1372

greatest assistance in leading to the detection and abatementof a very large number of nuisances. There is still, hereports, necessity for more sanitary inspectors in his

district; in fact, inspection of workshops could not beattempted in 1893 owing to the insufficiency of staff. Hestates that there is a growing feeling among sanitariansthat diphtheria is in some way caused by defective

sanitary conditions. We imagine this statement would bechallenged by a good many sanitarians. A table showingthe large number of children not accounted for as regardsvaccination in Hackney is given in Dr. Warry’s report, and ’’,the figures are commended to the attention of the Hackneyguardians. During 1893 the state of the Lea in the vicinityof Hackney appears to have been offensive, and Dr. Warrymade analyses of the Leyton and Walthamstow sewage farmeffluents which enter the Lea at Temple Mills ; the sampleswere, he states, "not much better than raw sewage." Thematter was subsequently made the subject of a complaint tothe Lea Conservancy Board, but we do not gather fromhis report that much good resulted.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6357 birthsand 3570 deaths were registered during the week endingDec. 1st. The annual rate of mortality in these towns, whichhad increased in the preceding three weeks from 16’9 to 17’3per 1000, further rose last week to 17-8. In London the ratewas 16’1 per 1000, while it averaged 19’0 in the thirty-two provincial towns. The lowest rates in these towns were13-8 in Huddersfield, 14-4 in Croydon, 15 2 in Bristol, 15’8in Birkenhead, and 15-9 in Wolverhampton ; the highestrates were 22-7 in Derby, 23-4 in Bolton, 23.5 in Gates-head ; 23-7 in Oldham, and 25’1 in Swansea. The3570 deaths included 431 which were referred to theprincipal zymotic diseases, against 375 and 354 in the

preceding two weeks; of these, 132 resulted from measles,89 from diphtheria, 57 from whooping-cough, 55 fromdiarrhoea, 53 from "fever" (principally enteric), 42 fromscarlet fever, and 3 from small-pox. No fatal case ofany of these diseases occurred last week in Plymouthor in Bristol; in the other towns they caused the lowestdeath-rates in Leicester, Brighton, and Preston, and thehighest rates in West Ham, Portsmouth, Burnley, Blackburn,and Gateshead. The greatest mortality from measles occurred in Sunderland, Derby, Leeds, Burnley, Ports- ’,mouth, and Gateshead ; from whooping-cough in Halifaxand Swansea ; from "fever " in Wolverhampton ; and from ’.

diarrhoea in Bolton and Blackburn. The mortality fromscarlet fever showed no marked excess in any of the

large towns. The 89 deaths from diphtheria included 54 in ’,London, 12 in West Ham, 4 in Birmingham, and 3 each in Liver-pool and Blackburn. Three fatal cases of small-pox were ’,registered in Birmingham, but not one in London or in

any other of the thirty-three large towns. There were 31 casesof small-pox under treatment in the Metropolitan AsylumHospitals, but not one in the Highgate Small-pox Hospitalon Saturday last, the lst inst., against 51, 42, and 33at the end of the preceding three weeks; 6 new

cases were admitted during the week, against 12, 3,and 2 in the preceding three weeks. The number ofscarlet fever patients in the Metropolitan Asylum Hos-pitals and in the London Fever Hospital at the end of

.

the week was 2148, against 2258, 2254, and 2198 on

the preceding three Saturdays ; 191 new cases were ad-mitted during the week, against 215 and 223 in thepreceding two weeks. The deaths referred to diseasesof the respiratory organs in London, which had been 245and 261 in the preceding two weeks, further rose to 263last week, but were 194 below the corrected average. Thecauses of 65, or 1’8 per cent., of the deaths in the thirty-three towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were

duly certified in Cardiff, Nottingham, Salford, Bradford,and in nine other smaller towns ; the largest proportionsof uncertified deaths were registered in West Ham, Brighton,Birmingham, Leicester, and Sheffield.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 20-3 and 21-3 per 1000 in the preceding two

weeks, further rose to 21’4 during the week ending Dec. 1st,and exceeded by 3’5 per 1000 the mean rate during the sameperiod in the thirty-three large English towns. The rates.in the eight Scotch towns ranged from 14’4 in Leith and17-2 in Perth, to 23’7 in Glasgow and 24-4 in Paisley.The 611 deaths in these towns included 22 which werereferred to measles, 17 to whooping-cough, 15 to diarrhoea,14 to diphtheria, 11 to scarlet fever, 8 to small-pox, and 4 to" fever." In all, 91 deaths resulted from these principalzymotic diseases, against 60 and 80 in the preceding twoweeks. These 91 deaths were equal to an annual rate of3-2 per 1000, which was 1’1 above the mean rate lastweek from the same diseases in the thirty-three large Englishtowns. The fatal cases of measles, which had been 12 and 19in the preceding two weeks, further rose to 22 last week,of which 17 occurred in Glasgow. The 17 deaths fromwhooping-cough showed an increase of 7 upon the numberin the preceding week, and included 11 in Glasgow and3 in Edinburgh. The fatal cases of diphtheria, whichhad been 12 and 13 in the preceding two weeks,further rose to 14 last week, of which 6 occurred inGlasgow and 4 in Edinburgh. The deaths referred to scarletfever, which had been 10 and 6 in the preceding two weeks,rose again to 11 last week, and included 6 in Glasgow and 3in Aberdeen. The 8 fatal cases of small-pox were all re-corded in Edinburgh. Of the 2 deaths from "fever," 2occurred in Glasgow and 2 in Aberdeen. The deaths re-

ferred to diseases of the respiratory organs in these towns,which had been 155 and 142 in the preceding two weeks,rose again to 164 last week, but were 106 below the high numberin the corresponding week of last year. The causes of 48,or nearly 8 per cent., of the deaths in these eight townslast week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had increased in the pre-ceding three weeks from 22 8 to 24’3 per 1000, declined againto 21’2 during the week ending Dec. 1st. During the pastnine weeks of the current quarter the death-rate in the cityhas averaged 22-3 per 1000, against 15’9 in London and19-6 in Edinburgh. The 142 deaths registered in Dublinduring the week under notice showed a decline of 21 fromthe number in the previous week, and included 10 which werereferred to the principal zymotic diseases, against 10 and14 in the preceding two weeks ; of these, 3 resultedfrom small-pox, 3 from diarrhoea, 2 from "fever," 1 fromscarlet fever, and 1 from whooping-cough, but not onefrom measles or diphtheria. These 10 deaths were equalto an annual rate of 1’5 per 1000, the zymotic death-rateduring the same period being 2’0 in London and 3’1 inEdinburgh. The fatal cases of small-pox, which had been4, 3, and 1 in the preceding three weeks, rose again to 3 lastweek ; 24 deaths have resulted from this disease in Dublinsince the end of September last. The deaths referred todifferent forms of "fever," which had increased from 2 to5 in the preceding three weeks, declined again to 2 last week.The 142 deaths in Dublin last week included 28 of infantsunder one year of age and 35 of persons aged upwardsof sixty years ; the deaths of infants corresponded withthe number in the preceding week, while the deaths of elderlypersons showed a further slight decline from those recorded inrecent weeks. Four inquest cases and 3 deaths from vio-lence were registered ; and 64, or more than a third, ofthe deaths occurred in public institutions. The causes of11, or nearly 8 per cent., of the deaths in the city last weekwere not certified.

THE SERVICES.

MOVEMENTS OF THE MEDICAL STAFF.THE following officers have embarked for India in the

Malabar: Surgeon-Lieutenant-Colonel Charlton, Surgeon-Captain Mould, and Surgeon - Lieutenants Jones andSlayter. The following have arrived from India in theBritannia : : Surgeon-Lieutenant-Colonel Macnamara, andSurgeon-Captains Hall and Dobson. Surgeon-Major Stuart,lately arrived from Egypt, has been posted to Aldershot, andSurgeon-Majors Peterkin and Twiss to the South-EasternDistrict. Surgeon-Lieutenant Walker has been transferredfrom Dublin to Belfast. Surgeon-Major Nealm has arrivedin Ceylon.

1373

ARMY MEDICAL STAFF.

Surgeon-Captain Frederick T. Skerrett, F.R.C.S.I., is

placed on temporary half-pay on account of ill-health.INDIA AND THE INDIAN MEDICAL SERVICES.

Surgeon-Captain S. A. C. Dallas, I.M.S. (Madras), whoseservices have been placed temporarily at the disposal of theChief Commissioner by the Government of India (HomeDepartment), is appointed to do duty under the orders of theCivil Surgeon, Nagpur. Surgeon-Lieutenant-Colonel S. B.Haliday and Surgeon - Major J. W. T. Anderson have

respectively delivered over and received charge of the AdenPrison. Surgeon-Captain J. S. Lumsden has made overcharge of the duties of Superintendent of the Bannu Gaolto Surgeon-Captain H. Fooks. On return from furloughon medical certificate of Surgeon-Captain J. Murray hasresumed charge of his duties as Professor of Pathology andMateria Medica in the Lahore Medical College, relievingSurgeon-Captain F. H. Burton-Brown, whose services havebeen replaced at the disposal of the Government of India.Surgeon - Lieutenant - Colonel H. P. Yeld, Deputy AssayMaster, Bombay Mint, subject to Her Majesty’s approval,retires from the service from Nov. 15th, 1894.

NAVAL MEDICAL SERVICES.

Staff-Surgeon James William Hambly Hawton has beenpromoted to the rank of Fleet-Surgeon in Her Majesty’sFleet.

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Lieutenant Campbell Boyd, 3rd Volunteer Bat-talion, the Queen’s (Royal West Surrey Regiment), has beenappointed Surgeon-Lieutenant.

VOLUNTEER CORPS.

Artillery 1st Edinburgh (City) : Surgeon-Lieutenant R. M.Robertson, M.B., resigns his commission. 2nd West Ridingof Yorkshire (Western D-vision, Royal Artillery) : Surgeon-Major I. Mossop to be Surgeon-Lieutenant-Colonel..Kc :5th (Irish) Volunteer Battalion, the King’s (Liverpool Regi-ment) : John Joseph O’Hagan, M.B., to be Surgeon-Lieu-tenant. lst (Exeter and South Devon) Volunteer Battalion,the Devonshire Regiment : Russell Coombe, Gent., to be

Surgeon-Lieutenant. 6th (Fifeshire) Volunteer Battalion, theBlack Watch (Royal Highlanders) : Lieutenant RobertThomson Ferguson, M.B., is appointed Surgeon-Lieutenant.

VOLUNTEER OFFICERS’ DECORATION.The Volunteer officers’ decoration has been conferred upon

the undermentioned officers of the Volunteer Force :—VoA-Western Dastrict Rifle: : 2nd Volunteer Battalion, EastLancashire Regiment : Surgeon and Honorary Surgeon-Major John Burns, retired. Eastern District: Zifte:2nd Volunteer Battalion, the Suffolk Regiment : Surgeon-Major John Sinclair Holden, M.D. Western -District: : l2ifle :2nd Volunteer Battalion, the Gloucestershire Regiment: Hono-rary Assistant-Surgeon Thomas James Cottle.

LONDON COMPANIES VOLUNTEER MEDICAL STAFF CORPS.The annual competition for the Company Challenge Shield

took place at the Guildhall on Nov. 28:<h. Three companiescompeted, and additional interest was given to the competi-tion as this year it was felt that it would be close and theaward difficult. This proved to be the case, and Surgeon-Captain D. M. O’Callaghan, A.M.S., the new adjutant, whoacted as judgp, in giving his decision, said that all he had seenwould have been highly creditable to Regulars, and that hehad great difficulty in coming to the decision, which he gavein favour of No. 1 Company, No. 5 being placed second.The work and efficiency of the companies has steadilyimproved ever since the formation of the corps, which is tobe congratulated on the general standard of the competingcompanies, which were each paraded by two officer:-No. 5, Surgeon-Captain J..-Edward Squire, M.D., Lieutenantand Quartermaster G. R. Glenfield ; No. 1, Surgeon-CaptainValentine Matthews, Surgeon-Lieutenant H. D. Buss, M.D. ;No. 4, Surgeon-Captain T. Horrocks Openshaw, F.R.C.S.,Lieutenant and Quartermaster J. H. Bennett. The winningcompany (No. 1) was drawn from the schools of UniversityCollege, Middlesex, King’s College, and Charing-cross Hos-pitals, and this is the fourth occasion on which it has beensuccessful in this competition. -

A gymnasium class has recently been formed at the head-quarters.

ARMY MEDICAL ORGANISATION.The writer of the article on this subject in the United

8&rrice Xagazine su=arises the main requirements of themedical departments as follows: "It must be recollected;hat wars now between the civilised Powers of Europe willbe short and decisive, that the numbers of killed andwounded in the battles of the future will be much larger,han in the past, and that the stress on the medicalservice for the treatment of the sick and wounded andtheir transport to the base of operations will be infinitely2-eater, and will require the utmost care and skill. This.being so, the medical staff desire that the system which mustsist in war time should be practised during peace, for it ismly by the experience so gained that they can obtainfamiliarity with the duties that would devolve upon themluring a campaign. They say, and rightly so, that if change:akes place in the relations of the army to the department on;he eve of war, it places the department in a false position,md but courts disaster and failure. Therefore it is urged;hat during peace a medical officer should be attached to,:ach corps, that field hospitals should be mobilised duringmtumn manoeuvres, and that ambulance transport should be.naintained at our large military centres, complete in everyrespect for an army corps."

THE JAPANESE WAR HOSPITALS.The Standard lately contained a very interesting account

)f one of these hospitals from the captain of an Americanwarship on the Asiatic station. He describes the results of a.7isit paid to the Japanese hospital near Nagasaki, wherenany of the Japanese soldiers and sailors (wounded in the:ecent battles) and some Chinese were under treatment. Thelescription is very flattering to the zeal and efficiency of theJapanese medical service. The writer declares that the

hospital was the admiration of the English, French, andAmerican surgeons, and that it was organised on modern linesmd supplied with the best modern instruments and newestantiseptics. The medical staff were all Japanese, who hadgraduated in medicine and surgery either in America orEngland, and then taken post-graduate courses at the Paris.md Berlin hospitals. The Japanese infantry arm is theMurata, the invention of a general of that name. Thecalibre of the rifle is ’315, and the bullet weighs 235 grains.Speaking of the effect of one of these bullets, fired at alistance of about 1000 yards, on the knee-joint of a woundedChinese officer, it is stated that the thin steel envelope of theaullet had broken, and the joint was a mass of comminutedoone splinters. The limb was, of course, amputated.

THE ARMY MEDICAL SERVICE AND THE PRESS.There has recently been a remarkably large number of

articles and a great deal of correspondence in the daily andweekly press about the military medical service. A well,informed article (to which we alluded last week) on ’’ ArmyMedical Organisation" is published in the current num-ber of the United Service Magazine. The Medical Magazine-had also an article dealing with the faulty organisation andauses of discontent in the army medical staff. The lastnumber of the Army and Navy Gazette has a column and aaalf of letters, the first of which is signed A GeneralOfficer," who writes very forcibly about the results of hispractical experience of the unsatisfactory working of exist-ing arrangements. The Pall .11Iall Gazette has also con-tained an editorial article and a communication from aorrespondent on the state of unpreparedness of the medicalservice for field service. It seems highly probable thatwhen Parliament meets Mr. Campbell-Bannerman’s attentionwill be called to these matters.

The steamship Britannia arrived at Portsmouth on

Nov. 29th with 134 invalids for Netley Hospital.The examination of Surgeon-Captains for promotion has

been fixed for Feb. 4th and 5th, 1895.

SHEFFIELD MEDICO - CHIRURGICAL SOCIETY.-Ameeting of this society was held on Nov. 22nd, Mr. MakeigJones, President, in the chair, when Mr. Atkin exhibited aman on whom he had operated three months previously forTri-facial Neuralgia. Mr. Richard Favell showed a specimenof Hdro-salpinx of the Right Tube removed from a marriedwoman twenty-nine years of age. Dr. Wilkinson exhibitedin a child the remains of a Spina Bifida which had beentreated by injection with Morton’s fluid. The President,Dr. Martin, Mr. D. James, Dr. McCall, Mr. Atkin, Mr. Pye.Smith, Dr. Addison, Dr. Sinclair White, Dr. Dyson, andDr. Reid took part in the discussion.