1242

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS. ,IN 76 of the largest English towns 8345 births and 4661

deaths were registered during the week ending Oct. 22nd.The annual rate of mortality in these towns, which hadbeen 15’6, 15’ 1, and 15 . 2 per 1000 in the three precedingweeks, further rose to 15’9 per 1000 last week. InLondon the death-rate was 16’ 6 per 1000, while it averaged15’ 6 per 1000 in the 75 other large towns. The lowestdeath-rates in these towns were 7’ in Hornsey, 8’ 3 inWillesden and in Wigan, 8’ 6 in Smethwick, 8’ 7 in Croydonand in Handsworth (Staffs.), and 8’9 in Reading, in

Rotherham, and in Cardiff; the highest rates were 20’ 0in Middlesbrough, 20’ in Bootle, 20’4 in Stockport,22-4 in Liverpool, 22-6 in Tynemouth, 23 ’ 2 in Salford,23-3 in Burnley, and 23-7 7 in Hanley. The 4661deaths in these towns last week included 532 whichwere referred to the principal infectious diseases, against836, 615, and 573 in the three preceding weeks ; of these532 deaths, 206 resulted from diarrhoea, 127 from measles,75 from diphtheria, 47 from "fever" (principally enteric),42 from whooping-cough, 30 from scarlet fever, and fivefrom small-pox. No death from any of these diseasesoccurred in Croydon, Bournemouth, Devonport. Coventry,Wallasey, Rochdale, or Cardiff ; while they caused thehighest death-rates in Plymouth, Grimsby, Liverpool, Bootle,Salford, Burnley, Preston, and Hull. The greatest propor-tional mortality from measles was recorded in Plymouth,Walsall, Grimsby, Birkenhead, Liverpool, Salford, Halifax,and Tynemouth ; from scarlet fever in Burnley; from

diphtheria in Bootle and Salford ; from " fever " in Grimsby,Stockport, and Wigan ; and from diarrhoea in Great Yar-mouth, Oldham, Burnley, Preston, Middlesbrough, and

Rhondda. The mortality from whooping-cough showed nomarked excess in any of the large towns. Of the five fatalcases of small-pox among persons resident in these towns twobelonged to Newcastle-on-Tyne and one each to Nottingham,Bury, and Preston. The numberof small-pox patients in theMetropolitan Asylums hospitals, which had been three, two,and one at the end of the three preceding weeks, was

again one at the end of last week. The number of scarletfever cases in these hospitals and in the London Fever

Hospital on Saturday, the 22nd inst., was 2687, against2158, 2341, and 2516 on the three preceding Saturdays ; 389new cases were admitted during the week, against 406,409, and 377 in the three preceding weeks. The deaths inLondon referred to pneumonia and diseases of the respira-tory organs, which had been 167, 166, and 194 in thethree preceding weeks, further rose to 251 last weekand were 57 in excess of the number in the corre-

sponding period of last year. Influenza was stated as

the primary cause of 16 deaths in London last week,against nine, ten, and 22 in the three preceding weeks.The causes of 47, or 1’0 0 per cent., of the deaths in the76 towns last week were not certified either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in West Ham, Bristol, Nottingham,Salford, Leeds, and in 51 other smaller towns ; the largestproportions of uncertified deaths were registered in Wallsall,Birmingham, Liverpool, Sheffield, Sunderland, and SouthShields.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 16-6, 15-1, and 15-8 per1000 in the three preceding weeks, further rose to 16-5 5per 1000 during the week ending Oct. 22nd and was0-6 per 1000 in excess of the mean rate during thesame period in the 76 large English towns. Therates in the eight Scotch towns ranged from 10’ 8in Perth and 13 - 5 in Greenock, to 18 - 0 in Paisley and20-1 in Leith. The 547 deaths in these towns included26 which were referred to diarrhoea, 17 to whooping-cough, eight to measles, eight to diphtheria, seven to" fever " (including one to typhus), and four to scarlet fever,but not any to small-pox. In all, 70 deaths resulted fromthese principal infectious diseases last week, against 101,71, and 75 in the three preceding weeks. These 70 deathswere equal to an annual rate of 2’ per 1000, which was0 ’3 per 1000 above the mean rate last week from the samediseases in the 76 large English towns. The fatal cases of

diarrhoea, which had been 58, 36, and 31 in the three pre-ceding weeks, further declined last week to 26, of which 17occurred in Glasgow, four in Dundee, two in Edinburgh, andtwo in Leith. The deaths from whooping-cough, which hadbeen 23, 20, and 21 in the three preceding weeks, declined againto 17 last week, and included 15 in Glasgow. The fatal casesof measles, which had been three and five in the two pre-ceding weeks, further rose last week to eight, of which fivewere registered in Aberdeen and three in Glasgow. Thedeaths referred to "fever," which had been six in eachof the two preceding weeks, increased to seven last week,and included four cases of enteric fever and one of typhusin Glasgow, and two of enteric fever in Greenock. The fourfatal cases of scarlet fever corresponded with the number inthe preceding week, and included two in Aberdeen. Thedeaths referred to diseases of the respiratory organs inthese towns, which had been 75, 73, and 76 in the three

preceding weeks, further rose last week to 95, and were

slightly in excess of the number in the corresponding periodof last year. The causes of 11, or more than 2 per cent., ofthe deaths registered in these eight towns last week werenot certified.

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HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 19 0, 17’ 5, and21’ per 1000 in the three preceding weeks, rose again to24’9 per 1000 during the week ending Oct. 22nd. Duringthe past four weeks the death-rate has averaged 20 8 per1000, the rates during the same period being 14’ 8 inLondon and 14’ 2 in Edinburgh. The 181 death, of

persons belonging to Dublin registered during the weekunder notice were 24 in excess of the number in the pre-ceding week and included 18 which were referred to theprincipal infectious diseases, against 19, 15, and 12 in thethree preceding weeks ; of these, 11 resulted fromdiarrhoea, six from measles, and one from diphtheria,but not any from small-pox, scarlet fever, whooping-cough, or " fever." These 18 deaths were equal to an annualrate of 2’ 5 per 1000. the death-rates last week fromthe principal infectious diseases being 1.3 in Londonand 0 ’ 9 in Edinburgh. The fatal cases of diarrhoea, whichhad been 16, ten, and eight in the three preceding weeks,rose again last week to 11. The deaths from measles numberedsix last week, none having been recorded in any of the threepreceding weeks. The 181 deaths in Dublin last week included63 of children under one year of age and 42 of persons aged60 years and upwards; the deaths of infants showed a con-siderable excess while those of elderly persons were but

slightly more numerous than in the preceding week. Five

inquest cases and three deaths from violence were registered,and 57, or nearly a third, of the deaths occurred in publicinstitutions. The causes of 11, or more than 6 per cent., ofthe deaths in Dublin last week were not certified.

VITAL STATISTICS OF LONDON DURING SEPTEMBER, 1904.’ IN the accompanying table will be found summarised

: complete statistics relating to sickness and mortality in the. City of London and in each of the metropolitan boroughs., With regard to the notified cases of infectious diseases it’

appears that the number of persons reported to be suffering’ from one or other of the nine diseases specified in the table

was equal to an annual rate of 8 ’ 0 per 1000 of the population,estimated at 4,648,950 persons in the middle of the year. Inthe three preceding months the rates had been 5’ 4, 6’ 1, and6’ 0 per 1000 respectively. The rates were considerably below

i the average in Kensington, Chelsea, the City of Westminster,r Lambeth, Greenwich, and Lewisham ; while they showed) the largest excess in St. Pancras, Stoke Newington, Hackney,3 Bethnal Green, Stepney, and Poplar. The notified cases ofsmall-pox, which had been 60,32, and four in the three preced-ing months, were again four last month, and included two in3 Camberwell, one in Wandsworth, and one in Woolwich. The

1 Metropolitan Asylums hospitals contained three small-pox1 patients at the end of last month, against 74, 46, and nine- at the end of the three preceding months; the weekly3 admissions averaged one, against 13, eight, and one in the, three preceding months. Scarlet fever was much more pre-1 valent during September than in any other recent month;, the greatest proportional prevalence of this disease occurreds in St. Pancras, Stoke Newington, Hackney, Finsbury,s Bethnal Green, Stepney, and Camberwell. The numbere of scarlet fever patients in the Metropolitan Asylumsf hospitals, which had been 1599, 1764, and 1801 at

1243VITAL STATISTICS OF LONDON DURING SEPTEMBER, 1904.

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the end of the three preceding months, had furtherrisen to 2127 at the end of last month; the weeklyadmissions averaged 311, against 214 in each of thetwo preceding months. The prevalence of diphtheriawas considerably in excess of that recorded in the

preceding month ; among the various metropolitanboroughs this disease was proportionally most preva-lent in Stoke Newington, the City of London, Bethnal

Green, Stepney, Poplar, and Deptford. The MetropolitanAsylums hospitals contained 871 diphtheria patients at theend of September, against 681, 763, and 818 at the end ofthe three preceding months; the weekly admissions averaged131, against 95, 124, and 119 in the three preceding months.The notified cases of enteric fever averaged 78 per week duringlast month, against 22, 27, and 49 per week in the three pre-ceding months ; the greatest proportional prevalence of thisdisease occurred in St. Marylebone, St. Pancras, Islington,Hackney, Stepney, Poplar, and Bermondsey. The number ofenteric fever patients in the Metropolitan Asylums hospitals,which had been 62, 67, and 135 at the end of the three

preceding months, had further risen to 237 at the end ofSeptember ; the weekly admissions averaged 45, against 12,15, and 29 in the three preceding months. Erysipelas wasproportionally most prevalent in St. Marylebone, Holborn,Finsbury, Shoreditch, Bethnal Green, and Stepney. The 13cases of puerperal fever notified during the month includedfour in Stepney, two in Hampstead, and one each in Islington,Hackney, Holborn, Finsbury, Shoreditch, Southwark, andWoolwich.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various metropolitanboroughs, the deaths occurring in public institutions havingbeen distributed among the several boroughs in which thedeceased persons had previously resided. During the fourweeks ending Oct. lst the deaths of 5003 personsbelonging to London were registered, equal to an annualrate of 14’ 0 per 1000 ; in the three preceding months therates had been 12 5, 13’ 6, and 19 ’ 1 per 1000 respectively.The lowest death-rates in London last month were

8 ’ 6 in Hampstead, 10’ 2 in Lewisham, 10 ’ 5 in Hammersmith,11’ 4 in Kensington, 11’ 7 in the City of London, and11 - 8 in Wands worth ; the highest rates were 16 6 in

Bermondsey, 17’ 4 in Southwark, 17’ 9 in Stepney, 19 ’ 0 inFinsbury, and 19.4 4 in Bethnal Green. The 5003 deathsfrom all causes included 843 which were referred to the

principal infectious diseases ; of these, 38 resulted frommeasles, 28 from scarlet fever, 64 from diphtheria, 46 fromwhooping-cough, 39 from enteric fever, two from ill-definedforms of continued fever, and 626 from diarrhoea. Thelowest death-rates from these diseases last month were

recorded in Hammersmith, the City of Westminster,Hampstead, Stoke Newington, and the City of London ;and the highest rates in Bethnal Green, Stepney, Poplar,Bermondsey, Deptford, Greenwich, and Woolwich. The38 fatal cases of measles showed a decline of 28 fromthe corrected average number; among the various

metropolitan boroughs this disease was proportionatelymost fatal in St. Pancras, Islington, Holborn, Deptford,and Greenwich. The 28 deaths from scarlet feverwere 19 below the average number in the correspondingperiods of the ten preceding years; this disease was pro-portionally most fatal in Paddington, Islington, StokeNewington, the City of London, Poplar, and Battersea. Thefatal cases of diphtheria numbered 64 last month, thecorrected average number being 139; among the various

metropolitan boroughs the greatest proportional mortalityfrom this disease occurred in Hackney, Bethnal Green,Stepney, Poplar, Bermondsey, and Deptford. The deathsfrom whooping-cough, which had averaged 102 in the corre-sponding periods of the ten preceding years, declined lastmonth to 46 ; this disease was proportionally most fatal inHammersmith, the City of Westminster, Holborn, Shore-

ditch, and Lambeth. The 41 fatal cases of "fever" were 21below the corrected average number ; among the various

metropolitan boroughs the highest ’’ fever" death-rateswere recorded in Hampstead, Hackney, Shoreditch,Stepney, Poplar and Bermondsey. The 626 deaths fromdiarrhoea showed a decline of 50 from the average number inthe corresponding periods of the ten preceding years; thisdisease was proportionally most fatal in Finsbury, BethnalGreen, Poplar, Bermondsey, Greenwich, and Woolwich. Inconclusion, it may be stated that the aggregate mortalityin London last month from the principal infectious diseaseswas nearly 22 per cent. below the average.

Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 146 per 1000. The lowest rates of infant

mortality were recorded in Hammersmith, the City of

Westminster, St. Marylebone, Hampstead, Holborn, and theCity of London; and the highest rates in Paddington,Bethnal Green, Stepney, Bermondsey, Camberwell, and

Deptford. _____

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Staff Surgeon

T. D. Halahan to the Scylla. Surgeons : J. H. Lightfoot tothe Vivid; J. W. Bird to the Vivid for Devonport Dock-yard ; R. R. Fasson to the Excellent, temporary ; andH. C. Arathoon to the Egmont.

Staff Surgeon Ernest Courtney Lomas, D.S.O., has beenpromoted to the rank of Fleet Surgeon.

ROYAL ARMY MEDICAL CORPS.

Captain H. H. Norman proceeds to Woolwich for duty.Lieutenant J. E. Powell is held in readiness for service inIndia. Captain S. W. Sweetnam embarks for India forservice in Madras. Colonel J. F. Williamson, C.B., takesup duty in India on the close of his active service with theSomaliland Field Force. Colonel W. J. R. Rainsford,C.I.E., is appointed Principal Medical Officer, Bermuda;and Lieutenant-Colonel P. H. Johnston, C.M.G., is appointedPrincipal Medical Officer, Jamaica. Lieutenant-ColonelS. C. B. Robinson is appointed to the charge of the MilitaryHospital, Colchester.

ROYAL MALTA ARTILLERY.Robert Randon to be Surgeon-Lieutenant (with local and

temporary rank) to complete establishment (dated Oct. 8th.1904).

VOLUNTEER CORPS.

-Rifle: 6th Volunteer Battalion the Royal Scots (LothianRegiment): James Henry Horsburgh to be Surgeon-Lieu-tenant (dated Oct.: 22nd, 1904). lst Volunteer Battalionthe Buffs (East Kent Regiment) : Surgeon-Lieutenant C. M.Atkinson resigns his commission (dated Oct. 22nd, 1904).1st Herefordshire : Brigade-Surgeon-Lieutenant-Colonel P. B.Giles is granted the honorary rank of Surgeon-Colonel (datedOct. 22nd, 1904).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).The London Companies: Surgeon-Lieutenant-Colonel J.

Cantlie, 7th Middlesex (London Scottish) Volunteer Rifle

Corps and Honorary Lieutenant-Colonel Commandant Maid-stone Companies, Royal Army Medical Corps (Volunteers),is appointed to the Honorary Colonelcy of the London

Companies (dated Oct. 22nd, 1904).There will be a parade of the London Companies for

Divine Service at the Church of St. Bartholomew the Great,West Smithfield, on Sunday, Oct. 30th, at 11 A.M., when theattendance of anyone interested in the Corps is cordiallyinvited. The headquarters of the Corps are 51, Calthorpe-street, London, W.C.

THE CASE OF MAJOR N. P. SINHA,LM.S.We have had an opportunity of reading a copy of the

memorial of Major N. P. Sinha, I.M.S., late civil surgeonof Rungpur, to the Government of India with its ordersthereon, against which we understand this officer isabout to submit an appeal to the Secretary of State forIndia. The papers setting forth the facts connected withthe case are somewhat voluminous and do not easily lendthemselves to any brief analysis. The case seems, however,to have arisen out of a charge of alleged neglect on thepart of Major Sinha in not having complied with a

telegram from the magistrate of Bogra asking him to

proceed to that station to attend an assistant surgeon incivil medical charge of that district who was seriouslyill and of having also been the cause of delay in not havingmore promptly furnished some requisite information by tele-gram. Apart from some corrected discrepancy about datesMajor Sinha explains the circumstances in which he was

placed at the time and expresses his regret for an unfortunateomission on his part, entirely attributable, he alleges, to anerror of judgment in not having ascertained before leavingheadquarters whether the information which he had receivedabout the death of the Bogra civil medical officer was.