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of Sb. Florence. And amongst the conclusions at which hearrives is the fundamental one that if the sanitary authorityintend to do their duty towards their constituents theymust meet sufficiently often to indicate some interest in theirwork and to supervise the labours of their oflicers. One of themost unfortunate results of constituting poor-law guardiansthe sanitary authorities for unions has been the maintainedattitude of indifference which some of these bodies show tosanitary as opposed to poor law work, and this seems to beone of the instances in point.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 6247 birthsand 5394 deaths were registered during the week endingJan. 10th. The annual rate of mortality in these towns,which had increased from 21-3 to 28-7 per 1000 in the pre-ceding four weeks, declined last week to 28’1. The ratewas 29’1 in London and 27’3 in the twenty-seven pro-vincial towns. During last quarter the death-rate in thetwenty-eight towns was 22’1 per 1000, and exceeded by 1.1the mean rate in the corresponding periods of the ten years1880-89. The lowest rates in these towns last weekwere 15’7 in Derby, 18’8 in Nottingham, 20’2 in Hull,and 21’2 in Huddersfield ; the highest rates were

32-9 in Newcastle-upon-Tyne, 33’9 in Birkenhead, 35.5in Manchester, and 39.8 in Preston. The deathsreferred to the principal zymotic diseases, which hadbeen 472 and 476 in the preceding two weeks, fartherrose last week to 485; they included 183 from measles,134 from whooping-cough, 54 from scarlet fever, 46 fromdiphtheria, 40 from diarrhoea, 28 from " fever" (principallyenteric), and not one from small-pox. The lowest death-rates from these diseases were recorded in Wolverhampton,Derby, Hull, andCardiff; thehighest in Birkenhead, Halifax,Bolton, and Preston. The greatest mortality from measlesoccurred in Oldham, Huddersfield, Bristol, Birkenhead,Halifax, Preston, and Bolton; from scarlet fever in Ply-mouth ; from whooping-cough in Preston, Halifax, and Nor-wich ; and from "fever" in Halifax. The 46 deaths from diph-theria included 28 in London, 3 in Norwich, and 3 in Man-chester. No death from small-pox was registered in any of thetwenty-eight towns ; one small-pox patient was under treat-ment in the Metropolitan Asylum Hospitals, butnot oneintheHighgate Small-pox Hospital on Saturday last. The numberof scarlet fever patients in the Metropolitan Asylum Hos-pitals and in the London Fever Hospital at the end oflast week was 1524, against numbers declining from 2122to 1593 on the preceding nine Saturdays; the patientsadmitted during the week were 92, against 78 and 107 inthe previous two weeks. The deaths referred to thediseases of the respiratory organs in London, which hadincreased in the preceding six weeks from 375 to 927,further rose last week to 991, and exceeded the correctedaverage by 408. The causes of 126, or 2-3 per cent., of thedeaths in the twenty-eight towns were not certified eitherby a registered medical practitioner or by a coroner. Allthe causes of death were duly certified in Norwich, Wolver-hampton, Sunderland, and in three other smaller towns.The largest proportions of uncertified deaths were recordedin Sheffield, Liverpool, Leicester, and Brighton.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased from 20’1 to 24.8 per 1000 in the pre-ceding four weeks, further rose to 28’8 during the weekending Jan. 10th, and was 0’7 per 1000 above the rate thatprevailed during the same period in the twenty-eight largeEnglish towns. The rates in the eight Scotch towns rangedfrom 19’4 in Dundee and 20-0 in Edinburgh, to 34’7 inPaisley and 39’1 in Glasgow. The 755 deaths in theseeight towns showed an increase of 112 upon the numberin the preceding week, and included 19 which were re-

ferred to whooping-cough, 15 to measles, 13 to diarrhoea,8 to scarlet fever, 8 to "fever" (principally enteric), 5 todiphtheria, and not one to small-pox. In all, 68 deathsresulted from these principal zymotic diseases, against 70and 65 in the preceding two weeks. These 68 deaths wereequal to an annual rate of 2’6 per 1000, which slightlyexceeded the mean rate last week from the same diseases inthe twenty-eight English towns. The fatal cases of whoop-

ing-cough, which had been 22 in each of the preceding twoweeks, declined last week to 19, of which 12 occurred inGlasgow and :3 in Edinburgh. The 15 deaths from measles ex-ceeded by 3 the number in the previous week; 8 were recorded’in Greenock and 7 in Glasgow The fatal cases of "fever,"which had increased from 6 to 14 in the preceding three weeks,declined last week to 8, of which 3 occurred in Edinburghand 3 in Leith. The 8 deaths referred to scarlet fever showedan increase of 4 upon the number in the previous week,and included 4 in Glasgow and 2 in Aberdeen. The fatalcases of diphtheria, which had been 9 and 6 in the preced-ing two weeks, further declined to 5 last week, all ofwhich occurred in Glasgow. The deaths referred to diseases.of the respiratory organs in the eight towns, which hadincreased in the four previous weeks from 137 to 191,further rose to 240 last week, but only slightly exceededthe number in the corresponding week of last year. Thecauses of 65, or nearly 9 per cent., of the deaths in the-eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had increased in thepreceding four weeks from 25.6 to 40.6 per 1000, declined’again to 36.0 during the week ending Jan. 10th. Duringlast quarter the death-rate in the city was 25’4 per 1000,the rate duiing the same period being 21’3 in London and18’8 in Edinburgh. The 241 deaths in Dublin showed a

decline of 31 from the unusually high number in the pre-ceding week, and included 6 which were referred to

whooping-cough, 4 to "fever," 2 to diphtheria, 2 to diar-rhcea, 1 to measles, and not one either to small-pox orscarlet fever. Thus the deaths from the principal zymoticdiseases, which had been 11 in each of the previous twoweeks, increased to 15 last week; they were equal to an annualrate of 2-2 per 1000, the rate from the same diseases being:2’5 in London and 1.5 in Edinburgh. The deaths referredto whooping-cougb, which had been 4 and 2 in the pre-ceding two weeks, rose again to 6 last week, a highernumber than in any week since March last. The fatal casesof "fever," which had risen from 4 to 7 in the previousthree weeks, declined to 4 last week. The 2 deaths from.diphtheria exceeded the number recorded in any recentweek. The 244 deaths in the city included 38 of infanta.under one year of age, and 79 of persons aged upwards ofsixty years ; the deaths of infants showed a slight decline,while those of elderly persons showed a further increase-upon those recorded in recent weeks. Three inquest casesand 4 deaths from violence were registered ; and 66, ormore than a fourth, of the deaths occurred in publicinstitutions. The causes of 17, or 7 per cent., of thedeaths in the city were not certified.

THE SERVICES.

GREENWICH HOSPITAL PENSION.—The Greenwich Hos-pital pension of £50 a year, rendered vacant by the death.of Deputy-Inspector General William Gnnn, M.D., ha&been awarded to Deputy-Inspector General Henry Piers.ARMY MEDICAL STAFF.—It has been decided to hold

an examination for commissions in the Army MedicalStaff in London on Feb. 9th and following days. It isunderstood that there are twenty commissions to be filled.-Surgeon Vere Edward Hunter has been placed on tem,porary half pay on account of ill-health (dated Dec. 29th,1890).INDIAN MEDICAL SERVICE.—The following Surgeons to

be Surgeons-Major on the Bengal Medical Establishment(dated Sept. 30th, 1890) : - Terence Humphrys Sweeny;Daniel Francis Barry, M. D.; Geo. Francis Angelo Harris; yJohn Anderson; Charles James Bamber; and MalachiO’Dwyer.-The Queen has approved of the transfer ofSurgeon-Major Joseph Blood, Bengal Medical Establish-ment, to the Half-pay List (dated Dec. 21st, 1890).-TheQueen has also approved of the retirement from the Serviceof the undermentioned Officers:—Brigade Surgeon Benj.Thomas Suffrein, Madras Medical Establishment (datedOct. 12th, 1890); Surgeon-Major William Duncan, BengalMedical Establishment (dated Dec. 4th. 1890); Surgeon-Major Edwin Sanders, Bengal Medi

1 Establishment.(dated Jan. lst, 1891).

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NAVAL MEDICAL SERVICE. - The following appoint-ments have been made at the Admiralty:-Staff Surgeon’Gerard J. Irvine to the Vivid (dated Jan. 10th, 1891); Sur-

,geon Phillip N. Randall to the Warspite (dated Jan. 10th,1891).VOLUNTEER CORPS.—Artillery: lst London (City of

London): The following announcement is substituted for that,on the same subject which appeared in the London Gazetteof Oct. 31st, 1890-viz.: Surgeon J. J. A. V. C. Rayeresigns his commission.-3rd Lancashire : Edwin Haworth,M.B., to be Acting Surgeon (dated Jan. 10th, 1891).

Correspondence.

MILK IN CONNEXION WITH SEPTIC DISEASE.

" Audi alteram partem."

To the Editors of THE LANCET.

SIRS,—With regard to my letter to Dr. Atkinson, to

’which " Public Health " referred in your columns last week,I may say that I was not alluding to any specific infectiveorganisms. The question as to the effect of boiling milkcontaining these organisms can be readily settled, withreference at least to two of them, by making the experi-ment ; the organisms of diphtheria and typhoid fever can beobtained from most bacteriological laboratories. It wouldroe of even greater importance to determine whether tuberclebacilli, when present in milk, can be destroyed by boiling ;because it is very probable that, in children at any rate,tubercular disease is frequently induced by the milk fromtuberculous cows. It is quite likely that experiments ofthis kind have already been made, but I do not happen to’have read of them.

I am, Sirs, yours faithfully,W. WATSON CHEYNE.

Welbeck-street, Cavendish-square, W., Jan. 13th, 1891.W. WATSON CHEYNE.

To the Editors of THE LANCET.

SIRS,—The character of the second epidemic mentionedin my previous communication ought certainly to have beengiven. It was one of follicular tonsillitis, and I ought tohave stated that my patients (though the epidemic wassaid to be due to milk) were ordered larger quantities ofunboiled milk than usual; and yet, in spite of this, nearlyall got well in about three days. The state of health ofthe population, in my opinion, has more to do with regu-lating the size and severity of epidemics than anything else,and thus we see the weakly affected first, then thuse thatpossess slightly greater power of resistance, whilst the per-fectly strong and healthy escape altogether. Children maybe said to have less resisting power than adults. Enteric’fever may in the ordinary way be said to be morean illness of adult life, because young children donot travel about so much, and are not in consequenceexposed to so many fresh zymotic influences. Recentcomers into an infected district are most likely, it is said, totake on the disease, and we certainly notice that thevisitors to noblemen’s mansions that are defective as regardssanitary arrangements are often the chief sufferers. Butwhere enteric fever is caused by contaminated milk thecases, I fancy, would be found to be more numerous in theyoung than the old, because the glandular system is parti-cularly active in early life, and the intestinal glands arevery easily irritated. It is all very well to say that suchand such a disease is more common at such and such aperiod of life; under certain circumstances it may be so,but under others the statement may be entirely wrong. Ourknowledge with regard to milk epidemics is even now sovery imperfect, and the ages of persons who have sufferedfrom various causes so mixed, that at the present time andfor the present purpose they are utterly unreliable. I haveknown several epidemics in recent years put down as dueto milk, while the drainage has been shown to bethoroughly defective. "Public Health may call in ques-tion Mr. Watson Cheyne’s statement, but surely, if hedoubts it, he ought to bring forward some sort of proof that

it is wrong. At any rate, some of our great microscopistsshould be able to satisfy us upon this point, and put anend to all doubts on the subject.

I am, Sirs, yours obediently,Surbiton, Jan. 13th, 1891. F . P. ATKINSON.F. P. ATKINSON.

MIDWIVES’ REGISTRATION BILL.To the Editors of THE LANCET.

SIRS,—I had hoped that any discussion on so important asubject as the above would have been conducted seriously,and I have read Dr. Aveling’s letter with both regret andsurprise. He seems to consider it sutficient to meet mycriticisms of the Bill by, in the first place, making twoassumptions, both of which are absolutely erroneous;secondly, by a statement which is obviously equally in-correct, and concludes with a "hope," which he will find,by reason of the frailty of human nature, never can berealised. Dr. Aveling says I have "not seen the Bill,and have contented myself with collecting the opinionsof others." I beg to inform him I have the Bill beforeme, and that it was sent to me by a member of Parlia-ment immediately on its introduction, that I have readvery little of what has been written on the subject, andtherefore if I reiterate the opinions of others, it only showsthat if those who judge for themselves, as I have done,arrive at the same opinion as to the demerits of the Bill,there must be some good grounds for our objections. ThatI state mine in an " uninviting" form is a matter of regretto me; it is my misfortune that it should be so, but not myfault. Next Dr. Aveling says I would "enforce their ex-amination [i.e., of midwives], but say nothing about grant-ing certificates or registering them." Had he read my letterwith any care, he would have observed that I state "inIreland" each woman on passing her examination at theend of her term of training is given a certificate," and re-commended that this system be introduced into England;and as to " registration," I really thought most of my letterwas about it. Finally, Dr. Aveling "hopes" " my "fearsare groundless" that amongst the many thousands ofwomen whom the Bill proposes to put on the register "agood many will be guilty, or at least be accused, ofdrunkenness, incompetence, &c." In fact, he appears toinfer that the moment a woman is registered she will befreed from the vices and defects which detract from themerits of ordinary mortals, and of which anyone who readsthe papers knows that the women at present acting as mid-wives, and who are all to be registered as soon as the Billbecomes law, seem to have their full share. Amongmedical practitioners many are annually accused of" drunkenness, incompetence, and disgraceful conduct."Nor are such accusations confined to members of our pro-fession ; the Bar, and even the Church, have amongst theirmembers not a few "black sheep." But amongst the15,000 uneducated women whom the Bill proposes to puton the register Dr. Aveling appears to believe that "thefear" that any such should be found is

" groundless."Dr. Aveling admits that in Ireland "midwives have cer-

tainly received more attention and been better educated"than in England, but he appears to be annoyed that onewho for forty years has taken an active part in bringingabout this desirable state of affairs should " kindly wish tohelp (Englishmen) with the management" of theirs. I ama registered medical practitioner, and my name appears onthe same Register as does Dr. Aveling’s, and I refuse toadmit that anything touching the welfare of the poor inany portion of the United Kingdom is alien to me; andmore, it augurs ill of the spirit in which the Bill is drawn ifthe authors of it refuse to accept "aid in this new de-parture from, or even to listen with patience to the opinionof, those who, whether they are foreigners or only inhabitantsof a distant portion of the same kingdom, have experiencein the matter equal at least to their own. Unboundedself-confidence has ere this wrecked many a good cause.

Dr. Aveling informs us tha,t "some of the objections havealready received attention," but no intimation has beengiven as to what these are; that alterations will be madegrudgingly and in consequence of the opinion of others,which I am glad to find must have coincided with my own,is evident; but when we are favoured with the knowledgeof what these concessions are, I fear they will be foundinsufficient to meet the requirements of the case, and Itrust that those who are really interested in endeavouring to