920

The halls are divided up by partitions, on the tops ofwhich stand pot hyacinths and cactuses, suggesting at firstsight some kind of flower show or exhibition. On each sideof the screens are the low beds, consisting of three longitudinalplanks raised an inch or two from the ground, with strawmattress, pillow, and blankets upon them. Ventilation strikesthe incomer as distinctly good. The heating is carried on bymeans, for the most part, of hot-water pipes beneath thefloor, which produce an upward current of air passing out atthe louvres in the high roof and drawing in fresh air throughthe cracks in doors and windows without the necessity of anyartificial system. The lavatory arrangements appear adequate.The original water-carriage system has been extended andwashing accommodation is abundant, while douches withhot and cold water are laid on, to the use of which norestriction is applied. Each battalion of prisoners has itsown particular portion of the Palace ground to exercise in,the area being marked off by wire entanglements, besidesthe use of the Italian garden in the Palace. At the time ofour representative’s visit the wind was cold in the extreme,with driving sleet, but several hundred men were pacingin the open in threes and fours around an enclosure pro-tected from the wind at the east end of the Palace building ;some were engaging in a friendly wrestling match, watchedby the sentries who stood by. As closing time approachedthe sentries drew in, warning the men back again to theirquarters.

Occupation for these men, who are all interned civilians,is, of course, purely voluntary. Several squads were

engaged in removing turf and making roads, being paidby the Palace trustees for this work. Some of the aliens assistwith the cleaning and housework. Large numbers are contentwith lying on beds idling about, or playing games. A con-siderable minority occupies a narrow enclosure runninground the whole extent of the hall with benches on eachside, on which skilled handiwork is carried out. Someare engaged in carving and fretwork inlay of no mean

quality ; others make wooden toys, models of boats and ships,and the like ; while others are occupied more seriously in

tailoring and cobbling for their comrades. All the cookingis done in the kitchens by interned civilians who commanda wage for doing so. The regular ration includes 8 ouncesof meat and 1½ lb. of bread per diem. The bread was notedto be wholemeal and of excellent quality, supplied by acontractor from outside. At one time some complaint wasmade with regard to the quality of the bread, and the con-tractor was changed. Those who can afford to pay mayobtain food of any desired kind at the canteen ; 10 per cent.of the canteen proceeds are allotted to delicacies for the

remaining inmates, and especially to the occupants of thehospital. We understand that the well-to-do inmates arekindly disposed towards the others, especially in assistingthem with a more varied diet. Vegetables supplied in theordinary ration are limited to potatoes and dried beans, andno special dietary is provided for the hospital.At the Post Office in the building parcels sent from the

men’s homes are examined; it is at the same time the librarywhere English and German books can be borrowed. Englishnewspapers circulate freely. The only German journals inevidence were of pre-war date. There is naturally an abundanceof musical talent, and an orchestra of 40 instruments is formedwhich gives good music on Sunday afternoons. Monthlyvisits are allowed to the prisoners by their friends, and asthese visits are spread out over the month, a constantstream of outsiders arrives each afternoon.The hospital accommodation occupies three separate rooms

at the end of the building, with a large consulting room anddispensary adjoining. Of the 35 beds in the main ward only4 were occupied, other cases being convalescent and sittingoutside in the Italian garden. Of 10 tuberculous cases

only 2 had positive sputum, and these were being isolatedfrom the rest of the men. A small room is allotted to thosesuffering from active forms of venereal disease. Thesewere in the early days sent to the German hospitalfor salvarsan injections and are now continuing withinternal mercurial treatment. The isolation hospital inthe grounds is now empty ; a single case of typhoid con-tracted before admittance and one of diphtheria have beenthe only serious infectious complaints ; as yet influenza, ifpresent, has occurred in very mild form. The prison in themain building is also empty, there being at the present timeno disciplinary difliculties. Large glass cases in the entrancehalls contain specimens of the work of prisoners, some

bearing patriotic mottoes such as "Gott, Ehre, und Vater-land, others referring to the period of their detention, "ZurErinnerung meiner Gefangenschaft," and so on.The courto-iy shown by the ofricials in conducting onr repre-

sentative an over the very large establishment and in showingus all the details contained therein is gratefully recognised.

ROYAL MEDICAL BENEVOLENT FUND.

AT the last meeting of the committee held on April llth26 cases were considered and C234 granted to 22 of theapplicants. Two additional annuitants of J:20 each were

elected, to be known as the Margaret Harker-SmithAnnuitants, the committee having recently received theamount of £1000 from the trustees. The following is a

summary of the cases relieved :-Widow, aged 70, of M. R. C. S. Eng. who practised at Heywood and died

in 1894. Was left totally unprovided for, and earns a somewhatprecarious living hyacting as a day cook. Owing to age is unable toobtain permanent work. Relieved twice. ;214. Voted 212 in 12 instal-ments.-M.R.C.S. Eng., aged 83, who had practised at Fulham. Practi-cally blind, and has to help to support one of his son’s family. Onlypermanent income a small pension from another society and the Old AgePension. Previous reliet fivetimes, .E34. Voted £12 in12 instalments.-Daughter, aged 58, of L.S.A. Lond. who had practised in London and isnow a pensioner of the Fund. Applicant has tried to make a living bykeeping an haberdashery shop, but owing to the increased costof commodities is unable to make it pay. Father lives with daughter.Voted E10 in two instalments, and referred to the Guild.-M.R.C.S. Eng., F. 1?. C.S. Edin., aged 76, married, and has practised atLincoln and London. Owing to age and inability to get about is unableto practise. Only income a small annuity. Requires help towards theeducation of his youngest daughter, aged 16. Two other children,married, and unable to he) p. Voted £12 in 12 instalments.- Widow,aged 63, of M.R.C.S. Eng. who practised at Burton-on-Trent anddied in October, 1915. Owing to long illness of husband, andthree sons having joined the army, all her savings are exhausted.Receiving a little help from her sons’ employers and a little fromdividends. Voted £5.-Widow. aged 74, of L.R.C.P. Edin. whopractised at Ross, Mon., and died in 1889. Was left totally un-

provided for, and only income a pension of B15 from anothersociety. Lives with two nieces who have to earn their own living.Voted B5 and referred to the Guild.-Widow, aged 45, of M.D.Edin.who practised at Sheffield and died in 1906. Was left unprovidedfor, and health is very indifferent. Has recently undergone an abdo-minal operation. One son. aged 16, at school and maintained by rela-tives. Previous relief twice..820. Voted 210 in two instalments-Widow, aged 59, of M.R.C.S. who practised in London and died in 1904.Applicant suffers from chronic rheumatism and general ill-health,and has no income. Previous relief 13 times, 2133. Voted £15 in12 instalments.-Widow, aged 62, of L.R.F.P.S. Glasg. who practited atRothesay and died in 1899. Endeavours to make a living by taking inlodgers, but has nnt been successful of late. Suffers from rheumatismand neuritis. Relieved twice, :624. Voted JB12 in 12 instalments.-Widow, aged 64, of M.H.C.S. Eng. who practised in London anddied in 1914. Was left with insufficient mean:,, and has an invaliddaughter to keep. Other children only able to help slightly.Relieved twice, E24. Voted B12 in 12 instalments.-Daughter. aged 54,of M.R.C.S. Eng who practised at Newport, Mon., and died in 1892.Is blind and health indifferent. Only income a pension of .621 fromanother society. Relieved five times, 260. Voted £12 in 12instalments.-Widow, aged 46, of M.B. Edin. who practised at Strathspey and died in1910. Was left quite unprovided for, with four children, ages 9-17. Triedto make a living by keeping a boarding house, but has recently had togive it up. Only permanent income a small pension from anothersociety. Relieved five times. B50. Voted SIO in two instalments.-Daughter, aged 67, of M.D. Edin, who practised in Lincolnshire anddied in 1898. Is matron of an orphanage, but owing to lack of sub-scriptions her salary has been suspended. Relieved once, £5. Voted212 in 12 instalments.-Daughter, aged 58, of M.D. Edin. who practisedat Kirkdale and died in 1867. Is a dressmaker, but owing to indifferenthealth her business has declined, and she cannot make sufficient tomeet expenses. Relieved once, 212. Voted B12 in 12 Instalments.-Widow, aged 68, of M.R.C.S. Eng. who practised at Sheffield and diedin 1884. Has endeavoured to make a living by teaching languages, butowing to the war her pupils have left her. Has a small pension fromanother society. Relieved live times, B25. Voted B12 in 12 instal-ments.-Daughter, aged 50, of F.R.C.S. Eng. who practised at Biggles-wade and died in 1890. Suffers from chronic gastritis and epileptictits. Only income B20 from another society. Relieved 17 times, B153.Voted B12 in 12 instalments.-Daughter, aged 60, of M.R.C.S. Bug.who practised at Peckham and died in 1885. Owing to the weakstate of her health she is unable to undertake any permanent work.Lives with sister, who has to earn her own living and is unable to helpapplicant. Relieved 18 times. JB209. Voted £12 in 12 instalments.-Widow, aged 58, of M.R.C.S. Eng. who practised at Sydney, N.S.W.,and died in 1901. Has no income, but receives occasional help fromfriends. Has a house in the country which she cannot let owing to itsbad condition. Has one daughter, a professional singer, but owing tothe war she cannot obtain any engagements. Relieved twice, t20.Voted ;E10 in two instalments.-Widow aged 68, of M.R.C.S. Eng. whopractised in London and died in 1898. Endeavours to make a livingby taking in boarders, but has been unsuccessful of late owing to ill-health, applicant suffering from a cancer. Has five daughters, allunable to help. Relieved 17 times, E205. Voted EI2 in two instal-ments through the Guild.-Widow, aged 53, of M.B. Aberd. who practised in Warwickshire and Australia and died in 1903. Was leftunprovided for, and only help a little from relatives. Has three

’ children, ages 29 to 31, but none able to help. Applicant is sufferingfrom asthma and heart trouble. Relieved seven times, .87.3. Voted

’ £12 in 12 ins’aimonts.’

Subscriptions may be sent to the honorary treasurer, Dr.Samuel West, at 11, Chandos-street, Cavendish-square,London, W.

921

THE LANCET.

LONDON: SATURDAY, APRIL 29, 1916.

The Registrar-General’s AnnualReport for 1914.

IN a prefatory address to the President of theLocal Government Board Mr. BERNARD MALLET,the Registrar-General, expresses regret that hisendeavours to expedite the publication of hisannual report for 1914 have been defeated bythe exigencies of war. He tells us that militaryrequirements have led to the imposition of newand unaccustomed duties on his department, as

well as to the serious depletion of his staff

- by the enrolment of many of its expert members.Out of 116 men in this Government depart-ment not fewer than 62 are already servingwith the colours, whilst 12 have been detachedfor war service in other departments. Altogether6,4 per cent. of the men of military age havebeen withdrawn from the General Register Office,and the residue includes several men whohave been refused by the military authorities formedical reasons. These losses have been met bythe closing down of all work not immediatelyrequired, by overtime employment, and by the sub-stitution of female clerks for male. In spite ofincreasing pressure on the department occasionedby the war, it is satisfactory to hear thatin certain directions material improvement hasbeen achieved in the period under review. The

Registrar-General has taken pains to minimisethe inconvenience of delay in the issue of his com-plete report by accelerating the publication of the"Annual Summary " for the same period-a docu-ment which will be found to convey importantinformation not otherwise available to. those

responsible for the preservation of the publichealth. For the information of those unfamiliarwith this publication, it may be useful to mentionthat it is now published within about three monthsof the close of the year to which it relates. The

accuracy of the provisional numbers there givendepends on returns by the local registrars, who aremainly laymen. But in the preparation of the officialreport, which is largely a medical function, thesenumbers are revised by comparison with the statu-tory registers deposited in Somerset House ; theyare analysed in greater detail, as well as, pre-sumably, with greater accuracy, than had beenpossible in the production of the earlier publica-tion. For these reasons it is obvious that the

summary can never be accepted as a substitute forthe elaborate official report. :

With few exceptions the vital statistics of 1914 may be considered satisfactory. The marriage-rate, like that of 1912 and 1913, showed a substantialrise on the average for 1908-11, and the provisionalfigures for 1915 indicate a further considerable a

rise. In order to compensate as far as possiblefor the casualties of war it is necessary tomaintain at the highest standard the constitu-tion of the general population ; and in this relationthe persistent decline in English fertility demandsscientific consideration. In 1914 a further fallingoff in the fertility of English mothers is recorded.In 1876 the rate of birth attained its highestpoint-namely, 36’3 per 1000 of the population-since which date it has fallen, with few exceptions,continuously from year to year. In the year 1914it was only 23’8, being the lowest rate on record;it was below the average rate for the last completedecennium by not less than 3’4 per 1000, a veryserious decline. The general mortality of 1914 inEngland and Wales was 14’0 per 1000 living,without distinction of age or sex; it was belowthe decennial average by 0’7 per 1000, Except inthe years of childhood males experience a highermortality than females, although the excess is veryunevenly distributed over the country. The fallin mortality has been rapid since 1891-5, when itstood at 18’5 per 1000. Up to the age of 35 formales and of 45 for females the mortality of 1914at each period was only half that recorded 50 yearsago, but after these ages the fall was only slight.Of the total deaths 17’8 per cent. were those ofinfants in their first year ; their rate of mortalitytherefore was equal to 105 per 1000 births. Infantilemortality is ordinarily higher in the town than inthe country, but the infant mortality of London,the centre of the largest urban population in exist-ence, continues lower than that of the country atlarge. In view of its constancy from year to yearthe geographical variation of infant mortality inEngland and Wales is remarkable. In each sex,and in every class of area, the rate continues highestin the north of England and lowest in the south,the position of the Midlands being intermediate.Even the rural districts of the north record a

higher rate than that of the metropolis, theexcess being greater in the male sex. Illegiti-macy is known to exercise a powerful influenceon infant life, and in 1914, as in previous years,the mortality of illegitimate infants was abouttwice as high as that of children. born inwedlock. The excess was highest at ages underthree months and least in the later months of thefirst year of life.

Respecting the mortality from the common infec-tious diseases the Registrar-General writes briefly,probably because detailed information respectingtheir incidence and fatality has already appeared inthe annual summary which was published in April,1915. The death-rates from these diseases, withthe single exception of diphtheria, were belowthe average. Diphtheria was responsible for

greater destruction of life than. usual, and inits regular tendency to excessive prevalence inthe same area from year to year this disease

strongly resembles enteric fever. The loss of lifedue to tuberculosis in 1914, although somewhatgreater than in the preceding year, was below theaverage in the latest quinquennium by nearly14 per cent. The fall in mortality was sharedalmost equally by both sexes, but the rate among