1340 ARMY FIELD HOSPITALS IN WAR.—BIRMINGHAM.

were dressed antiseptically. Some urine escaped from thewound, but caused no appreciable irritation. Three daysafter the operation urine was passed naturally per urethram,rendering the catheter unnecessary. None appeared sub-

quently at the wound. The abdominal incision was com-pletely healed in three weeks. The temperature rose slightlyafter the operation and was never high.

I am. Sirs. vours trulv.HERBERT W. G. MACLEOD, M.B., M.C. Edin.,

Surgeon-Captain, late H.M. Bengal Army.Victoria-square, Clifton, Bristol, May 29th, 1893.

ARMY FIELD HOSPITALS IN WAR.To the Editors of THE LANCET.

SIRS,-Your sympathetic article in THE LANCET of the20th inst. about the Army Medical Service has given muchsatisfaction. I beg to point out that the deputation whichaddressed the War Minister seems to me to have omitted some

important matter. They made no reference to our utter

ignorance of our field hospital equipment and working. Thesehospitals are packed away in the arsenals, are never mobilisedexcept on the outbreak of war, and we know nothing of theirgood or bad points. The artillery batteries exist in peace, theengineer companies do the same, and the Army Service Corpssimply expand their peace companies when war occurs. Wehave to begin ab initio with strange officers, strange men,strange equipment and strange transport. How can we helpbut fail ? Neither gods nor men can succeed under such con-ditions. I have myself been hurried into the field and underfire with such scratch organisations, and I can never cease toprotest against this "organisation of failure." All classesof society to whom the matter is explained are shocked atthis condition of affairs and still we seem paralysed in carry-ing out the idea of a field hospital as ready for war as a fieldbattery. With such hospitals at Aldershot, Woolwich, Ports-mouth, Dublin and the Curragh how efficient we mightbecome. If you can realise this hope for us you will do areal good to our service.

There is another burning point that needs discussion. Imean the increasing, never-ending changing of the PrincipalMedical Officer in districts in England. Anything to equalit does not exist in the army, and the Principal MedicalOfficers are practically non-existent. They come and theygo, and where can efficiency be? ? The remainder of the

military staff of a district stay for five years certain. Ourchiefs are ever on the run to far-away colonies or Indiangarrisons, and the home efficiency of the department is in

jeopardy. It is monstrous to allow the Netley PrincipalMedical Officer to change every few months. We can

hold no one responsible for the place, we can blame noone, praise no one, and do not know who is chief there, asperpetual change is the rule. The Sandhurst Governor staysseven years, the Woolwich Academy Governor does the same ;likewise the Staff College Chief remains seven years. At

Netley, where our young men are trained, an unceasing flowand ebb of Principal Medical Officers recur, and we do notknow who controls the place or sees into the thoroughnessof the teaching and the work. We seem ignorant of thefirst principle of administration, which is well-defired andlocalised and means personal responsibility of one man forone place or duty. Indian pay, Indian service and all therest of it are valueless if the very foundations of our

training and administrative teaching are being underminedby change, change, and never-ending change. The Director-General, who seems to be also Inspector-General of Hospitalsin England, is busied with a mass of detail in London, butshould he not be constantly on the move inspecting thedistricts ? If he would decentralise the overburdened Londonoffice and throw on the districts pait of the work that over-weights the head-quarter offices, then he could see his depart-ment and know its working. None of these points werebrought to notice by the recent deputation. I beg you wilfnot ignore them. They lie deep down at the foundation olour efficiency, be it as Corps or Department.

I am, Sirs, yours truly,May 23rd, 1893. N. D. F.

″THE MISTRAL AND THE RIVIERA."To the Editors of THE LANCET.

SIRS,—In THE LANCET of May 27th the reviewer of

Dr. Linn’s "Health Resorts of Europe" takes objection tothe author’s optimist view of the mistral and as a clenching’

argumentasks him whether henever heard of the old Provencalditty "-

" Le Parlement. le mistral et la DuranceSont les trois fléaux de la Provence."

But in what this I I ditty applies to the Riviera I am unableto see. Neither Cannes nor Nice formed part of "ProvençalParlement " ; even in prehistoric times the Durance couldnever have damaged the Riviera; and the mistral, although itdoes occasionally blow on this coast, is not the fléau whichis connected with Provence. From Oct. Ist, 1892, to

May 28th, 1893-i.e., during eight months-we have hadfive days only during which the mistral has been at all felt.To call this a fléau is to use a very big word for a very smallthing. Doubtless during that period in the old "Provence"it may have blown for many days and with great violence,but we are, fortunately, separated from the wind-sweptregion of Provence by several mountain ranges, and it is butcomparatively seldom that the mistral reaches the Rivieraitself. T am- Sirs vnnrs t,rnlv-

Cannes, May 28th, 1S93. H. BLANC, M.D., F.R.C.P.

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

The Health of the City.THE report of the medical officer of health, Dr. Hill, is

elaborate and instructive. It is evidently compiled with muchcare and the special report as to the large infant mortality i’:suggestive. There is no doubt that the high situation of

Birmingham and the amount of breathing space it possessescontribute largely to the low death-rate in comparison withother great towns. It was 20 per 1000 in 1892, which, it mustbe admitted was very moderate. When the infant mortalityof this town is reviewed it will be seen that Birmingham sharesthe discredit attaching to the majority of large towns in

respect of the large proportion of deaths at this earlyage. 169 per 1000 born is a lamentable ratio. The fre-

quent want of adequate protection and general care, with

injudicious feeding, is mainly responsible and still leavesmuch to be desired. In spite of philanthropic efforts and theattempts to spread an intelligent knowledge on these subjectsthere is still a huge amount of ignorance and indifference tobe overcome before the mortality can be lessened.

Cruelty to Children.As bearing upon the preceding remarks there has lately

been some activity shown by the Society for the PreveL-tion of Cruelty to Children in prosecutions directed againstparents for neglect of the commonest instincts of humanitv.In one instance a man and his wife were sent to gaol fura month for neglecting their children in 1892. This hada good effect on the husband, but the wife was latelycharged again with the same offence and was committed togaol for a period of two months. It is difficult to predict thefuture of children brought up, or rather allowed to exi6r,under such unfavourable conditions. The State suSer.’,whilst the benevolent public take the responsibility of pru-secuting the parents and protecting the children.

Prevalenee of Small-pox and Scarlet Fever.The number of cases of small-pox still increases. At pre.

sent there are 109 cases of small-pox and 236 cases of scar1ttfever under treatment in the City Hospital. Medical officersof health in outlying districts are on the alert, and, in spiteof all precautions, express their apprehension that there willbe a considerable addition as time goes on.

Medical Benevolent Society.The annual meeting of this Birmingham society was held

on the 26th inst. under the presidency of Mr. Garner. The

report, which was very satisfactory, showed that the investedfunds amount to 11,736, and that there was a balanceof 148 at the bank. The number of assistants is fifteen.The society numbers 3SO members-a smaller number thanthere should be in proportion to the profession in the di,-trict. Various votes of thanks were passed and Dr. Wyer ofLeamington was elected president for the ensuing year.

Singular Stabbing Cases.The residents of the suburbs have been very much exercised

in their minds by the presence at large of a supposed lunatic.t whose sudden appearance here has created much alarm andsome injury. Pouncing unexpectedly upon passing ladies he

1341NORTHERN COUNTIES NOTES.-SCOTLAND.-IRELAND.

has struck them with a large pin similar to those used by ladiesin fastening their hats and has as rapidly disappeared.So far he has eluded pursuit, but the terror of several personsattacked at various times has given rise to much sensation.The police are actively engaged in the endeavour to arrestthe individual and to allay the excitement caused by thissingular mode of attack. May 29th.

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NORTHERN COUNTIES NOTES.(FROM OUR OWN CORRESPONDENT.)

The White Lead Commission. THE Commission which was appointed by the Home J

Secretary to inquire into the white lead industry and which ]has been sitting in our city to take evidence, is at present inGlasgow, from whence it will proceed to Sheffield and Hull.The commission is composed of Mr. Henderson as chairman,Messrs. Camson and Gould, factory inspectors, Dr. Dupre andDr. Oliver of Newcastle, as chemical and medical experts re-spectively, whilst Mr. J. H. Tennent of the Home Office is

secretary. The work undertaken by this commission will beextensive and the inquiry exhaustive, and it is to be hoped thatits investigations will tend to diminish the dangerous natureof this occupation.

-Durham Mini-2ig District.The report of Mr. Thomas Bell, H.M.’s Inspector of Mines

for the Durham district, has been issued. He characterisesthe history of the coal trade in the county of Durham for1892 as being one of strikes, disaster and disappointment ;and he shows that the amount of coal raised in 1892 wasseveral millions of tons less than it was in 1891. At the same time, the Durham district shows a decrease of 1987 persons employed in and about the mines. The report mentions lthe establishment by the Marchioness of Londonderry ofan excellent nursing association at the Seaham and othercollieries of the Marquis of Londonderry. The object of theassociation is to provide a body of trained and skilled nursesto nurse the sick and those who may receive any accident attheir homes and to raise the standard of nursing by all meansin their power.

The Epidemic of Measles at Brampton.The epidemic of measles at Brampton, near Carlisle, is

reported as being very serious ; during the last week ninedeaths have been reported. The mortality is principallyamongst children of from two to five years of age. There is

hardly a house in the town, where there are children, whichhas escaped.

The Water-supply of Penrith.The Penrith local board, which’,for some time has been

considering the water-supply of the town and has taken stepsto procure an adequate supply, has lately received longreports from Mr. G. F. Deacon, the engineer, and Dr. Steven-son, analyst. The reports are most favourable. Dr. Stevensonspeaks of some of the available sources for Penrith as

possessing the highest degree of purity. The engineer saysthat one of the streams alone if tapped 1000 feet above thesea level would be more than abundant for Penrith in thelongest recorded droughts without help, and if tapped highup it would rarely affect the apparent volume of the streambelow.

Ambulance TVor7z in the North.Mr. C. Clark Burman of Alnwick, as gratuitous instructing

surgeon of the railway employés at Alnmouth, at a publicmeeting held there, has received their thanks and a pre-sentation.

Newcastle.on-Tyne, May 31st.

SCOTLAND.(FROM OUR OWN CORRESPONDENT.)

Tlte Lord High Commissioner at the Hospitals.HER MAJESTY’S representative at the General Assembly of

the Church of Scotland this year has been the Marquis ofBreadalbane. He and the Marchioness have, as is usual, paidState visits to the various hospitals and other philanthropicinstitutions-the Royal Infirmary, the Royal Hospital for

Sick Children, the Hospital for Incurables, the Corstorphineand the City convalescent hospitals being amongst thosevisited.

Royal British Nurses’ Association.An inaugural meeting of the Scottish national branch of

this association is to be held in Edinburgh on June lst,at which it is expected Her Royal Highness PrincessChristian will preside. The scope and aims of this associa-tion have not been made sufficiently known to the medicalmen of the city to ensure their hearty cooperation, neitherhas it been made sufficiently clear that the Scottish branchis to have that complete and satisfactory autonomy whichthe bulk of the profession consider absolutely essentialto their cordial participation in the scheme. It is hopedthat this unwise negligence on the part of those responsiblefor the arrangements may be efficiently counteracted byprompt action now.May 31st.

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IRELAND.(FROM OUR OWN CORRESPONDENT.)

Royal College of Surgeons.SiR CHARLES CAMERON will be opposed for the secretary-

ship of the College by Mr. Wheeler. For the Council thereare twenty-six candidates for nineteen vacancies. The fol-

lowing are the candidates who were not members of the out-going Council : Mr. J. K. Barton, surgeon to the AdelaideHospital ; Mr. Swan, surgeon to the Orthopaedic Hospital ;Mr. Montgomery Ward, surgeon to Mercer’s Hospital; Dr. R.Purefoy ; Dr. John Cranny; Mr. Coppinger, surgeon to theMater Misericordiæ Hospital ; Mr. E. Thompson, surgeon tothe Tyrone Infirmary ; and Mr. John Lentaigne, surgeon to theMater Misericordise Hospital. The elections will be held onMonday, the 5th inst.

Smail-pox.The question as to the possibility of this disease invading

Dublin has for some time past exercised the attention of thePublic Health Committee. Sir C. Cameron, Medical Super-intendent Officer of Health, and Mr. Stafford, Inspector to theLocal Government Board, have had consultations as to thedesirability of issuing a circular advising re-vaccination anddirecting attention to the necessity of vaccination, but havearrived at the conclusion that the Local Government Boardshould issue a general circular to all the sanitary authorities onthe subject. The council of the Dublin Sanitary Associationhave adopted the following resolution : "That, having regardto the fact that small-pox at present prevails in several

English towns, some of which are in daily communication withDublin, this council are of opinion that it is desirable thatthe public in Dublin should be warned of the danger to whichthey are liable and that measures be taken to issue a noticefor this purpose."

Examiozersfor the Army Medical S’ervice.The Provost and Senior Fellows of the University of Dublin

have adopted the following memorial to the Secretary of Statefor War: "We, the Provost and Senior Fellows of TrinityCollege, Dublin, desire to offer the following remarks on theconstitution of the proposed new Court of Examiners for theArmy Medical Service. We recognise fully the high qualifi-cations of such London physicians and surgeons as may beappointed examiners under the new system, but are of opinionthat equally qualified physicians and surgeons from importantmedical centres such as Dublin and Edinburgh are entitled tobe appointed quite as well as their London colleagues. Weare of opinion that a full inquiry would show that a majorityof the army surgeons are, and have always been, educated inthe Dublin and Edinburgh Medical Schools, and that it wouldbe unfair to exclude the physicians and surgeons of Dublinand Edinburgh from the office of examiners of candidates forthe Army Medical Service..,

, Healt7t of Dublin for April.i

As compared with March there was a diminution by nearlyone-half of the number of fatal cases of typhoid fever, but

there were slight increases in the mortality from scarlet fever,whooping-cough and diarrhcea. The unusually warm weatherwhich prevailed during the whole month reached most favour-ably upon the public health. The death-rate was 3 .17 per 1COObelow the mean rate for the corresponding period in theprevious ten years.May 30th.