800 HEALTH OF ENGLISH AND SCOTCH TOWNS.

Burnley, and it is to be hoped that the future action takenwill be in such directions as to reduce the excessive mortalityfrom enteric fever which has so long prevailed there.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

St. Pancras.-Estimating the population of this metro-politan parish at 239,174 for 1883, Mr. Shirley Murphy reportsan exceptionally low birth-rate of 32 2 and a death-rate of20-7 per 1000 living. Only thirteen cases of small-pox wereheard of, and vaccination is carried out with great efficiency.Indeed, there is not a single birth remaining quite un.

accounted for during the latter half of 1882, and there areonly three outsta,nding cases amongst the children born inthe first half of 1883. Speaking of scarlet fever, Mr. Murphypoints out some of the conditions under which it was foundto spread, and he records a case in which a family of fourwere occup"ing the single room they possessed together witha scarlet fever corpse. Such conditions as these, he urges,show strongly the need for proper mortuary accommodation,and it is certain that so long as the only mortuary is at theworkhouse, where it is surrounded with all the de-

grading associations of pauperism, the population can-

not be educated to understand the value which attachesto the early removal of the dead from amongst theliving. Enteric fever caused 132 deaths in 1883, thisbeing nearly 78 more than the average number for thepreceding ten years. The cause of the large outbreakwhich attacked 431 persons will be remembered inconnexion with Mr. Murphy’s inquiry in the autumn oflast year into the circumstances of a dairy farm near St.Albans, the milk from which was unquestionably shown tohave been the vehicle of infection. In connexion with theinfant mortality, Mr. Murphy presses the vestry to makeregulations as to tenement houses, and he urges that untilthey have done so they will not have exercised to their fullextent the powers they possess for improving the conditionof their poorer parishioners. We note with much regret thatthis important matter receives but tardy attention at thehands of some metropolitan authorities. Mr. Murphy wouldgladly see fresh legislation on this subject, and he points outthat if, in default of the immediate owners of tenementedproperty maintaining their houses in proper condition, as byneglecting to carry out the repairing clauses of leases, theycould be made to forfeit their leaser, houses that are occupiedby the very poor would not continue to be owned by thosewho are unwilling or unable to maintain them in a properhabitable condition.

Limehouse. -In the Limehouse district the birth anddeath-rates for 1883 were 25 and 38 per 1000 respectively.The sewer ventilators in several parts of the di&trict havebeen a constant source of complaint, and a new system isnow being attempted at some of the principal points. Somemeasures are also being taken to do away with some of thoseconditions of housing which are a disgrace to the metropolis.After several efforts at improvement, Elizabeth-court hasbeen closed under a magistrate’s order. An area in Shad-well, too, has been reported to the Metropolitan Board ofWorks under the Artisans and Labourers Dwellings Act,1875. Many of the houses are built back-to-back, most ofthem are in a very bad structural state, and the death-ratefor the last three years has averaged 44 per 1000. In otherlocalities either works of alteration and improvement oractual closure of houses is going on ; but it is evident fromthe description given by Mr. Rogers that much more isneeded in this direction than he is at present able to effect.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

Daring the week ending the 25th ult., 5986 births and3517 deaths were registered in twenty-eight of the largestEnglish towns. The annual rate of mortality in these towns,which in the two preceding weeks had been 19 ’8 and 21’1per 1000, declined last week to 20 9. During the past fourweeks of the current quarter the death-rate in these townsaveraged 20’5 per 1000, a&inst20’9a,ndl9’6 in the correspond-ingperiods of 1882 and 1883. The lowest rates last week in thesetowns were 16’1 in Portsmouth, 16’5 in Sunderland, 18’4 inBirkenhead, and 18’7 in Plymouth. In the other towns therates ranged upwards to 25 4 in Bolton, 26’1 in Manchester,26 ’4 in Liverpool, and 31 in Preston. The 390 deaths re-ferred to the principal zymotic diseases in the twenty-

eight towns included 105, which resulted from diarrhoea,66 from scarlet fever, 66 from "fever" (principally enteric),55 from measles, 46 from whooping-cough, 32 from diph-theria, and 19 from small-pox. These diseases caused thelowest death- rates in Norwich and Plymouth, and the highestin Cardiff, Preston, and Derby. The highest rates of mor-tality from scarlet fever were recorded in Newcastle-upon.Tyne and Halifax, from measles in Cardiff, from whooping.cough in Bradford and Salford, and from "fever" in Preston,Leeds, and Derby. The 32 fatal cases of diphtheria in thetwenty-eight towns included 22 in London, 2 in Brighton, 2in Liverpool, and 2 in Birmingham. Small-pox caused 15deaths in London (exclusive of 6 London cases registeredoutside Registration London), 1 in Wolverhampton, 1 inBirmingham, and 1 in Hull. The number of small-poxpadenta in the metropolitan asylum hospitals situated in andaround London, which had been 504 and 558 at the end ofthe two preceding weeks, further rose to 596 on Saturdaylast ; the cases admitted were 173, against 68 and 144 in thetwo previous weeks. The Highgate Small-pox Hospitalcontained 20 patients on Saturday last, 6 new cases havingbeen admitted during the week. Tlxe deaths referred todiseases of the respiratory organs in London, which in thefive previous weeks had increased from 159 to 286, declinedto 274 last week, and were 92 below the average. Thecauses of 75, or 2’1 per cent., of the deaths in the twenty-eight towns last week were not certified either by a regis.tered medical practitioner or by a coroner. All the causesof deaths were duly certified in Portsmouth, Leicester,Plymouth, and in three smaller towns. The largest pro-portions of uncertified deaths were recorded in Bristol, Old-ham, and Hull.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 22’S and 21’3 per 1000 in the two precedingweeks, was 21’4 last week, and exceeded by 0’5 per 1000the mean rate during the same period in the twenty-eightlarge English towns. In the Scotch towns the rates lastweek ranged from 14 and 17 ’1 in Leith and Greenock, to24’9 in Paisley and 25 in Glasgow. The 517 deaths inthe Scotch towns included 22 which were referred to measles,21 to diarrhoeal diseases, 19 to scarlet fever, 17 to diphtheria,15 to whooping-cough, 15 to "fever," and 1 to small-pox;in all, 110 deaths resulted from the principal zymotic dis.eases, against numbers declining from 137 to 101 in thethree preceding weeks. these 110 deaths were equal toan annual rate of 4’6 per 1000, which was double theaverage rate from the same diseases in the twenty-eightEnglish towns. The 22 fatal cases of measles exceeded by 4the number in the previous week, and included 12 in Glas.gow. The 21 deaths from diarrhceal diseases showed a fur-ther decline from recent weekly numbers. Of the 19 fatalcases of scarlet fever, 13 were returned in GJasgow. Thedeaths referred to whooping-cough, which had been 20 and18 in the two preceding weeks, further fell to 15, of which &occurred in Glasgow and 3 in Edinburgh. The deaths from"fever" showed a slight increase; 8 were returned in Glas.gow and 3 in Paisley. A fatal case of chicken pox (whichin Scotland is classed as small-pox) was recorded in Glasgow.The 85 deaths referred to acute diseases of the respiratoryorgans in the eight Scotch towns showed a decline, andwere 16 below those returned in the corresponding periodof last year. The causes of 82, or nearly 16 per cent.,.of the deaths in the eight Scotch towns last week were notcertified.

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HEALTH OF DUBLIN.

The rate of mortality in Dublin, whiah in the three pre-ceding weeks had increased from 26 ’3 to 30 2 per 1000, de-clined to 26’8 during the week ending the 25th ult. Duringthe first four weeks of the current quarter the death-rate inthe city averaged 28 0 per 1000, the rate for the same periodnot exceeding 16 ’4 in London and 17 ’6 in Edinburgh. The180 deaths in Dublin last week showed a decline of 23 fromthe number in the previous week, and included 29 whichresulted from the principal zymotic diseases, against 49, 32,and 25 in the three preceding weeks ; of these, 12 were re-ferred to scarlet fever, 7 to diarrhoea, 6 to "fever," 3 towhooping-cough, 1 to diphtheria, and not one either tomeasles or small-pox. These 29 deaths were equal to anannual rate of 4’3 per 1000, the rate from the same diseasesbeing 1 7 in London and 2 in Edinburgh. The fatal cases

801CORROSIVE SUBLIMATE AS A SURGICAL DRESSING.

of scarlet fever, which in the two previous weeks had been 11and 5, rose to 12 last week. The 7 deaths from dia.rrhoea.1diseases showed a further decline from recent weekly num-bers, and the fatal cases of " fever " were 4 less than thoserecorded in the previous week. Five iuquest cases and 6deaths from violence were registered during the week, and6 deaths occurred in public institutions. The deaths bothof infants and of elderly persons showed a decline from thenumbers in the previous week. The causes of 18, or 10 percent., of the deaths registered during the week were not.certified.

Correspondence... Audi alteram partem."

THE LATE DR. RABBETH.To the Editor of THE LANCET.

SIR,-The exemplary, generous, and fatal devotion ofDr. Samuel Rabbeth to the duties of his profession hasadded his name to the list of our medical heroes. Weshould all be loeers if his example were forgotten. It suggestsitself therefore to me that a gold medal, bearing Dr. Rabbeth’sname, and to be annually awarded to a Bachelor of Medicineof the University of London, on terms to he hereafter con-sidered, might be a suitable memento of his heroism, as ofthat of many others. I cannot doubt that the Senate wouldgladly become trustees of any fund for such a purpose, andcharge themselves with the duty of awarding the medal. Ishall gladly contribute to any such fund.

I am, Sir, your obedient servant,WILLIAM W. GULL.

Brook-street, Grosvenor-square, W., Oct. 27th, 1884.P.S.-The question whether such risk need have been

incurred is quite another matter, and upon which I willwrite later.

_____

CORROSIVE SUBLIMATE AS A SURGICALDRESSING.

To the Editor of THE LANCET.SIR,-In his address on this subject Sir Joseph Lister

called attention to the irritating properties of the sublimatesolution in a case of amputation of the mamma. He says,"On the day after the operation, when we changed thedressing, I found that under the oiled silk, exactly corre.sponding to its extent, the skin was highly irritated, andwas covered with small vesicles. I also found that theinner side of the arm, where there was no wound, was in thesame state of intense irritation." " The explanation of thelatter he gives as follows :-" In the case of the arm whatoccurred was, free perspiration had taken place, and theperspiration forming with the corrosive sublimate in thegauze, a watery solution had produced irritation where theperspiration was, on the same principle as the watery solutionhad caused irritation under the protective." Whatever mayhave been the cause of the eruption under the protective, itappears to me that the cause of the irritation in the arm isto be found in the irritating properties of the eucalyptol, andthe following case seems to confirm this view.On April 28th last I removed the mamma of a woman

aged thirty-four, and cleared out the axilla. According tomy usual practice, the operation was performed without anyantiseptic. The wound was immed iatelycovered with thy molgauze, which I prefer on account of its absorbent property ;over this was placed a thick pad of absorbent wool (VonBruns’ Red Cross), and these dressings were kept in place bya many-tailed bandage of eucalyptol gauze-a method whichI would commend to the notice of surgeons instead of theold-fashioned plaster and roller bandage. The left bare armlay on the chest in contact with the gauze. On the followingday, corresponding exactly with Sir Joseph Lister’s case, thearm was intensely irritated, and the limits were those ofdirect and close contact with the gauze. So great was theirritation that near the wrist the vesicles coalesced, and inthe course of another day alone formed a blister as large asa half-crown piece. After the second day, of course, theskin was protected from the gauze. On the skin of the bodythere was very little effect produced, probably on account

of its greater power of resistance. The wound, which,with one-half of the chest, was protected by the thymolgauze and wool, healed by first intention and without ablush, as I am accustomed to see it ; the tube, on its removalon the fifth day for the purpose of clearing and shortening,contained a beautiful specimen of organised blood-clot, whichis now before me, and the patient went home quite well onthe fifteenth day.

Here, then, there could be no doubt as to the cause of theirritation, and I would suggest that the same cause operatedin the case in question, rather than that the sublimateshould have passed through the "abundant eucalyptusdressing," which was put on outside the sublimate gauze.

I am, Sir, yours faithfully, -

GEO. GRANVILLE BANTOCK.Uranville-place, W., Uct. 28th, 1884.

THE COLLEGE OF SURGEONS EXAMINATIONS.To the Editor of THE LANCET.

SIR,-At a time when there is a probability of the coali-tion of the Colleges of Physicians and Surgeons it may beopportune to express the views of a teacher on what he con-siders the unsatisfactory results of the College of Surgeonsexamination. It has become a trite saying amongst students"that there is no disgrace attending a rejection by theCollege of Surgeons, since the examination is of such a flukycharacter. " I put this in the words of one who had recentlyobtained his membership, and I believe it echoes the senti-ments of a considerable number of teachers as well as students.I speak as a teacher when I say that I think theCollege of Surgeons examination is a most unfair one,for I am perfectly certain that it often rejects verygood men, whilst inferior ones are occasionally allowedto pass. At present it is impossible for any teacherto send up his pupils with confidence; for he feels that it isalmost as likely that the better men will be referred and theworse accepted, as that the weak student will be rejectedand the good one pass. To the London student this mayperhaps be no very great hardship, for if there be no greatloss of prestige he has not been put to much expense, andpossibly no one knows that he has been in for an examina-tion ; but to the provincial student no little inconvenienceensues, for the necessity of a several days’ absence inLondon compels him to acquaint his friends and puts him toa considerable amount of expense ; thus to the financialloss is added the multiplication of friendly condolence. Ifthe rejections were just I should be the last to protestagainst them, but I am convinced that many referred candi-dates are extremely well up in their work, and have beenrejected from simple nervousness, the time allowed beingtoo short and the examiners too hasty to elicit the know-ledge, which though present is incapable of being roughlyextracted. To mention a few examples :-Of two students, one, rejected several times for his

primary, and again for his final, advised by his teachers notto go for examination, proceeds to London with a gentlemanwho had passed his primary creditably, had done well at theschool, had acted as resident assistant house-surgeon for ayear, where he was highly appreciated for his good work andwas advised by his teachers to enter his name for the final.Result : the former passed, the latter was referred, and,strange to say, only in the subject which it was well-knownhe knew best-viz., surgery. A medalist in all the subjectsof examination was referred for six months. The medalistof the year in anatomy and physiology, but a reticent, some-what shy man, was rejected ; whereas several, whom he washead and shoulders above in knowledge of the subjects,passed. A qualified practitioner, welt acquainted with hiswork and known by his teachers to be extremely well up,was rejected because be could not recognise a pathologicalspecimen, and so by losing the greater part of the tenminutes allotted for this section, getting a bad mark andspoiling an otherwise good examination. An excellentstudent, as proved by school and clinical examinations, wasrejected, and yet very shortly afterwards was able toobtain his final M.B. at one of the universities. Wereit necessary, the above lit could be increased, but Ithink these cases are sufficient to show that there issome ground for complaint. Where does the fault lie1. With the hunied character of the examination-e.g.,ten minutes for pathology, which time is utterly inade-