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which are only admitted in exceptional cases.

Diphtheria, the enteric fevers, the dysenteries, andthe acute infections of the central nervous systemshould always be taken. Provided that nurses are

properly trained, the danger of cross-infection isnot serious in these diseases, with the exception ofdiphtheria, so that there is little need for reconstruc-tion of wards to provide for their accommodation.Puerperal fever should be admitted if there are smallwards suitable for the purpose, for few maternityhospitals and homes are properly constructed andequipped for controlling the spread of infection.The problem of measles, whooping-cough, and

pneumonia is more difficult. Their waves are high,short-lived, and relatively infrequent. Measles and

whooping-cough often fall on alternate years, thussomewhat smoothing out the irregularities of hospitalstrain, but pneumonia is apt to coincide with both.Moreover, structural facilities for the segregation ofbroncho-pneumonic cases of measles and whooping-cough are desirable, and more opportunity for open-airtreatment should be afforded than the old-fashionedtype of fever hospital provides. As the financialposition gets easier, councils will probably turn theirminds to new hospital provision or the enlargementof old, and the requirements of these diseases shouldbe kept in mind. Greater elasticity and a higherstandard of efficiency can be attained by erectingbigger hospitals to serve areas greater than thoseof many sanitary districts, and far more provisionshould be made for segregration of cases and open-airtreatment than has been made in the past. Thereis little reason, indeed, why the fever hospital shouldnot cease to exist as such, being replaced by a unitforming an essential part of-not a mere annexe to-a general hospital. If special small-pox hospitalsmust be provided to serve large areas they should beproperly constructed, not temporary shacks, so thatthey may be available for other diseases in the longperiods when small-pox is not epidemic. In themeantime, a change of attitude toward the admissionof scarlet fever on the one hand and the more fatalinfections on the other, would give authorities theexperience necessary to determine the type ofaccommodation they will require in the future.

INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

FEB. 24TH, 1934

VoM/tcoMWS.—The following cases of infectiousdisease were notified during the week : Small-pox, 23(last week, 20) ; scarlet fever, 3075 (last week, 3336) ;diphtheria,, 1296 ; enteric fever, 23 ; acute pneumonia(primary or influenzal), 1750 ; puerperal fever, 40 ;puerperal pyrexia, 133 ; cerebro-spinal fever, 31 ;acute poliomyelitis, 6 ; acute polio-encephalitis, 3 ;encephalitis lethargica, 15 ; dysentery, 15 ; oph-thalmia neonatorum, 97. No case of cholera, plague,or typhus fever was notified during the week.The number of cases in the Infectious Hospitals of the London

County Council on Feb. 27th-28th was as follows - Small-pox,31 under treatment, 1 under observation (last week 34 altogether);scarlet fever, 1820 ; diphtheria, 1934 : enteric fever, 7 ; measles,2414 (last week 2143) ; whooping-cough, 370 ; puerperal fever,24 mothers (plus 3 babies) ; encephalitis lethargica, 259 ;poliomyelitis, 6 : " other diseases," 142. At St. Margaret’sHospital there were 18 babies (plus 5 mothers) with ophthalmianeonatorum.

Deaths.-In 118 great towns, including London,there were 2 (1) deaths from small-pox, 2 (0) fromenteric fever, 119 (35) from measles, 10 (4) fromscarlet fever, 39 (15) from whooping-cough, 47 (6)from diphtheria, 38 (14) from diarrhoea and enteritisunder two years, and 85 (24) from influenza. Thefigures in parentheses are those for London itself.The deaths from influenza included 5 in Birmingham, but no

more than 2 in any other town. There were 13 fatal cases ofmeasles in Liverpool (last week 11), 10 in Manchester (last week

12), 9 in Middlesbrough, 6 in Leeds, and 5 in Preston. Diphtheriacaused 6 deaths in Birmingham and 4 in Leeds. Five of thedeaths from diarrhoea and enteritis were reported fromBirmingham.The number of stillbirths notified during the week was277 (corresponding to a rate of 42 per 1000 totalbirths), including 52 in London.

DEATH FROM :4IALL-POg.-Tlle fatal case of small-pox in London mentioned in the above return wasthat of a male, aged 16 years and 11 months, admittedto the Long Reach Hospital on Feb. 14th, who diedthere on the l8th. Sir Frederick Menzies, the medicalofficer of health, tells us that the attack was a severeone of the mild type. The rash appeared on theSth, but on the evening of the 16th symptoms ofnervous disease set in, and death was due to encephalo-myelitis. The patient had never been vaccinated.

THE SERVICESROYAL NAVAL MEDICAL SERVICE

Surg. Comdr. (retd.) R. J. G. Parnell to be Surg. Capt.(retd.).

D. W. Walker to be Surg. Lt.Surg. Capt. A. G. V. French is placed on the retd. list.The following appointments are notified : Surg. Lt.-

Comdrs. : R. L. G. Proctor to Calcutta; E. V. Barnes toNeptune; M. B. Devane to Victory, for R.N.B.; P. J. A.The O’Rourke and R. R. Baker to Pembroke, for R.N.B. ;W. Flynn to Durban; and R. R. Baker to Titania.

ARMY MEDICAL SERVICESLt.-Col. J. St. A. Maughan, from R.A.M.C., to be Col.

ROYAL ARMY MEDICAL CORPSLt.-Col. H. T. Wilson, having attained the age for

retirement, is placed on retd. pay.Maj. and Bt. Lt.-Cols. R. C. Priest and P. S. Tomlinson

to be Lt.-Cols.

Capt. S. M. Burrows is restd. to the estabt.ARMY DENTAL CORPS

Lt. G. T. Drummond to be Capt.MILITIA

Maj. W. McK. H. McCullagh resigns his commn. and isgranted the rank of Lt.-Col.

TERRITORIAL ARMY

Lt.-Col. F. R. Harris resigns his commn.Maj. J. 0. Thomas to be Lt.-Col., and to comd. the 140th

(Co. of Lond.) Fd. Amb.Lt. G. H. Thompson to be Capt.W. C. Jack (late Offr. Cadet, Glasgow Univ. Contgt.,

Sen. Div. O.T.C.) to be Lt.C. H. Johnson (late Cadet Lee.-Corpl., Merchant Taylors’

Sch. Contgt., Jun. Div., O.T.C.) to be Lt.The King has conferred the Territorial Decoration upon

Maj. and Bt. Lt.-Col. R. A. Lennie, and on Majs. W. Leslieand L. M. Weeks.

INDIAN MEDICAL SERVICECols. H. R. Nutt and Sir Frank P. Connor to be Maj.-Gens.Lt.-Col. A. H. Proctor to be Col.To be Lts. (on prob.): C. B. Miller (seed.), E. Parry, and

W. G. Kennedy.Maj.-Gen. J. D. Graham retires.

COLONIAL MEDICAL SERVICEDr. D. T. Birt (sen. M.O. Gambia) has been appointed

Asst. Director of Medical Services, and J. W. Thomson(Deputy-Director of Medical Services, Gold Coast) DeputyDirector, Nigeria. Dr. J. E. Wright (late Chief M.O. andMedical Superintendent, Holberton Hospital, Antigua)has been reappointed Medical Superintendent.

Dr. C. R. Lutze-Wallace (Sen. M.O.) has been appointedAssistant Director of Medical Services, Uganda, and Dr.G. M. Hargreaves (M.O., Kenya) has been made HealthOfficer, Hong-Kong.The King has approved of the appointment of Air-

Commodore Alfred William Iredell, M.R.C.S., as an

Honorary Physician to His Majesty, vice Air-CommodoreHardy Vesey Wells, C.B.E., M.R.C.S., who has vacatedthe appointment on retirement from the Royal Air Force.