1442 VITAL STATISTICS OF LONDON DURING OCTOBER, 1901.-THE SERVICES.

appears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in the tablewas equal to an annual rate of 13 ’8 per 1000 of the population,provisionally estimated at 4,543,757 persons in the middle ofthe year. In the three preceding months the rates had been9’6, 8’6, and 12-4 per 1000 respectively. The rates were con-siderably below the average in Kensington, Hammersmith,Chelsea, Hampstead, Shoreditch, and Woolwich ; while

they showed the largest excess in St. Pancras, Hackney,Holborn, Finsbury, Southwark, Bermondscy, and Camber-well. During the five weeks ending Nov. 2nd 347 cases ofsmall-pox were notified in London, against 22, 94, and 157in the three preceding months ; 58 cases belonged to Ber-mondsey, 47 to Holborn, 37 to the City of Westminster, 37to St. Pancras, 27 to Stepney, and 21 to Finsbury. Of these347 cases the number during the last week of the monthamounted to 173, and included 39 in Bermondsey, 38 inHolborn, and 29 in the City of Westminster. The number ofsmall-pox patients under treatment in the MetropolitanAsylums hospitals, which had been 13, 74, and 163 at theend of the three preceding months, had further risento 284 on Saturday, Nov. 2nd; the weekly admissions

averaged 72, against 23 and. 44 in the two precedingmonths. The prevalence of scarlet fever showed a consider-able increase ;over that recorded in the preceding months ;among the various metropolitan boroughs this diseasewas proportionally most prevalent in Hackney, Southwark,Bermondsey, Battersea, Camberwell, Deptford, and Green-wich. The Metropolitan Asylums hospitals contained 3281,scarlet fever patients at the end of October, against3026, 2971, and 2752 at the end of the three precedingmonths; the weekly admissions averaged 399 during lastmonth, against 343, 288, and 412 in the three precedingmonths. The prevalence of diphtheria showed a slightexcess over that recorded in the preceding month ; thegreatest proportional prevalence of this disease occurred inPaddington, Fulham, St. Pancras, Stoke Newington, andHackney boroughs. There were 1570 diphtheria patients undertreatment in the Metropolitan Asylums hospitals at the endof last month, against 1332, 1336, and 1499 at the end of thethree preceding months ; the weekly admissions averaged 243,against 209, 177, and 248 in the three preceding months. Theprevalence of enteric fever showed a considerable diminu-tion from the exceptionally high rate of the preceding month ;among the various metropolitan boroughs this disease wasproportionally most prevalent in Fulham, St. Pancras,Islington, Hackney, Finsbury, Poplar, and Bermondsey.The number of enteric fever patients under treatment inthe Metropolitan Asylums hospitals, which had been 166,225, and 292 at the end of the three preceding months,had declined to 291 at the end of October ; the

weekly admissions averaged 38, against 29, 42, and 50 inthe three preceding months. Erysipelas was proportionallymost prevalent in Hackney, Finsbury, Shoreditch, BethnalGreen, Stepney, and Southwark. The 21 cases of puerperalfever included three in Camberwell, two in Kensington,two in St. Pancras, two in Bermondsey, and two inWandsworth.The mortality statistics in the table relate to the deaths of

persons actually belonging to the various metropolitanboroughs, the deaths occurring in the public institutions ofLondon having been distributed among the boroughs inwhich the deceased persons had previously resided. Duringthe five weeks ending Nov. 2nd the deaths of 6703persons were registered, equal to an annual rate of 15’4per 1000, against 16-1, 18-5, and 15-4 per 1000 in thethree preceding months. The lowest death-rates in thevarious metropolitan boroughs were 10’5 in Lewisham,10’8 in Greenwich, 10-9 in Hampstead, 11’0 in Paddington,11’8 in Stoke Newington, and 11’9 in Wandsworth ; the highest rates were 18’0 in Holborn and in BethnalGreen, 18’1 in Bermondsey, 18’7 in Shoreditch, 19’1 inSouthwark, 20’6 in Finsbury, and 22-0 in Stepney.During the five weeks of October 739 deaths were referred to the principal zymotic diseases ; of these 29 resulted from small-pox, 95 from measles, 70 fromscarlet fever, 179 from diphtheria, 50 from whooping-cough, 64 from enteric fever, and 252 from diarrhoealdiseases. The lowest death-rates from these diseasesoccurred last month in Chelsea, City of Westminster,St. Marylebone, Hampstead, City of London, and Green-wich ; and the highest rates in St. Pancras, Islington, i

Holborn, Finsbury, and Poplar. The 29 fatal cases of small-pox greatly exceeded the average, and included six in St.

Pancras, five in Bermondsey, four in Stepney, and threein Holborn. The 95 deaths from measles were 21 below theaverage number in the corresponding periods of the 10 pre-ceding years ; among the various metropolitan boroughs thisdisease was proportionally most fatal in Kensington, Islington,Finsbury, Bethnal Green, and Battersea. The 70 fatal casesof scarlet fever were 29 below the corrected average number; athe greatest proportional fatality from this disease occurred inHampstead, Hackney, St. Marylebone, Finsbury, Southwark,and Bermondsey. The 179 deaths from diphtheria showed a,decline of 90 from the average number in the correspondingperiods of the 10 preceding years ; this disease was pro-portionally most fatal in Paddington, Fulham, St. Pancras,Islington, Stoke Newington, Hackney, and Camberwell.The 50 fatal cases of whooping-cough were 42 below thecorrected average number ; the greatest proportional mortalityfrom this disease wa.s recorded in Hammersmith, Fulham,Holborn, Stepney, and Lambeth. The 64 deaths referred toenteric fever showed a considerable decline from theaverage number; among the various metropolitan boroughsthis disease was proportionally most fatal in Islington,Hackney, Finsbury, Bethnal Green, Poplar, Wandsworth,and Lewisham. The 252 deaths from diarrhoeal diseases.were slightly in excess of the corrected average number;the proportional mortality from these diseases was highestin Finsbury, Shoreditch, Poplar, Southwark, Lambeth.and Deptford. In conclusion, it may be stated that theaggregate mortality in London from these diseases duringOctober was more than 16 per cent. below the average.

Infant mortality in London last month, measured by theproportion of deaths among children under one year of ageto registered births, was equal to 128 per 1000. The lowestrates of infant mortality were recorded in Chelsea, Cityof Westminster, St. Marylebone, Hampstead, Greenwich,and Lewisham ; and the highest rates in City of London,Shoreditch, Bethnal Green, Stepney, Southwark, and

Bermondsey.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

Fleet Surgeon Edward Ferguson has been placed on theretired list of his rank. Dated Nov. llth, 1901.The following appointments are notified : Surgeon

J. E. H. Phillips to the Royal Naval Hospital at Chatham.Civil Practitioners : J. F. Mannix to be Surgeon and

Agent at Cahirciveen and Kells and S. Davidson to be Sur-geon and Agent at Helmsdale.

ROYAL ARMY MEDICAL CORPS.

Captain R. E. Phillips has been selected for service withthe South African Constabulary. The following time-

expired officers in India will shortly return to England withinvalids : - Lieutenant-Colonel P. J. Dempsey, Bengal ;Major F. S. Le Quesne, V.C., Punjab; Captain H. S.Thurston, Bengal; Major J. C. Haslett, Bengal; MajorC. S. Sparkes, Bombay ; Captain T. W. Gibbard, Madras -Lieutenant-Colonel R. Blood, Bombay; Major R. J. A.

Durant, Madras ; and Captain C. E. Pollock, Bengal.Lieutenant-Colonel T. B. A. Tuckey has been appointed

Senior Medical Officer in charge of the Connaught Hospitaland to command No. 2 Company at Aldershot, in successionto Lieutenant-Colonel Wilson, retired.

Lieutenant Brunskill has arrived at Sierra Leone andhas been posted for duty.

Colonel J. L. Notter, late professor at the Royal Victoria,Hospital, Netley, has been appointed Principal MedicalOfficer at Aldershot, in succession to Surgeon-GeneralO’Dwyer.

VOLUNTEER CORPS.

Rifle: 3rd Volunteer Battalion the Prince of Wales’sOwn (West Yorkshire Regiment) : The undermentionedofficer resigns his commission : Surgeon-Captain E. 0.Croft.

VOLUNTEER MEDICAL STAFF CORPS.The Glasgow Companies :-James Bruce to be Surgeon-

Lieutenant. VOLUNTEER OFFICERS’ DECORATION.

The King has conferred the Volunteer Officers’ Decorationupon the undermentioned officers of the Volunteer Force :—

Eastern District: : Riflc : 2nd (Hertfordshire) VolunteerBattalion the Bedfordshire Regiment : Surgeon-Qaptain

1443THE SERVICES.-A CASE OF PESTIS MINOR IN LONDON.

Richard Legg Batterbury. 3rd Volunteer Battalion the Bed-fordshire Regiment : Surgeon-Lieutenant-Colonel DavidThomson. North-Eastern District Artillery: 1st Lincoln-shire (Western Division, Royal Garrison Artillery) : Sur-

geon-Lieutenant-Colonel Thomas Newby, retired. -Rifle :2nd Volunteer Battalion the Sherwood Foresters (DerbyshireRegiment): Surgeon-Lieutenant-Colonel Alfred Chawner.-Vorth-Western District Artillery: lst Cheshire and Car-narvonshire Volunteer Artillery : Surgeont-Lieutenant-ColonelEdward James Lloyd. 7th Lancashire (the ManchesterArtillery) Volunteer Artillery : Surgeon-Lieutenant-ColonelRichard Augustus Shelton Daly. Scottish District :

Artillery: lst Fifeshire Volunteer Artillery : HonoraryAssistant Surgeon James Welsh.

MENTIONED IN DESPATCHES.The following are mentioned in Lord Kitchener’s

despatches, publishe in the London Gazette on Nov. 15th:Captain F. W. Begbie, R.A.M.C., who, at Maatjesspruit onJuly 7th, 1901, behaved very gallantly in riding into Boerlines under continuous fire to attend to the wounded ; Lieu-tenant W. H. Odlum, R.A.M.C., for tending wounded underheavy fire at Draaihoek, Orange River Colony, on July 8th,1901; Civil Surgeon J. Prentice, for going under very heavyfire to attend to a wounded man lying in the open, and forcontinuous good work ; Major H. N. Thompson, R.A.M.C.,who, near Jamestown, Cape Colony, on June 4th, 1901, wenta considerable distance under fire towards the enemy’sposition to attend to Lieutenant Hogg has been con-

spicuous for good service throughout.Corporal W. W. Weeden, R. A.M. C., who, at Bersefontein,

Orange River Colony, on July 24th, 1901, rode some distanceunder fire to assist a wounded man lying in the open andstayed with him 20 minutes, being fired at all the time,has been promoted sergeant by the Commander-in-Chief.

SOUTH AFRICAN WAR NOTES.Civil Surgeons Mackay, Stanley. Pomeroy, Sandalands,

Howe, Davey, Worth, Lees, and Robertson are on passagehome.Lieutenant-Colonel C. W. Thiele, R.A.M.C., and Captain

B. Forde, R.A.M.C., have been discharged trom hospital toduty.

AFFAIRS IN SOUTH AFRICA.There does not appear to be any unusual amount of

disease among the troops serving in South Africa, but thelist, of those reported as dangerously ill-from enteric fevermostly-is still a -long one. Although fresh outbreaks -on ‘

any large- scale are not recorded, this fever is widespread,for cases are reported from different places very far apart. ,It is to be feared that with the arrival at the Cape ofsusceptible material in the shape of reinforcements freshfrom this country and the approach of hot weather there willbe no decrease of its prevalence. The reports from therefugee camps are such as might have been anticipated.They show that the excessive mortality and sickness werenot due to any want of care and effort on the part ofthe English authorities, but were largely attributable tounavoidable causes and to ignorance and neglect,on thepart of the Boers, whose customs and practices violate the ‘most rudimentary laws of hygiene and occasionally evenof decency. As regards the progress of the war the -pro-cess of "wearing down" the enemy’s opposition is slowlybut surely going on and Lord Kitchener’s reports are, on the

whole, increasingly favourable. There is this to be said,that if terms could have been settled between the Boers andLord Roberts it seems almost certain that war would havebroken out again.

’

UNREGISTERED MEDICAL MEN AT THE CAPE.A correspondent draws our attention to the following

cutting from the Cape Times referring to a case in which aDr. Sterne sued the Queen’s Town Corporation for servicesrendered. The case was decided against him on the groundthat he was not registered in Cape Colony as a medical prac-titioner, and it came out in evidence that he had only gonethrough a three years’ course :—

StE.-In.your report of this week’s issue of the legal case " Sterne 1’.Queen’s Town Town Council," Mr. Van der Reit is said to have madethe entirely erroneous statement that no American diplomas are

recognised in this colony. No American (liploiiias are registeredtuttess they indicate a period of five years’ study, a most, neces-

*’arv provision, a,; every medical man knows. As a matter offact, there are quite a number of registered American medicalmen at the Cape, hailing from universit.ies which come up tofhf requirements I have just indicated. Another point in the case

is that the military authorities were acting illegally in engaging

Dr. Sterne, oven for their own work. The army regulationsforbid the employment of any man not legally registered by theMedical Council of the United Kingdom, and, curiously enough, therequirement has been strictly enforced as regards Canadian graduates.although I personally know of another American graduate, and oneonly possessing the Staats Examen certificate of Germany who havebeen appointed to the military service.Re the action of the Queen’s Town Municipal Council, I cannot but

think that that body must have had motive, not disclosed in theaction, for contesting the claim. Otherwise its conduct is curious. Itshould be remembered, however, that the council ran some legal risk.If any person dealt with, on certificate from Dr. Sterne. liked to fightthe council an action would certainly lie, as such certificate would beinvalid, and the council would be responsible.-I am, &c.,Cape Town, Sept. 24. M.D.

THE NEW DIRECTOR-GENERAL OF THE ARMY MEDICALSERVICE

The Army and Na1JY Gazette states that it is now

generally understood that the new Director-General ofthe Army Medical Service will take up the office earlyin December, when he, with the Advisory Board, willhave to carry Mr. Brodrick’s scheme into execution.That scheme in its present form is capable of large modifi-cations before being embodied in a Royal Warrant, andthere is little doubt that such modifications will be carriedout. Indeed, rumours point to a reassembly at an early dateof Mr. Brodrick’s Committee. It is satisfactory to know thatSurgeon-General W. Taylor’s early arrival in England willgreatly facilitate the settlement of several knotty points.That Mr. Brodrick is in earnest in his desire to producesuccess is certain.

DEATHS IN THE SERVICES.

Surgeon-General William G. N. Manley, C.B., V.C., at hisresidence at Cheltenham on Nov. 16th, aged 70 years. Heserved in the Crimea, the New Zealand War, the AfghanWar, and the Egyptian Expedition of 1882. He was alsowith the British ambulance during the Franco-Prussian Warof 1870-71, and received the Iron Cross and other Germandecorations, as well as a French decoration. He obtainedthe Victoria Cross for gallantry in New Zealand. Heentered the Army Medical Service in 1855 and retired in1884. Further particulars of his life and work will be foundin our obituary columns.

VOLUNTEER MEDICAL STAFF CORPS RELIEF FUND.The sum subscribed for this fund according to the report

just issued amounus to £293 14s. 10d., which, with a

donation from the Woolwich Companies sent direct to

Aldershot, make a total of .B314 15.9. 9d. The whole amountcollected, with the exception of the cost of postage andstationery, was handed over to the Royal Army MedicalCorps Depot Mobilisation Fund. It has been decided toclose the fund for the present.’

Correspondence.

A CASE OF PESTIS MINOR IN LONDON.

"Audi alteram partem."

To the Editors of THE LANCET.

SIRS,—I thought you might be interested in a few par-ticulars of the case lately under my care in the West LondonHospital which has been referred to in the daily papers as"a supposed case of plague." The man came to my out-patient room on Monday, Nov. llth, complaining of lumpsin his groins. He had two large, very tender buboes in thosesituations for which no surgical cause was apparent. On

questioning him he stated that he had been suffering from,and had then, severe pain in his back, that he had had forsome days a splitting headache, also some shivering buthad not vomited. His tongue was covered with whitefur and was red at the tip and edges ; the spleen couldbe felt easily; the conjunctivas, especially one, were injected.He had been in bed several days during the previous week.He had tried to work that morning, but had to give up.His temperature was 101° F. Some slightly enlarged glandscould be felt in the neck and axilla. He stated thathe was a lighterman and worked on a barge on the Thamesand was engaged in unloading merchandise from theBaltic. Three weeks previously he had a fall and thoughtthat the buboes started then, but he had become much worsethe previous Monday and had to knock off work ; he felt tooill to keep about and had to go to bed for several days.