important suggestionand we await the result of the discussion with interest. For

nearly 900 years no foreign invader has set foot on Englishsoil and possibly we have become lulled into a false security.It may be true that the British people will never agree touniversal military service but surely it is not too much toask that every able-bodied man should, say between the agesof 18 and 25 years, give up one year of his time to learningto shoot straight and to perform simple military evolutions.One of the greatest strategists of the last century said thatit was perfectly easy to get an army into England but almostimpossible to get it out again. If Sir William Ramsay’sscheme were adopted other classes than those who go to theuniversities would probably follow suit and in that case aninvader would probably never penetrate far into the countryeven if he succeeded in landing.THE ROYAL NAVAL HOSPITAL, STONEHOUSE, PLYMOUTH.Lord Tweedmouth and the other Lords of the Admiralty

made a visit of inspection to the Royal Naval Hospital,Stonehouse, on April 10th. They were received by Inspector-General J. C. B. Maclean, Deputy-Inspector-General L. H.Kellett, and Deputy-Inspector-General C. James. Fleet-

Surgeon W. Eames, Staff-Surgeon M. L. B. Rodd, andseveral other officers were also present. Lord Tweedmouthvisited the medical and surgical wards. The sick officers’quarters were seen and also the improved blocks of

buildings, which have been practically rebuilt, with theirannexes and sanitary arrangements. Lord Tweedmoutb, whoremained a considerable time in the hospital, was muchpleased with his inspection.

ROYAL ARMY MEDICAL CORPS FUND.The Army and Navy Gazette states that the fourth general

meeting of subscribers to the Royal Army Medical CorpsFund will be held in the theatre of the Royal United ServiceInstitution on Monday, June 18’,h, at 3 P.M. The Director-General will preside. It is hoped that officers will freelyexpress their views on any points connected with the fundwhich they may wish discussed. Those officers who wish forinformation on any special point are asked to communicatewith the honorary secretary, Lieutenant-Colonel B. M.Skinner, at 68, Victoria-street, London, S.W., in order thatfacts and figures may be furnished in response to anyquestion aked.

THE TEETH OF ARMY RECRUITS.

In future the teeth of army recruits will be tested notfrom the standpoint of a campaign like that in SouthAfrica but from the general average conditions of Europeanwarfare.

SPANISH MILITARY HYGIENE. ,

Dr. E. Alonso G. Sierra, a Spanish military surgeon,writing in the Revista dc Sanidad Militar, deplores thegreat want of cleanliness in the army. - The soldiers scarcelyever take a bath or brush their teeth, and are not accustomedto wash their hands before their meals, added to which thereis a most deplorable want of cubic space in the barrack-rooms. Were these matters rectified and a more liberalsupply of easily assimilable proteids allowed in their rationshe thinks that the present high mortality would bye decreasedby something like 95 per cent.

Correspondence.

ANTERIOR OR POSTERIOR GASTRO-JEJUNOSTOMY ?

"Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-In THE LANCET of April 14th, p. 1071, Mr.B. G. A. Moynihan maintains that I replied to, but did not

answer, the arguments and criticisms in his former letter.; This is a matter of opinion which I leave to the judgment

of your readers. With your permission I will endeavour toreply to the arguments which Mr. Moynihan now puts forward.In his first paragraph Mr. Moynihan evades my point thatthe no-loop operation has not been practised long enough

’ to warrant a definite decision as to its value. He nextremarks that "the operation of gastro-jejunostomy, if onemay judge from published reports, is not so frequentlyperformed in London as elsewhere." Possibly we are

behind the times, although I think that published reportsare not a trustworthy indication of the volume of workdone, inasmuch as surgeons in London, whether frompressure of work or from disinclination, are very sparing asto the reports of cases which they publish. The great bulkof the cases are buried in the oblivion of hospital notes.Mr. Moynihan tells me that if I will look further afield Ishall discover that the posterior operation with no loop isreally the operation usually performed. I can only say thata careful search through the literature of the subject leadsme to an opposite conclusion. In preparing my lectures Icommunicated with surgeons all over the country and I

gathered from my inquiries that the no-loop operation is notcommonly employed.As regards Dr. Mumford’s case, it is quite true that it was

an instance of an anomaly of the duodenum, in that thefixed portion of the duodenum ended on the right side of thespinal column instead of on the left. This, however, Isubmit, does not affect the conclusion to be drawn from therecord. The case is, as Mr. Moynihan admits, an argumentagainst the no-loop operation. It illustrates the danger offixing the jejunum to the stomach without the play affordedby a loop. As Dr. Mumford remarks, "The play allowed tothe movable stomach and jejunum was limited by the shortradius-the ligament of Treitz to the anastomotic opening-afforded by the three-inch limb of jejunum." In otherwords, the no-loop operation is mechanically incorrect. Mr.

Moynihan maintains that the condition found would havevitiated an anterior probably as much as a posterior opera-tion. Even that fertility of imagination with which Mr.Moynihan kindly credits me does not enable me to conceivehow, with the play afforded by the 12-inch loop of ananterior operation, the colon could be constricted, especiallyas in this particular case the stomach appears to havecontracted in a lateral rather than in a vertical direction.

I am surprised to learn that Mr. Moynihan has adoptedthe method of stitching for two and a half years, for I findfrom his published records that one of his cases of gastro-jejunostomy performed in December, 1903, was operated onsubsequently for an internal hernia through the aperture inthe mesocolon. As gastro-jejunostomy in this case was

performed less than two and a half years ago, I supposethat Mr. Moynihan must have stitched the jejunum to the