A DOCTOR'S INCOME. To the Editors of THE LANCET. SIRS,—The subject of medical incomes has been much commented on and discussed in the columns of THE LANCET during the past year. Amid much diversity of opinion there was one matter upon which agreement was generalnamely, that the average earnings of a medical man are unpleasantly small. Exceptions were made by some as regards hospital physicians and surgeons, whose incomes are commonly believed both by the professional and the nonprofessional

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... ic to be not only exceeding great but easily earned. The letter signed " A Hospital Surgeon," which appeared in THE LANCET on June 25th, showed that this does not at all events apply to young hospital surgeons. As one of these, I should like to show what a year's work means. Ten years ago I was elected to the surgical staff of an ophthalmic hospital, and about seven years ago to the ophthalmic departmant of a general hospital, to which a large medical school is attached. For eight years after obtaining my qualification sixteen years ago my income from professional fees barely averaged £100 a year. After that, however, it steadily increased, till last year it amounted to-well, it perhaps does not much matter what the precise amount was; it was sufficient, and, so far, I am satisfied. But whatever it was, it was certainly not exceeding great, nor was it easily earned. Only to mention one incidental matter, it necessitated the writing of over 2000 letters, short or long. But what I wish more particularly to point out is that the exigencies of medical practice require the hospital surgeon to perform an amount of gratuitous labour of which few 'persons seem to have any conception. My case may, 1 believe, be taken as a sample. At neither of the hospitals with which I am connected is there any remuneration for the services rendered to the institution itself. I attend each twice a week, and during the past year these attendances (including the time occupied in going to and fro) have consumed more than an aggregate of 800 hours, or 100 working days of eight hours each. I have seen more than 5000 different cases ,at least once, and many of them several times, and have performed over 200 major operations on the eye, including seventy-six for the removal of cataract, and forty-seven iridectomies. Nor is this all. Besides the unremunerated work at the hospitals, I find that I have seen or visited over 400 bond fide private patients who, on one ground or other, were entitled to gratuitous help and advice, or took them. I have also been called upon to perform seven iridectomies, two excisions, and one operation for thE extraction of cataract, besides several minor operations ic private, without fee. 1 am far from grudging this service, inasmuch as much of it was rendered to medical brethren or persons directly dependent upon them. I merely refei to it as a part of the yearly round of duty. This fact however remains: it would seem that as professional practice is at present conducted, even a fairly successful hospital surgeon must expend a substantial portion of his time, energy, health, and strength in the performance oj unremunerated labour, and suffer the corresponding mental and physical anxiety and wear and tear before he begins tc Jan. 2nd, 1888. J. T. THE FEVER EPIDEMIC IN EGYPT. To the Editors of THE LANCET. SIRS, — Your Cairo correspondent has raised certain questions as to the nature of the epidemic of fever at present prevalent in Egypt, and amongst others its infectiousness. The history of one family resident near Alexandria serves, I think, to support the theory of propagation by infection. In the first week of November two daughters had fever, severe frontal headache, pains (mainly muscular) in back and limbs, &c., followed on subsidence of the fever aftei four days by a well-developed scarlatinal rash. A fortnight later the mother had a rigor followed by similar symptoms and a scarlatinal rash. In the first week of December a son had a similar but more severe attack, and in his case the rash was abundant on his body, both front and back, and was of a scarlatinal character. On Dec. 15th another son, aged nine years and a half, was laid up with the fever, and to-day I find him covered from head to foot with a brilliantly red rash, not distinguishable from that of scarlatina. His temperature this morning was 102°, with a soft pulse of 96. For his age, there is the marked slowness of the pulse, compared with the high temperature, which we find in most of our cases of this fever. The tongue was clean, and the morale of the patient excellent.