VITAL STATISTICS FOR ENGLAND AND WALES DURING 1925.

192 the deaf, the facilities-such as they are-that exist for their institutional treatment, the scope of any trusts or charities for their benefit, and any provision that exists for the instruction and supply of comA Series of Special Articles, contributed by petent teachers. Apart from the record of performance if the report makes interesting, invitation, on the Treatment of Medical pathetic, reading because of the numerous and important places where and Surgical Conditions. the need for activity is demonstrated in order that the deaf subjects may have proper opportunity to prove their high measure of capacity to make good CLVII.TTHE TREATMENT OF SALPINGITIS. in life, given the necessary help at the start. The good I.-ACUTE SALPINGITIS.11 objects of the Institute are clearly set out in the ACUTE salpingitis for all practical purposes is either report and the promise at the beginning is fruitful, so that the necessary funds to carry on the work ought gonococcal or streptococcal, and the latter nearly surely to be found. At present the Institute has an always follows labour or abortion. Further, whilst in income of about 2650 per annum, and one of at gonococcal infections the inflamed tube is the one least 22000 is required to carry on the current work. important feature, in the streptococcal cases the If the facts set out in the report are realised by even tubal lesion is only an incident in a widespread pelvic a small section of the general public, annual subinflammation. Acute gonococcal tubes always arise scriptions far in excess of this modest want would be as a spread of infection along the mucous membrane forthcoming. And a much greater sum could be used from the uterus to the tubes, whilst in streptococcal immediately and with certain results. cases the tubal infection is secondary to a pelvic peritonitis, the organisms gaining access to the tubes either by the lymphatics or via the abdominal ostium. VITAL STATISTICS FOR ENGLAND AND WALES Thus it happens in practice that treatment is directed towards the tubes primarily in gonorrhoea, but DURING 1925. towards a widespread but local peritonitis in streptoTHE Registrar-General has issued a provisional coccal puerperal infections, the tubes being only of statement of the figures for birth-rate, death-rate, secondary importance. and infantile mortality (per 1000) during the year Diagnosis. 1925. In gonococcal cases much depends upon diagnosis. The diagnosis is often of great difficulty, the differentiation from acute appendicitis raising a problem very baffling to the surgeon. The localisation of pain to the right iliac region is not always so marked a feature of appendicitis as might be expected, nor is the pain of acute salpingitis always bilateral at first. In both diseases there may be involvement of large areas of paritoneum producing more or less generalised pain in the lower abdomen. The temperature, pulse-rate, and the occurrence of vomiting present nothing characteristic of either lesion. At the commencement of an attack, when time is so important in appendix cases, there may be nothing definite to be felt on The smaller towns are those with an estimated abdominal or pelvic examination. On the whole, population in 1921 of 20,000-50,000. The (crude) there is more to be discovered by a pelvic examination death-rate for England and Wales relates to the whole in acute salpingitis than there is in appendicitis. One population, but that for London and the groups of particular sign is of great importance, and that is the towns to the civilian population only. The Registrar- acute pain which is evoked by attempts to move the General remarks that the birth-rate of England and uterus in tubal inflammations. Although not fixed Wales, as a whole, is the lowest recorded, except at first, any movement of the uterus always produces during the war years 1917 to 1918. The death-rate great pain and is much resented by the patient. This is and infantile mortality rate are equal to those recorded not so in most appendix cases, as long as the appendix These provisional figures, and surrounding inflammatory focus are situated in the previous year. which are not likely to require substantial modifica- above the pelvic brim. In doubtful cases an examination, have been issued for the information of medical tion under an anaesthetic should never be omitted, officers of health. since it will often decide the diagnosis, bilateral thickening of the tubes and of the structures around THE first number of the Registrar-General’s Weekly them, definitely excluding appendicitis. Another condition sometimes mistaken for salReturn of Births and Deaths for 1926 is unchanged inside, but has a cover whose phrasing gives a more pingitis is a ruptured ectopic gestation, or tubal accurate idea of its contents, which include a topo- abortion. The history of the latter often decides the graphical list of infectious disease notified in England diagnosis, especially if a period has been missed, which and Wales. The welcome reduction in the price of is not always. The very rapid onset, the sudden the Return from 1.9. to 6d. weekly should ensure the pain and faintness, followed by a rapidly rising pulsewide circulation which this invaluable document rate from internal haemorrhage, and later the onset of vaginal bleeding (very important) make a clinical deserves. picture sufficiently pathognomonic of ectopic gestation and its acute results. INDEX TO " THE LANCET," VOL. II., Operative versus Conservative Measures. 1925. Once the diagnosis of acute gonococcal salpingitis THE Index and Title-page to Vol. II., 1925, which is made, the question has to be decided whether an is to be performed or not. Seeing that the was completed with the issue of Dec. 26th, will shortly operation inflammation which determines the acute peritoneal be published. A copy will be sent gratis to subscribers attack is always localised, and that the risk of general on receipt of a post-card addressed to the Manager peritonitis is practically nil, there is never the same of THE LANCET, 1, Bedford-street, Strand, W.C. 2. necessity for immediate operation as there is in Subscribers who have not already indicated their appendicitis. Moreover, the natural tendency of a desire to receive Indexes regularly as published 1 An article by Mr. Stevens on the Treatment of Chronic hould do so now. Salpingitis will appear in the next issue of THE LANCET.

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