1376

executed it, but the lengthy nature of extradition proceedingsis well known, and the urgency of bringing to Bow-streetwithout half-an-hour’s lelay a man charged with obtaininggoods by false pretences in Germany is not very apparent.Such cases as that described are fortunately rare, and theproportion of prisoners who ask to see a medical practitionerbefore being taken to a police-station in a cab can hardly beconsiderable. When they do happen it must sometimes occurthat a private practitioner has already acquired knowledge ofthe condition of the accused person by attending him, andto consult him before the patient’s life is endangered wouldbe wise.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 77 of the largest English towns 8338 births and 4394deaths were registered during the week ending May 13th.The annual, rate of mortality in these towns, calculatedon their probably over-estimated population, which had

steadily declined in the four preceding weeks from 15’ 9 to13-3 per 1000, was equal to 13’4 in the week under notice.During the first six weeks of the current quarter theannual rate in these towns averaged 14’6 6 per 1000. InLondon during the same period the reported annual rate didnot exceed 13-9 per 1000. The annual reported death-rateslast week in the 77 large towns ranged from 5-7 in Leyton,6’1 in Reading, 6-4 in East Ham, and 6’9 in Grimsby, to19-4 in Rochdale, 20’1 in Tynemouth, 20-3 in Dewsbury,and 20-7 in Merthyr Tydfil. The 439. deaths from allcauses in the 77 towns last week exceeded by 9the number in the previous week, and included 422which were referred to the principal epidemic diseases,against numbers declining steadily from 702 to 412in the nine preceding weeks. Of these 422 deaths,173 resulted from measles, 116 from whooping-cough,55 from infantile diarrhoea, 45 from diphtheria, 21 fromscarlet fever, and 12 from enteric fever, but not one

from small-pox. The mean annual death-rate from these

epidemic diseases in the 77 towns was equal to 1’3 per 1000,and corresponded with the rate in the previous week.The fatal cases of measles in the 77 towns, which hadsteadily declined from 474 to 180 in the nine precedingweeks, further fell last week to 173 ; the highest annualdeath-rates from this disease recorded last week in thesetowns were 1-5 in Rotherham, 1-7 in South Shields, and2 - 2 in Rhondda. The deaths from whooping-cough, whichti U .L1 unt. jLnc Ut:aUL1175 .L.LU.LU. vvilvv!-’.1U5"’VUUöu, VYllJ.BjUhad been 134, 118, and 100 in the three preceding weeks,

u

had been 134, 118, and 100 in the three preceding weeks,rose ’again last week to 116 ; they caused death-rates equalto 1’3 in Bristol, 1-4 in Warrington, and 1’5 5 in Blackburn.The 55 deaths of children under two years of age attributedto diarrhoea were fewer by 5 than the number in the

previous week. The deaths referred to diphtheria, whichhad been 31 and 33 in the two previous weeks,further rose to 45 last week; they included 10 in Londonand its suburban districts, 7 in Manchester and Salford, 4 inLeeds, and 3 in Stoke-on-Trent. The 21 fatal cases ofscarlet fever were fewer by one than those in the previousweek ; 4 occurred in London, 4 in Liverpool, and 2 inPreston. The deaths referred to enteric fever, which hadbeen 9 and 17 in the two previous weeks, declined again to12 last week; 3 occurred in London and its suburbandistricts. The number of scarlet fever patients undertreatment in the metropolitan asylums and the LondonFever Hospital, which had increased from 982 to 1045 onthe four preceding Saturdays, had further risen to 1070at the end of last week; 167 new cases of this diseasewere admitted to these hospitals during last week, against141 and 142 in the two preceding weeks. These hospitalsalso contained 743 cases of measles, 798 of diphtheria,310 of whooping-cough, 25 of enteric fever, and 13 ofsmall-pox on Saturday last. Seven fresh cases of small-poxwere admitted to the Joyce Green Hospital during the week.The 1148 deaths from all causes in London last week (a 1lower number than in any previous week of this year) in-cluded 232 which were referred to diseases of therespiratory system, against 268 and 227 in the two previousweeks ; 7 deaths were directly referred to influenza, against16 in the previous week. The deaths attributed to differentforms of violence in the 77 towns, which had been 167 and136 in the two preceding weeks, were 170 last week. The

causes of 27, or 0’6 6 per cent., of the deaths registered i]2the 77 towns during the week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in London and in itseight suburban districts, in Manchester, Leeds, Sheffield,Bristol, Newcastle-on-Tyne, Hull, Salford, and in 45 other-smaller towns ; the 27 uncertified causes of death in the77 towns last week included 7 in Birmingham, 4 in

Liverpool, and 2 each in] Sunderland, South Shields, andGateshead.

___

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns, having an,

estimated population of 1,710.299 persons (based on therecent Oensus enumeration) 929 births and 558 deathswere registered during the week ending May 13th.The annual rate of mortality in these towns, whichhad been equal to 19 and ];7; 3 per 1000 in the two pre.ceding weeks, further declined to 17’ 0 in the week undernotice. During the first six weeks of the current quarter theannual rate in these towns averaged 18’ 4 per 1000 of therecently enumerated population. The annual death-rate lastweek ranged in the eight towns from 13-1 and 14’2 per1000 in Perth and Leith to 18-3 in Glasgow and 24 - inGreenock. The 558 deaths from all causes in the eighttowns last week showed a further decline of 9 from thenumbers in recent weeks, but included 82 which were

referred to the principal epidemic diseases, against 8165, and 67 in the three preceding weeks; of these 82 deaths,43 resulted from whooping-cough, 15 from measles,9 from diarrhoea, 7 from scarlet fever, 6 from diphtheria, and2 from enteric fever, but not one from small-pox. The meanannual rate from these epidemic diseases in the eight townslast week was equal to 2-5 per 1000, and exceeded by l’Z Zthe mean rate from the same diseases in the 77 Englishtowns. The fatal cases of whooping-cough in the eighttowns, which had been 56, 40, and 37 in the three precedingweeks, rose again last week to 43, and included 27 in

Glasgow, 4 in Edinburgh, and 3 both in Dundee and Aber.deen. The 15 fatal cases of measles exceeded the numberin any recent week ; 12 occurred in Glasgow and 3 in,

Edinburgh. The 9 deaths attributed to diarrhoea were fewerby 2 than those in the previous week, including 5 in Glasgowand 2 in Dundee. The 7 fatal cases of scarlet fever showeda marked increase, 6 being recorded in Glasgow. Of the

6’deaths from diphtheria,. corresponding with the numberin the previous week, 2 occurred both in Glasgow andin Dundee. A death was referred to enteric fever inPaisley and in Perth. The deaths resulting from diseases.of the respiratory system in the eight towns, which hadbeen 136. 120. and 84 in the three Drecedine weeks, furtherdeclined last week to 75, and were 24 below the number inthe corresponding week of last year. Of the. 558 deaths fromall causes in the eight towns, 184, or 33 per cent., wererecorded in public institutions, and 33 were attributed tadifferent forms of violence. The causes of 14 deaths in the

eight towns last week, or 2’ 5 per cent., were not certified ornot stated ; in the 77 English towns last week the proportionof uncertified causes of death did not exceed Q’ 6 per cent.

HEALTH OF IRISH TOWNS.

In 22 town districts of Ireland, having an estimatedpopulation of 1,163,596 persons, 684 births and 397 deaths-were registered during the week ending May 13th. Theannual rate of mortality in these towns, which had beenequal to 22-0, 20-8, and 18-2 per 1000 in the three pre-ceding weeks, further declined to 17’8 in the week undernotice During the first six weeks of ’the current quarter theannual death-rate in these towns averaged 20’3 per 1000;the mean rate during the same period in the 77 Englishtowns did not exceed 14-6, and in the eight Scotch towns18 4 per 1000. The annual death-rate during the weekunder notice in the 22 Irish towns was equal to 20-8 inDublin (against 12 in London), 15-7 in Belfast, 20-5 inCork, 10’7 7 in Londonderry, 10 - 9 in Limerick, and 11’7 7 inWaterford; in the 16 smallest of these Irish towns themean annual death-rate during last week was equal to 18’? 7per 1000. The 397 deaths from all causes in the 22 towns

during the week showed a further decline of 10 from the highnumbers in recent weekp, and included 35 which were

referred to the principal epidemic diseases, against 2&-

1377

1378

in each of the two preceding weeks ; these 35 deaths 4

were equal to an annual rate of 1- 6 per 1000, 1

which exceeded by 0 - 3 the mean rate from the samediseases in the 77 English towns. Of these 35 deaths from Ithe principal epidemic diseases in the Irish towns, 17 resulted ]from measles, 6 from whooping-cough, 5 from diphtheria, I5 from diarrhoea, and 1 each from enteric fever and scarlet scarlet fever, but not one from small-pox. All the 17 fatal !cases of measles (an increase of 9 upon the number in the Jprevious week) occurred in Dublin. The 6 deaths fromwhooping-cough corresponded with the number in theprevious week; they included 2 each in Dublin, Cork, andSligo. Of the 5 deaths referred to diphtheria, 3 were re-corded in Dublin and 2 in Dundalk. The 5 deaths attributedto diarrhoea were fewer by 3 than those in the previous week.

I

The fatal case of enteric fever occurred in Dublin, and thatof scarlet fever in Belfast. The deaths in the 22 towns re-ferred to diseases of the respiratory system, which had been87 and 105 in the two preceding weeks, declined again to 86last week. Of the 397 deaths from all causes, 155, or 39 percent., were recorded in public institutions. The causes of 11,or 2’8 per cent., of the deaths in the 22 towns were

not certified either by a registered medical practitioneror by a coroner after inquest; the proportion of uncertifiedcauses of death in the week under notice did not exceed 0 - 6 6per cent. in the 77 largest English towns, and was equal to25 5 per cent. in the eight principal Scotch towns.

VITAL STATISTICS OF LONDON DURING APRIL, 1911.

IN the accompanying table will be found summarisedcomplete statistics relating to sickness and mortality in theCity of London and in each of the metropolitan boroughs.With regard to the notified cases of infectious diseases, itappears that the number of persons reported to be suffer-ing from one or other of the nine diseases specified in thetable was equal to an annual rate of 3’8 per 1000 of thepopulation, provisionally estimated at 4,912,054 persons inthe middle of the year. In the two preceding months therates were 4’1 and 3’9 per 1000 respectively. The lowestrates last month were recorded in Paddington, Kensington,the City of Westminster, St. Marylebone, Hampstead, andStoke Newington ; and the highest rates in the City ofLondon, Poplar, Bermondsey, Deptford, Greenwich, andWoolwich. Only 2 cases of small-pox were notifiedlast month, against 28 and 30 in the two precedingmonths; the 2 cases belonged to Poplar. The prevalenceof scarlet fever showed a slight increase compared withthat in the preceding month ; this disease was proportionallymost prevalent in Hammersmith, Fulham, Poplar, Ber-mondsey, Lambeth, Greenwich, and Woolwich. The numberof scarlet fever patients under treatment in the MetropolitanAsylums Hospitals, which had been 1280, 1224, and 1012at the end of the three preceding months, was 1018 atthe end of last month; the weekly admissions averaged127, against 142 and 124 in the two preceding months.Diphtheria was considerably less prevalent than in the

preceding month ; among the several metropolitan boroughsthe greatest proportional prevalence of this diseasewas recorded in Hammersmith, Fulham, Bethnal Green,Stepney, Poplar, Bermondsey, Greenwich, and Lewis-ham. The Metropolitan Asylums Hospitals contained827 diphtheria patients at the end of last month, against902 and 881 at the end of the two preceding months;the weekly admissions averaged 97, against 120 and107 in the two preceding months. The prevalence of entericfever showed but little variation from that recorded in the pre-vious month ; this disease was proportionally most prevalentlast month in Hackney, Finsbury, Southwark, and Lambeth.There were 22 enteric fever patients under treatment in theMetropolitan Asylums Hospitals at the end of the month,against 68, 41, and 32 at the end of the three precedingmonths; the weekly admissions averaged 5, against 7 and3 in the two preceding months. Erysipelas was propor-tionally most prevalent in Finsbury, Shoreditch, BethnalGreen, Stepney, Southwark, Deptford, and Greenwich. The32 cases of puerperal fever notified during the month in-cluded 3 in Fulham, in Islington, in Stepney, in Ber-mondsey, and in Battersea. The 9 cases notified as cerebro-spinal meningitis included 2 in Islington and 2 in Poplar.The mortality statistics in the table relate to the deaths of

persons actually belonging to the several boroughs, the deaths

occurring in institutions having been distributed amongthe boroughs in which the deceased persons had pre.viously resided; the death-rates from all causes are furthercorrected for variations in the sex and age constitution of thepopulation of the seve ral boroughs. During the four weeksending April 29th the deaths of 5533 London residents wereregistered, equal to a corrected annual rate of 15’5 per 1000,against 16-5,17-6, and 16- 0 per 1000 in the three precedingmonths. The death-rates last month ranged from 10-4 inLewisham, 12-1 in Fulham and in Hampstead, 12-2 inWoolwich, 12 - 6 in Battersea, 13’1 in Greenwich, and 13. 7in Deptford, to 18 - 3 in lPoplar, 18 - 4 in Holborn, 18.9 inBethnal Green, 19-1 in Bermondsey, 19-9 in Finsbury,20-6 in the City of London, and 20-8 in Shoreditch.The 5533 deaths from all causes included 1 from small.

pox, 381 from measles, 12 from scarlet fever, 46 from

diphtheria, 161 from whooping-cough, 4 from enteric fever,and 60 (among children under two years of age) from diarrhceaand enteritis. The lowest death-rates from these diseasesin the aggregate were recorded in Kensington, the City ofWestminster, Hampstead, Holborn, Battersea, Lewisham,and Woolwich; and the highest rates in Paddington,Shoreditch, Bethnal Green, Stepney, Poplar, and Wands.worth. The 381 deaths from measles were 142 in excessof the corrected average number for the correspondingperiod of the five preceding years; among the metro.

politan boroughs this disease was proportionally mostfatal in St. Marylebone, Hackney, Bethnal Green, Stepney,Poplar, and Wandsworth. The 12 deaths from scarletfever showed a decline of 25 from the corrected averagenumber, and included 2 in Paddington and 2 in Poplar.The 46 fatal cases of diphtheria were slightly fewerthan the corrected average number; the greatest pro.portional mortality from this disease was recorded lastmonth in Hammersmith, Finsbury, Shoreditch, BethnalGreen, Bermondsey, Greenwich, and Woolwich. The 161deaths from whooping-cough were 17 below the correctedaverage number ; this disease was proportionally most fatalin Paddington, St. Pancras, Bethnal Green, Southwark,Bermondsey, and Deptford. The 4 fatal cases of entericfever showed a decline of 9 from the corrected averagenumber, and belonged respectively to Islington, Southwark,Lambeth, and Wandsworth. The 60 deaths from diarrhoeaand enteritis among children under two years of ageincluded 7 in Wandsworth, 6 in Hammersmith, 5 in

Islington and in Stepney, and 4 in Paddington, in Fulham,and in Shoreditch. In conclusion, it may be stated thatthe aggregate mortality in London last month from the

principal infectious diseases (excluding diarrhoea) was

17.5 per cent. above the average.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE undermentioned Staff-Surgeons have been promoted to

the rank of Fleet-Surgeon in His Majesty’s Fleet: RobertJohn MacKeown, Paul Hohling Mills Star, Edwin SwainsonMiller, Herbert Henry Pearse, Oswald Rees, Cecil HowardRock, Sidney Thomas Reid, Charles James Edward Cock,John Elphinstone Hood Phillips, and Albert Xavier Lavertine(dated May 15th, 1911).The undermentioned Surgeons have been promoted to the

rank of Staff-Surgeon in His Majesty’s Fleet: AlfredWilliam Iredell, Frederick Cecil Robinson, Maurice TaylorMale, Charles Henry Dawe, Reginald Thompson, WilliamKenneth Dudoit Breton, Edgar Sheldon Wilkinson, RobertKennedy, Edward Aubrey Guy Wilkinson, John StewardLabouverie Page, William Edwin Ormsby, John JosephHogan Rooney, and Aloysius Francis Fleming (datedMay 16th, 1911).The following appointments are notified :-Fleet-Surgeons :

W. B. Macleod to the Invinoible on recommissioning; andE. B. Townsend to the Superb on recommissioning. Staff-Surgeons : M. J. Smith to the Mars; and C. H. J. Robinsonto the Roxburgh on recommissioning. Surgeons : W. T.

Haydon to the Invinoible on recommissioning ; A. C. Rusackto the Superb on recommissioning ; R. Willan to the Viotm7,for R.N. Barracks ; R. Kennedy to the Viotory, additional,for disposal; J. E. Johnston to the Gossamer ; and B. Taylorto the Dreadno2cght.