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appears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 6-4 per 1000 ofthe population, estimated at 4,613,812 persons in themiddle of the year. In each of the two preceding monthsthe rate had been 6’0 per 1000. The rates were con-

siderably below the average in Hammersmith, Chelsea,Hampstead, Stoke Newington, Southwark, and Camberwell,while they showed the largest excess in Hackney, the

Clty of London, Bethnal Green, Poplar, Bermondsey,and Deptford. The prevalence of small-pox during Julyshowed but little variation from that recorded in the

preceding month; of the 55 cases notified last month,20 belonged to the City of Westminster, ten to St.Pancras, seven to Wandsworth, five to Lambeth, five to

Camberwell, and three to Islington. The MetropolitanAsylums hospitals contained 66 small-pox patients at theend of last month, against 47, 60, and 57 at the end ofthe three preceding months; the weekly admissionsaveraged 15, against 12, 13, and 12 in the three pre-ceding months. Scarlet fever was slightly more prevalentlast month than it had been during June; among thevarious metropolitan boroughs the greatest proportionalprevalence of this disease occurred in Paddington, Holborn,Finsbury, Bethnal Green, Poplar, Deptford, and Woolwich.The number of scarlet fever patients in the MetropolitanAsylums hospitals, which had been 1685, 1738, and 1614 atthe end of the three preceding months, had risen againto 1697 at the end of last month ; the weekly admissionsaveraged 236, against 201, 226, and 195 in the three

preceding months. The prevalence of diphtheria was

considerably in excess of that recorded in the precedingmonth ; this disease was proportionally most prevalent inHackney, the City of London, Poplar, Bermondsey, Deptford,and Lewisham. There were 840 cases of diphtheria undertreatment in the Metropolitan Asylums hospitals at the endof last month, against 760, 808, and 781 at the end ofthe three preceding months ; the weekly admissions averaged130, against 105, 120, and 119 in the three preceding months.The prevalence of enteric fever showed a further increaseupon that recorded in recent months ; the greatest pro-portional prevalence of this disease occurred in Fulham,Hackney, the City of London, Shoreditch, Poplar, andBattersea. The number of enteric fever patients undertreatment in the Metropolitan Asylums hospitals, which hadbeen 53, 51, and 88 at the end of the three preceding months,had further risen to 119 at the end of last month ; the

weekly admissions averaged 18, against five, ten, and 17 inthe three preceding months. Erysipelas was proportionallymost prevalent in Kensington, Hackney, Holborn, Shore-ditch, Bethnal Green, Poplar, Bermondsey, and Deptford.The 17 cases of puerperal fever notified during the monthincluded two each in Islington, Hackney, Finsbury,Southwark, and Woolwich.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various boroughs, thedeaths occurring in public institutions having been dis-tributed among the various boroughs in which the deceasedpersons had previously resided. During the four weeks

ending August 1st the deaths of 4424 persons belongingto London were registered ; these deaths were equal to anannual rate of 12-5 per 1000, against 15-8, 14-2, and 12-9 9per 1000 respectively in the three preceding months. Thelowest death-rates in London last month were 7-0 inStoke Newington, 7-2 in Hampstead, 9-3 in Lewisham,9-4 in Wandsworth, 10’5 5 in Hackney, 10.7 7 in Camberwell,and 10’8 8 in Padding ton ; the highest death-rates were

14-5 in Southwark, 15-7 in Stepney, 16’2 in Bermondsey,16’7 7 in Bethnal Green, 18-3 in Finsbury, and 18 9 inShoreditch. The 4424 deaths from all causes included510 which were referred to the principal infectiousdiseases; of these, 112 resulted from measles, 34 fromscarlet fever, 48 from diphtheria, 85 from whooping-cough, 22 from enteric fever, and 209 from diarrhoea,but not one from small-pox, from typhus fever, or from anyill-defined form of continued fever. The lowest death-rateslast month from these infectious diseases were recorded inPaddington, Chelsea, Hampstead, Holborn, Lewisham, andWoolwich; and the highest rates in Fulham, Finsbury,Shoreditch, Bethnal Green, Stepney, Bermondsey, and

Deptford. The 112 deaths from measles were 88 below thecorrected average number ; among the various metropolitanboroughs this disease was proportionally most fatal in theCity of Westminster, St. Pancras, Finsbury, Shoreditch,

Bethnal Green, and Battersea. The 34 fatal cases ofscarlet fever showed a decline of 29 from the averagenumber in the corresponding periods of the ten precedingyears ; the greatest proportional mortality from this diseaseoccurred in St. Marylebone, Bermondsey, Deptford, Green-wich, and Lewisham. The 48 deaths from diphtheria wereless than one-third of the corrected average number ; amongthe various metropolitan boroughs this disease was propor-tionally most fatal in Kensington, Poplar, Bermondsey,Wandsworth, and Deptford. The 85 fatal cases of whooping-cough showed a decline of 73 from the average number inthe corresponding periods of the ten preceding years ; thegreatest proportional mortality from this disease occurred inHackney, Finsbury, Bethnal Green, Stepney, Battersea, andGreenwich. The 22 deaths referred to " fever" were 15below the corrected average number; of these 22 deaths,three belonged to Islington, three to Hackney, two to

Fulham, two to Poplar, and two to Camberwell. The209 fatal cases of diarrhoea were over 500 fewer than theaverage ; among the various metropolitan boroughs thehighest death-rates from diarrhoea were recorded in Ham-mersmith, Fulham, Shoreditch, Bethnal Green, and Ber-mondsey. In conclusion, it may be stated that theaggregate mortality in London last month from these prin-cipal infectious diseases was nearly 61 per cent. below theaverage.

Infant mortality in London during July, measured by theproportion of deaths among children under one year of ageto registered births, was equal to 103 per 1000. The lowestrates of infant mortality were recorded in Hampstead,Holborn, Battersea, Wandsworth, Lewisham, and Woolwich,and the highest rates in the City of Westminster, Shore-ditch, Bethnal Green, Stepney, Bermondsey, and Deptford.

THE SERVICES.

ROYAL ARMY MEDICAL CORPS.THE temporary rank of Captain in the Army granted to

temporary Lieutenant M. Taylor is dated July 2nd, 1902.Captain C. T. Samman joins at Woolwich for temporary

duty. Captain H. V. Prynne is ordered to join at Woolwichfor duty. Captain F. J. C. Heffernan proceeds to Londonfor a course of study at the Royal Army Medical College.Lieutenant-Colonel H. J. McLaughlin, D.S.O., retired pay,has arrived at York for duty as Recruiting Medical Officer atBradford.

IMPERIAL YEOMANRY.Scottish Horse : William Stewart Gray Kidd, late Sur-

geon-Captain, lst Scottish Horse, to be Captain. DatedMarch 30th, 1903. Surgeon-Captain John Anderson, from5th (Perthshire Highland) Volunteer Battalion the BlackWatch (Royal Highlanders), to be Lieutenant. DatedMarch 30th, 1903. James Anderson Taylor to be Surgeon-Lieutenant. Dated March 30th, 1903.

VOLUNTEER CORPS.

Royal Garrison Artillery (Volunteers): : lst N orthumber.land : Surgeon-Lieutenant R. A. Nesham to be Surgeon-Captain. Dated August 8th, 1903.Rifle 1st Volunteer Battalion the King’s Own (Royal

Lancaster Regiment) : Surgeon-Lieutenant R. J. Morris tobe Surgeon-Captain. Dated August 8th, 1903. 4th Volun-teer Battalion the King’s (Liverpool Regiment) : Surgeon-Lieutenant R. Fielding-Ould to be Surgeon-Captain. DatedAugust 8th, 1903. lst Volunteer Battalion the DorsetshireRegiment: Surgeon-Captain W. G. Brett resigns his com-mission. Dated August 8th, 1903.

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).The Glasgow Companies : The undermentioned Captains

to be Majors : J. McGregor Robertson (dated August 8th,1903) and A. Moyes (dated August 8th, 1903).

VOLUNTEER OFFICERS’ DECORATION.The King has conferred the Volunteer Officers’ Decoration

upon the undermentioned officers of the Volunteer Force :-North-Eastern District : Artillery: lst Newcastle-upon-TyneRoyal Garrison Artillery (Volunteers) : Surgeon-Lieutenant-Colonel Arthur Taylor Wear. Rifle: 2nd Volunteer Battalionthe Sherwood Foresters (Nottinghamshire and DerbyshireRegiment) : Surgeon-Major William Sandham Symes andSurgeon-Captain William Moxon. lst (Hallamshire) Volun-teer Battalion the York and Lancaster Regiment: Surgeon-Lieutenant-Colonel John Wise Martin. North-Western

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District : Rifle : 2nd Volunteer Battalion the LancashireFusiliers : Surgeon-Major William Pooley.

THE ROYAL ARMY MEDICAL CORPS EXAMINATION.The entry for the Royal Army Medical Corps at the

late examination has been a singularly good one, 72men having applied in the first instance to competefor 30 vacancies, as has already been announced inTHE LANCET. Among the competitors were many men whohad distinguished themselves at their respective medicalschools, Guy’s Hospital bearing off the palm with five menout of the first ten of the successful candidates. The namesare as follows :-A. C. H. Gray, M. B. Lond. ; D. P.

Watson, M.A., M.B., D.P.H. Cantab. ; T. S. Dudding ;C. H. Robertson, M.B. Lond. ; F. M. M. Ommaney ; J. S.

Powell; R. H. MacNicol, M.B., B.Ch. Dub. ; O. Ievers,M.B. Lond. ; D. D. Paton, M.B., B.Ch. Edin. ; S. L.

Pallant; C. R. Bradley; H. H. J. Fawcett, B.A. Cantab ;T. J. Wright; G. A. Kempthorne, B.A. Cantab. ; J. S.MacEntire, M.A., M.B., B.Ch. Dub. ; S. E. Lewis, M B.,B. Ch. Glasg. ; N. D’E. Harvey, M. B. R. U.I. ; J. A.

Longley, M.B, B.Ch. Vict.; N. S. Dunkerton; P. J.Hanafin, D.P.H. Irel. ; A. C. Osburn ; M. C. Wetherell,M.B., B.S. Durh. ; R. T. Oollins ; W. MacD. MacDowall;F. J. Turner; H. C. Hildreth, F.R.C.S. Edin. ; G. S.Mackay, M.B., B.Ch. Edin. ; J. D. Richmond, M.B., B Ch.Glasg.; F. M. G. Tulloch ; and E. M. Glanvill, M.B.,B. Ch. Edin. It is to be hoped that this service is at lastattracting the attention it deserves and that the prospects ofprofessional advancement which it now offers may prove acontinued attraction to a thoroughly good class of youngmedical men in the future as in the present instance.

INDIAN MEDICAL SERVICE EXAMINATION.

The following is a list of the candidates for His Majesty’sIndian Medical Service who were successful at the com-

petitive examination held in London on August 3rd, 1903,and following days. Forty-one candidates, of whom 23had University degrees, competed for 16 appointments ; 29were reported qualified :—

THE ROYAL NAVAL HOSPITAL, STONEHOUSE.Sir Henry F. Norbury, K.C.B., Director-General of the

Royal Naval Medical Department, paid his annual visit ofinspection to the Royal Naval Hospital, Stonehouse, on

August 4th, 5th, and 6th. He was accompanied by threemembers of the medical board and was received at the hos-pital by Inspector-General T. Bolster, R.N. The party werealso accompanied by Deputy Inspector-General T. D.

Gimlette, R. N., and Deputy Inspector-General R. Bentham,R.N. Sir Henry Norbury concluded his visit by the inspec-ction of the sick quarters of the Royal Naval Barracks,Devonport, and the Royal Marine Infirmary, Stonehouse, andsubsequently held a levee of the medical officers connectedwith the hospital.

Correspondence.

THE TREATMENT OF GOITRE BY DIS-TILLED OR RAIN WATER.

10 the Editors of THE LANCET.

SIRS,-In the paper of which I made mention in mylast letter I have collected nearly all the known factsabout the production of goitre and a short résumé may beuseful in connexion with Dr. C. A. Rayne’s letter inTHE LANCET of August 8th, p. 424. The goitrous poisonis born of the soil and the soil only. It is absent fromrain water. Pliny says, "Tales sunt aquae quales terræper quas flunnt." St. Lager relates that the youths of acertain township in France in order to escape military servicedrank copiously for several months before the arrival of the

recruiting authorities from a well the waters of which werenotoriously goitrigenous. Their thyroid glands rapidlyenlarged and by this means they escaped service. Lombrosorelates a similar instance occurring in Lombardy where theformation of goitre was even more rapid : "La fonte delgozzo ove soglione andare i giovani all’ epoca dellacoscrizione onde acquistare in quindici giorni quel diffettoche li sostrae dal servizio."The hardness or otherwise of a water has nothing to do

with its goitre-producing faculties. Some of the softestwaters are the most goitrigenous. One poisonous water Iam acquainted with contains only 0’ 5 of a grain per gallonof calcium carbonate. No calcium or magnesium salts inwater cause goitre nor does the absence of chloride of sodium(a reputed cure). The two theories most in vogue at

present are : (1) the bacillary theory of the Italian physiciansLustig and Carle and (2) what I may call the metallic-saltstheory advocated by St. Lager in his two series of " etudessur les Causes du Ci6tinisme et du Goitre End6mique and thesalts which he chiefly makes reference to are the sulphidesof iron and copper (iron and copper pyrites). I have nottime to go into the pros and cons of these two theories. Ishall content myself with saying that the iron theory hasmuch to be said in its favour. The flushing action of aniron-containing water on a loosely connected gland like thethyroid must be considerable. I have found evidence ofiron in many goitrigenous waters, but not invariably, nor is itlikely to be present in every sample of water examined. In

proof of this iron theory it is a curious fact that in verynumerous instances the water coming in contact with

pyritous marls is highly goitrigenous. In England theblue marls of the Gault and Wealden undoubtedly producegoitrigenous water. In France the marls corresponding tothe above, the "marnes aptiennes" and the "marnesnéocomiennes inferieures," are equally dangerous. Boththese formations in France contain a superabundanceof iron bisulphide and the blue colour of the Englishmarls is, of course, due to disseminated iron pyrites.Goitre is found sometimes on the chalk and chalk-marlin England. We know that calcium carbonate does not

produce goitre. What, then, is the cause of the diseasein this case ? So far as I am aware the only acci-dental minerals found in these formations are disseminatedlime phosphate, glauconite (a hydrous silicate of iron and

magnesia) and curiously enough marcasite, which is a veryreadily decomposable form of iron bisulphide. I could quotenumerous instances of the same kind in support of thistheory. It may be that some subtle combination of organicmatter with the decomposing sulphides may be the truecause of goitre, but much work remains still to be done onthis question. Dr. Rayne will find a mine of information onendemic goitre in the works of St. Lager, which, I think, areamong the ablest ever penned by a physician. Herein, too,are related many instances of goitres cured by the imbibitionof rain water, showing that Dr. Rayne’s idea that this was anew method of treatment is not founded on fact, as it hashappened in numerous instances in the history of medicineand is now a matter of fairly ancient knowledge. Apologisingfor the length of this letter,

I am, Sirs, yours faithfully,LOUIS E. STEVENSON, M.B., B.C. Cantab., F.G.S.

Temple Sowerby, Penrith, August 9th, 1903.

MEDICAL DOCTRINES OF HEREDITY.To the Editors of THE LANCET.

’ SIRS,-It is interesting and instructive to find thetraditional conflict between the advocates of vitalism andnaturalism making its periodical appearance; interestingalso, perhaps, to see the vitalist school relinquish none ofits ancient ardour or infallibility, and certainly interesting,in particular, to discover no allusion to Professor Weismannby those who so strenuously support his views. Thisomission on the part of Dr. G. Archdall Reid and Dr.C. R. Niven is unkind, to say the least of it. I confessthat I cannot quite understand, however, why this dis-cussion has been reopened, for neither Dr. Reid nor

Dr. Niven, in the course of reasoning which leaves the

impression of being more subtle than lucid, seems tohave advanced anything particularly new. When I took

up THE LANCET this morning and found that a corre-

spondence was being carried on in its columns on the medicaldoctrines of heredity I thought that I would at least come