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THE LONDON COUNTY COUNCIL ANDMEDICAL AFFAIRS.

Treatment of Titberoitlosis.THE Public Health Committee of the London County

Council has reported with reference to the instruction ofthe Council in February to prepare forthwith a scheme fordealing with tuberculosis throughout the country.’ 1 Thecommittee noted a change of view on this subject on thepart of the Local Government Board ; the Board apparentlyno longer desired the Council to prepare a scheme dealingwith dispensary provision, but desired the metropolitanboroughs to make arrangements, the Council to act merelyas a critic. The committee had asked for a clear statementfrom the Board on this point. It would be realised howdifficult it was to prepare a comprehensive scheme if thelocal authorities were dealing with the problem simul-

taneously from a local standpoint and without regard to theneeds of London as a whole. Several borough schemesalready prepared provided for the establishment of municipaldispensaries to the exclusion of existing provision, whereasit was manifestly desirable that regard should be had toexisting available institutions.The Council, at the request of the committee, expressed

approval of the’ following principles in regard to provisionfor tuberculosis treatment :-

,

1. All possible use should be made of existing institutions. ’

2. Approval should not be given to any scheme which fails to providefor each dispensary being linked up with a hospital to which specialcases shall be referred for consultation or treatment, residential orotherwise; and that the Local Government Board be so informed., I .

Regulation of Lying-in Homes.Notice has been given of the intention to promote legisla-

tion in the session of 1914 to obtain power to license lying-inhomes in the county of London. The Midwives Act Committeestated in recommending this step that in administering theMidwives Acts it had been impressed with the necessity,both from the sanitary and from the moral point of view,for some measure of public control being exercised over

lying-in homes. Over 100 houses and institutions at whichpregnant women were received were known to exist in

London, and the necessity for conferring on local authoritiespowers to regulate such places was recognised to some

extent in the two Bills for the amendment of the MidwivesAct, 1902, which were introduced in the House of Lords inthe session of 1910. Moreover, representations had recentlybeen made by delegates from various charitable societies andothers that, as the result of the passing of the NationalInsurance Act, 1911, unmarried women who formerlyobtained admittance to Poor-law institutions for their con-finements, now in many cases received maternity benefitunder the Act and entered lying-in homes, at which, in someinstances, they were subjected to immoral influences.

School ]}Iedical Service reply to Criticisms by the Board t{Ed1wation.

Dealing with the criticisms of the school medical servicein London contained in the letter of the Board of Education,as reported in THE LANCET of August 2nd, the EducationCommittee promises a report in due course as to theextension of the functions of the assistant medical officerssuggested by the Board. As to the criticism that certain

inspection work was undertaken by nurses instead ofby doctors, the committee stated that the nurses must

necessarily do some routine work in preparation for thevisit of the doctor and in order that he might inspectthe requisite number of children at each of his visits.The physical measurements carried out by the nurses in 1911were in complete agreement with the standards arrived at informer years from measurements made by medical officers.Arrangements, however, were being made for the schooldoctors to take the physical measurements on all occasionsof children suffering from malnutrition. The school doctorshad been instructed to examine all cases of defective visionreported as a result of the preliminary examination by thenurse, and the standard of defect was to be made morestringent. The preliminary examination of children for

hard-of-hearing classes was made by the school doctor, andsome cases were further specially examined by the Council’sotologist.

1 THE LANCET, Feb. 15th, 1913, p. 476.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns, 7589 births and4125 deaths were registered during the week ended Saturday,August 9th. The annual rate of mortality in these towns,which had been 11 - 3, 11 - 0, and 11-6 6 per 1000 in the threepreceding weeks, turther rose to 12 0 per 1000 in the weekunder notice. During the first six weeks of the current

quarter the mean annual death-rate in these towns averaged11-4, against 10-8 per 1000 in London during the sameperiod. Among the several towns the death-rate in the weekunder notice ranged from 4-5 5 in Wimbledon, 4’6 6 in Cam-bridge, 5-0 0 in Merthyr Tydfil, 5’1 in Willesden, and 5-8in Oxford, to 18-4 in Walsall, 19-4 in Dewsbury, 19-5 5 inWigan, 19-8 8 in Aberdare, and 21- 2 in Birkenhead.The 4125 deaths from all causes in the 96 towns were

172 in excess of the number in the previous week, and in-cluded 562 which were referred to the principal epidemicdiseases, against numbers rising from 281 to 448 in the fivepreceding weeks. Of these 562 deaths, 391 resulted frominfantile diarrhceal diseases, 67 from measles, 45 fromwhooping-cough, 25 from diphtheria, 21 from scarlet fever,and 13 from enteric fever, but not one from small-pox.The mean annual death-rate from these diseases in theweek under notice was equal to 1-6, against 1-2 and 1-3per 1000 in the two preceding weeks. The deaths of infants(under two years of ag6) attributed to diarrhoea andenteritis, which had been’ 149, 214, and 264 in the threepreceding weeks, further rose to 391, and included 73in London, 25 in Birkenhead, 24 in Liverpool, 24 inManchester, 19 in Sheffield, 19 in Birmingham, 14 inCardiff, and 13 in St. Helens. The deaths referred tomeasles, which had been 68, 77, and 77 in the three pre-ceding weeks, declined to 67 in the week under review; 13deaths occurred in London, 13 in Stoke-on-Trent, 5 in Liver-pool, 4 in West Bromwich, and 4 in Manchester. The fatalcases of whooping-cough, which had been 62, 50, and 47in the three preceding weeks, further fell to 45; of thisnumber 9 were registered in London, 5 in Manchester, 3 inLiverpool, and 3 in Oldham. The deaths attributed to

diphtheria, which had been 35, 31, and 36 in the three pre-ceding weeks, declined to 25, and included 8 in London,2 in Stoke-on-Trent, and 2 in Birmingham. The deathsreferred to scarlet fever, which had been 20, 15, and 18 inthe three preceding weeks, slightly rose to 21; 5 deathswere recorded in Birmingham, 4 in London, 2 in Bury, and2 in Manchester. The fatal cases of enteric fever, whichhad declined from 14 to 6 in the four preceding weeks, roseto 13 and included 2 in London and 2 in South Shields.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,which had steadily increased from 1418 to 2125 in the

preceding eight weeks, had further risen to 2131 on

Saturday, August 9th ; 244 new cases were admittedduring the week, against 357, 346, and 258 in thethree preceding weeks. These hospitals also containedon August 9th 887 cases of diphtheria, 236 of measles,233 of whooping-oough, and 54 of enteric fever, butnot one of small-pox. The 987 deaths in London were 99in excess of the number in the previous week, andcorresponded to an annual death-rate of 11’4 per 1000.The deaths referred to diseases of the respiratory system,which had been 115, 107, and 108 in the three precedingweeks, slightly rose to 115, and were 16 in excess of thenumber recorded in the corresponding week of last year.’Of the 4125 deaths from all causes in the 96 towns, 201

resulted from various forms of violence and 394 were

the subject of coroners’ inquests. The causes of 43, or1 -0 per cent., of the total deaths were not certified either bya registered medical practitioner or by a coroner after

inquest. All the causes of death were duly certified inSheffield, Leeds, Bristol, West Ham, Bradford, Newcastle-on-Tyne, Nottingham, and in 64 other smaller towns. Ofthe 43 uncertified causes of death, 8 were recorded inBirmingham, 3 in London, 3 in Gloucester, 3 in Liverpool,and 2 each in Portsmouth, in St. Helens, in Southport, inDarlington, and in Carlisle.

In the 96 English and Welsh towns, with populationsexceeding 50,000 at the last Census, and whose aggre-gate population at the middle of this year is estimatedat 17,852,766 persons, 9266 births and 4569 deaths were

586

registered during the week ended Saturday, August 16th.The annual rate of mortality in these towns, which hadbeen 11-0, 11’ 6, and 12. per 1000 in the three pre-ceding weeks, further rose to 13’3 per 1000 in the weekunder notice. During the first seven weeks of the currentquarter the mean annual death-rat,e in these towns averaged11-7, against 11-0 per 1000 in London during the same

period. Among the several towns the death-rates last weekranged from 2-4 in Ilford, 2-9 in Eastbourne, 4-4 in

Bournemouth, 5-4 in Ealing, and 5’5 5 in Cambridge, to 18 8in Bootle, 18’9 in St. Helens, 21-2 in Walsall, 21’8 inWigan, and 21-9 9 in Birkenhead.The 4569 deaths from all causes in the 96 towns were

444 in excess of the number in the previous week, andincluded 751 which were referred to the principal epidemicdiseases, against numbers rising from 281 to 562 in the sixpreceding weeks. Of these 751 deaths, 581 resulted frominfantile diarrhoeal diseases, 56 from measles, 49 fromwhooping-cough, 34 from diphtheria, 22 from scarlet fever,9 from enteric fever, and not one from small-pox. Themean annual death-rates from these diseases last weekwas equal to 2-2, against 1-3 and 1-6 per 1000 inthe two preceding weeks. The deaths of infants (under2 years of age) attributed to diarrhoea and enteritis,which had been 214, 264, and 391 in the three precedingweeks, further rose to 581 last week, and included 96 inLondon, 49 in Liverpool, 41 in Manchester, 35 in Birming-ham, 29 in Birkenhead, and 27 in Bradford. The deathsreferred to measles, which had been 77, 77, and 67 in thethree preceding weeks, fell to 56 last week; 11 deathsoccurred in London, 9 in Stoke-on-Trent, 6 in Liverpool, and5 in Manchester. The fatal cases of whooping-cough, whichhad been 50, 47, and 45 in the three preceding weeks, roseagain to 49 last week ; of this number 7 were registered inLondon, 4 in Liverpool, and 4 in Bolton. The deathsreferred to diphtheria, which had been 31, 36, and 25 in thethree preceding weeks, rose again to 34 last week, andincluded 4 each in London, Birmingham, Liverpool, andLeeds, and 3 in Cardiff. The deaths from scarlet fever,which had been 15, 18, and 21 in the three precedingweeks, were 22 last week ; 8 deaths occurred in London and4 in Birmingham. The 9 deaths from enteric fever wereabout equal to the average in recent weeks, and included 3in London.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,which had steadily increased from 1418 to 2131 in the

preceding nine weeks, fell slightly to 2124 on Saturdaylast ; 230 new cases were admitted during the week,against 346, 258, and 244 in the three precedingweeks. These hospitals also contained on Saturdaylast 855 cases of diphtheria, 202 of measles, 230 of

whooping-cough, and 47 of enteric fever, and not one

of small-pox. The 1047 deaths in London were 60 morethan the number in the preceding week, and correspondedto an annual death-rate of 12-1 per 1000. The deathsreferred to diseases of the respiratory system, which hadbeen 107, 108, and 115 in the three preceding weeks, furtherrose to 130 last week, and were 11 above the numberrecorded in the corresponding week of last year.

Of the 4569 deaths from all causes in the 96 towns, 175resulted from various forms of violence and 374 were thesubject of coroners’ inquests. The causes of 33, or 0’7 percent., were not certified either by a registered medicalpractitioner or by a coroner after inquest. All the causesof death were duly certified in London, West Ham,Bristol, Leicester, Nottingham, Manchester, Salford,Bradford, Leeds, Hull, and Newcastle-on-Tyne, and in 67other smaller towns. Of the 33 uncertified causes ofdeath, 7 were recorded in Birmingham, 5 in Liverpool,3 each in Stoke-on-Trent and in South Shields, and 2 inSheffield.

___

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns 1081 births and 609deaths were registered during the week ended Saturday,August 9th. The annual rate of mortality in these towns,which had been 13 - 2, 13-1, and 14-8 per 1000 in the threepreceding weeks, declined to 141 per 1000 in the weekunder notice. During the first six weeks of the current

quarter the mean annual death-rate in these Scotch townsaveraged 13-8, against 11-4 per 1000 in the 96 large

English towns. Among the several Scotch towns thedeath-rates in the week under review ranged from 6’0 inKilmarnock, 9’1 in Leith, and 10’4 in Perth, to 15 6 inKirkcaldy, 16-8 in Ayr, and 22 - 6 in Dundee.The 609 deaths from all causes were 34 below the

number in the previous week, and included 79 which werereferred to the principal epidemic diseases, against 64 and61 in the two preceding weeks. Of these 79 deaths, 39resulted from infantile diarrhoeal diseases, 20 from measles,10 from whooping-cough, 6 from diphtheria, 2 from entericfever, and 2 from scarlet fever, but not one from small-pox. These 79 deaths from the principal epidemic diseasescorresponded to an annual death-rate of 1 8, against 1’6 6per 1000 in the 96 large English towns. The deaths ofinfants (under 2 years of age) attributed to diarrhoea andenteritis, which had been 13, 24, and 21 in the threepreceding weeks, rose to 39 in the week under review, andincluded 25 in Glasgow, 4 in Dundee, 3 in Motherwell, and2 in Paisley and in Leith. The deaths referred to measles,which had been 28, 18, and 16 in the three precedingweeks, rose to 20, and comprised 16 in Glasgow, 2in Paisley, and 2 in Greenock. The fatal cases of

whooping-cough, which had been 11, 15, and 14 inthe three preceding weeks, declined to 10, and included5 in Glasgow. The 6 deaths attributed to diphtheria,of which 2 occurred in Glasgow and 2 in Aberdeen,were slightly in excess of the average in the earlier weeksof the quarter. The 2 fatal cases of enteric fever wererecorded in Glasgow, and those of scarlet fever in Edin-burgh.The deaths referred to diseases of the respiratory system,

which had been 71, 63, and 83 in the three precedingweeks, were 79 in the week under notice ; 27 deaths resultedfrom different forms of violence, against 24 and 21 in thetwo preceding weeks.

In the 16 largest Scotch towns, with an aggregate popula-tion estimated at 2,259,600 persons at the middle of thisyear, 1103 births and 567 deaths were registered during theweek ended Saturday, August 16th. The annual rate of

mortality in these towns, which had been 13-1, 14-8, and14-1 in the three preceding weeks, further fell to 13’1 per1000 in the week under notice. During the first seven weeksof the current quarter the mean annual death-rate in theseScotch towns averaged 13-7, against 11-7 7 per 1000 in the96 large English towns. Among the several Scotch towns thedeath-rates last week ranged from 6’ 0 in Kilmarnock, 8’4 4 inLeith, 8’5 in Clydebank, and 8-8 in Falkirk, to 14-4 in

Glasgow, 14-9 in Perth, 17’6 in Hamilton, and 19-2 inCoatbridge.The 567 deaths from all causes were 42 below the

number in the previous week, and included 80 which werereferred to the principal epidemic diseases, against 61 and79 in the two preceding weeks. Of these 80 deaths, 45resulted from infantile diarrhceal diseases, 13 from measles,11 from whooping-cough, 10 from diphtheria, and 1 fromenteric fever, but not one from scarlet fever or from small-pox. These 80 deaths from the principal epidemic diseasescorresponded to an annual death-rate of 1’8, against 2’2 2 per1000 in the 96 large English towns. The deaths of infants

(under 2 years of age) attributed to diarrhoea and enteritis,which had been 24, 21, and 39 in the three preceding weeks,further rose to 45 last week, and included 28 in Glasgow,6 in Dundee, and 3 in Hamilton. The deaths referredto measles, which had been 18, 16, and 20 in the three pre-ceedirg weeks, fell to 13 last week, and included 9 in

Glasgow and 2 in Edinburgh. The fatal cases of whooping-cough, which had been 15, 14, and 10 in the three precedingweeks, rose slightly to 11 last week, and included 7 inGlasgow. The deaths from diphtheria, which had been 2, 5,and 6 in the three preceding weeks, further rose to 10 lastweek, of which 5 occurred in Glasgow and 2 in Aberdeen.The death from enteric fever occurred in Clydebank.The deaths referred to diseases of the respiratory system,

which had been 63, 83, and 79 in the three preceding weeks,fell to 44 last week; 28 deaths resulted from different formsof violence, against 28 and 27 in the two preceeding weeks.

HEALTH OF IRISH TOWNS.

In the 27 town districts of Ireland 551 births and 357deaths were registered during the week ended Saturday,August 9th. The annual rate of mortality in these towns,which had been 15-2, 16 - 4, and 16 - 6 per 1000 in the three

587

preceding weeks, declined to 15’ 5 per 1000 in the week undernotice. During the first six weeks of the current quarter the I

mean annual death-rate in these Irish towns averaged I15’ 9 per 1000 ; in the 96 large English towns the correspond- I

ing rate did not exceed 11’4, while in the 16 Scotch I

towns it was equal to 13’8 per 1000. The annual death-ratein the week under review was equal to 17’9 in Dublin

(against 11’4 in London and 14’7 in Glasgow), 15’1 inBelfast, 15’0 0 in Cork, 13-7 in Londonderry, 9’5 5 in Limerick,and 30’4 in Waterford, while in the 21 smaller towns themean death-rate did not exceed 11’ 8 per 1000.The 357 deaths from all causes were 24 fewer than the

number in the previous week, and included 58 which werereferred to the principal epidemic diseases, against 27 and42 in the two preceding weeks. Of these 58 deaths, 47resulted from infantile diarrhoeal diseases, 7 from measles,2 from diphtheria, 1 from scarlet fever, and 1 from whooping-cough, but not one from enteric fever or from small-pox.The mean annual death-rate from these diseases was equalto 2’5 per 1000; in the 96 large English towns the corre-sponding rate did not exceed 1’6, while in the 16 Scotchtowns it was equal to 1’8 per 1000. The deaths of infants(under 2 years of age) attributed to diarrhoea and enteritis,which had been 16, 15, and 28 in the three preceding weeks,further rose to 47, and included 25 in Belfast, 17 in Dublin,and 3 in Cork. The deaths referred to measles, which hadbeen 4, 5, and 8 in the three preceding weeks, were 7 in theweek under notice, and comprised 6 in Waterford and 1 inDublin. The 2 fatal cases of diphtheria occurred in Dublin,that of scarlet fever in Belfast, and that of whooping-coughin Galway.The deaths referred to diseases of the respiratory system,

which had been 56, 41, and 42 in the three precedingweeks, were 43 in the week under notice. Of the 357 deathsfrom all causes, 112, or 31 per cent., occurred in publicinstitutions, and 9 resulted from different forms of violence.The causes of 6, or 1’7 per cent., of the total deaths werenot certified either by a registered medical practitioneror by a coroner after inquest; in the 96 large Englishtowns the proportion of uncertified causes of death did notexceed l’ 0 per cent.

In the 27 town districts of Ireland, with an aggregatepopulation estimated at 1,199,180 persons at the middle ofthis year, 616 births and 442 deaths were registered duringthe week ended Saturday, August 16th. The annual rate of

mortality in these towns, which had been 16’4, 16’6, and15’5 in the three preceding weeks, rose again to 19-2 per1000 in the week under notice. During the first seven weeksof the current quarter the mean annual death-rate in theseIrish towns averaged 16’ 4 per 1000 ; in the 96 large Englishtowns the corresponding rate did not exceed 11’9, while inthe 16 Scotch towns it was equal to 13-7 per 1000. Theannual death-rate last week was equal to 18’ 6 in Dublin(against 12’1 in London and 14’4 in Glasgow), 20-9 inBelfast, 25-2 in Cork, 17-8 in Londonderry, 16-2 in

Limerick, and 20-9 in Waterford, while in the 21 smallertowns the mean death-rate did not exceed 15-7 per 1000.The 442 deaths from all causes were 85 above the

number in the preceding week, and included 84 which werereferred to the principal epidemic diseases, against 42 and58 in the two preceding weeks. Of these 84 deaths, 63resulted from infantile diarrhceal diseases, 7 from measles,5 from whooping-cough, 4 from enteric fever, 4 from scarletfever, and 1 from diphtheria, but not one from small-pox.The mean annual death-rate from these diseases last week wasequal to 4- 0 per 1000 ; in the 96 large English towns the corre-sponding rate did not exceed 2 - 2, while in the 16 Scotch townsit was equal to 1 - 8 per 1000. The deaths of infants (under2 years of age) attributed to diarrhoea and enteritis, whichhad been 15, 28, and 47 in the three precedings weeks,further rose to 63 last week and included 27 in Dublin, 25in Belfast, and 3 in Portadown. The fatal cases of measles,which had been 5, 8, and 7 in the three preceding weeks,were again 7 last week ; 3 deaths occurred in Londonderry.The deaths from whooping-cough, which had been 4, 2, and1 in the three preceding weeks, rose to 5 last week, andincluded 3 in Dublin. Three of the deaths from entericfever and 3 of those from scarlet fever were registered inBelfast.The deaths referred to diseases of the respiratory system,

which had been 41, 42, and 43 in the three preceding weeks,were 51 in the week under notice. Of the 442 deaths from

all causes, 128, or 29 per cent., occurred in public institu-tions, and 6 resulted from different forms of violence. Thecauses of 11, or 2’5 5 per cent., of the total deaths were notcertified either by a registered medical practitioner or by acoroner after inquest ; in the 96 large English towns theproportion of uncertified causes of death did not exceed0’7 7 per cent.

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VITAL STATISTICS OF LONDON DURING JULY, 1913.In the accompanying table will be found summarised

complete 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 sufferingfrom one or other of the ten diseases specified in the tablewas equal to an annual rate of 6-6 6 per 1000 of the popula-tion, estimated at 4,518,191 persons in the middle of theyear ; in the three preceding months the rates were 4’ 6,4-8, and 5’4 per 1000 respectively. The lowest rates lastmonth were recorded in Kensington, the City of Westminster,St. Marylebone, Hampstead, Stoke Newington, and Holborn;and the highest rates in Hammersmith, Poplar, Southwark,Battersea, Deptford, and Woolwich. The prevalence of scarletfever showed a considerable increase over that recorded inthe preceding month ; this disease was proportionally mostprevalent in Hammersmith, Fulham, Poplar, Bermondsey,Battersea, and Deptford. The number of scarlet fever

patients under treatment in the Metropolitan AsylumsHospitals, which had been 1353, 1414, and 1579 at the endof the three preceding months, had further risen to 2093at the end of last month ; the weekly admissions averaged312 last month, against 183, 184, and 232 in the three pre-ceding months. Diphtheria was slightly more prevalent thanit had been in the previous month ; the greatest proportionalprevalence of this disease was recorded in St. Pancras, theCity of London, Shoreditch, Poplar, Southwark, Greenwich,and Woolwich. The Metropolitan Asylums Hospitals con-tained 886 diphtheria patients at the end of lastmonth, against 792, 803, and 811 at the end of thethree preceding months; the weekly admissions averaged128, against 91, 105, and 116 in the three precedingmonths. The prevalence of enteric fever last month wasgreater than it had been in any of the five precedingmonths ; among the several metropolitan boroughs thisdisease was proportionally most prevalent in Stoke Newing-ton, Holborn, Stepney, Southwark, Deptford, and Woolwich.There were 50 enteric fever patients under treatment in theMetropolitan Asylums Hospitals at the end of last month,against 34. 41, and 35 at the end of the three precedingmonths ; the weekly admissions averaged 10, against 4, 7,and 5 in the three preceding months. Erysipelas was pro-portionally most prevalent in Finsbury, Shoreditch, BethnalGreen, Stepney, Poplar, Southwark, and Deptford. The 37cases of puerperal fever notified during the month included 5in Islington, 5 in Wandsworth, 4 in Kensington, 4 in Fulham,and 3 in Southwark. The 7 cases of cerebro-spinalmeningitis belonged respectively to Islington, Hackney,Finsbury, Poplar, Bermondsey, Lambeth, and Battersea ;and the 14 cases of poliomyelitis included 2 each inHackney, Shoreditch, and Lewisham.The mortality statistics in the table relate to the deaths of

persons actually belonging to the several boroughs, thedeaths occurring in institutions having been distributedamong the several boroughs in which the deceased personshad previously resided ; the death-rates from all causes arefurther corrected for variations in the sex- and age-constitu-

tion of the populations of the several boroughs. During therfive weeks ending August 2nd the deaths of 4597 Londonresidents were registered, equal to an annual rate of 10’ 6

per 1000 ; in the three preceding months the rates had been15 3, 12-9, and 11’1 respectively. The death-rates last

month ranged from 7-8 in Lewisham, 8-1 in Fulham andin Wandsworth, 8-9 in St. Marylebone, 9’1 in Kensingtonand in Woolwich, and 9 - 2 in Greenwich, to 12-7 in Holborn

and in Deptford, 13’0 0 in St. Pancras, 13-3 in the City ofL London, 13- 5 in Finsbury, 13-9 in Southwark, and 14 0 in: Bermondsey. The 4597 deaths from all causes includedl 380 which were referred to the principal infectious diseases ;

of these, 73 resulted from measles, 18 from scarlet fever,, 28 from diphtheria, 57 from whooping-cough, 6 from enteric, fever. and 198 from diarrhoea and enteritis among childrenI under two years of age. No death from any of these

588

589

diseases was recorded last month in Stoke Newington orthe City of London ; among the other boroughs they causedthe lowest death-rates in Hammersmith, Chelsea, the City ofWestminster, St Marylebone, Hackney. Wandsworth, andCamberwell, and the highest rates in Shoreditch, Stepney,Southwark, Bermondsey, Lambeth, and Deptford. The 73deaths from measles were 58 below the corrected averagenumber in the corresponding period of the five precedingyears ; this disease was proportionally most fatal in Pad-dington, Hammersmith, Southwark, Bermondsey, Lambeth,Deptford, and Greenwich. The 18 fatal cases of scarletfever showed a decline of 8 from the corrected averagenumber, and included 2 each in the City of Westminster,Hampstead, Islington, Lambeth, Battersea, Wandsworth,Lewisham, and Woolwich. The 28 deaths from diphtheriawere 12 fewer than the corrected average, and included3 each in Stepney, Poplar, and Southwark. The 57 fatalcases of whooping-cough were 20 below the correctedaverage number ; this disease was proportionally most fatalin Fulham, Shoreditch, Bermondsey, and Deptford. The6 deaths from enteric fever were 4 below the correctedaverage number, and belonged respectively to Kensington,Chelsea, the City of Westminster, Stepney, Southwark, andCamberwell. The mortality from diarrhoea and enteritisamong children under 2 years of age was proportionallygreatest in St. Pancras, Shoreditch, Bethnal Green, Stepney,Poplar, Southwark, and Bermondsey. In conclusion, it maybe stated that the aggregate mortality in London last monthfrom the principal infectious diseases, excluding diarrhoea,was 35’9 9 per cent. below the average.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments have been notified :-Fleet-

Surgeons : W. E. Mathew to the CocArane; M. L. M. Vaudinto the Triumph, for medical charge on voyage out, and forWei-hai-wei sick quarters ; R. S. Bernard to the Triumph,on relieving the Tamar; and T. W. Philip to the Queen Mary,on commissioning. Staff-Surgeons: W. C. B. Smith to thePembroke, additional, and to the London, H. B. Hill to theWildfire, additional, for Royal Naval Barracks and Dock-yard, Sheerness, W. G. Edwards to His Majesty’s Dockyard,Portsmouth, and R. F. MacMahon to Plymouth Hospital, alltemporary ; E. A. G. Wilkinson to the ’Fiotory, additional,and to the -/vM7M; F. J. Gowans to the QueenMary, on commissioning; E. R. Townsend to the Forth /F. J. L. P. McKenna to the Don6qal; L. C. Hunt to theTriumph, additional, for Hong-Kong Yard, on relieving theTamar; A. I. Sheldon to the Philomel; and T. G. Blunt tothe Rosario. Surgeons : G. A. Finegan to the Blenheim;G. D. G. Fergusson to the Clio; H. St. C. Colson to the

Suffolk; F. H. Holl to the Torch, additional, and onrecommissioning; A. Fairley to the Merlin, on recom-

missioning ; W. E. Lloyd to the Triumph, on relieving theTamar; A. E. Malone to the Halcyon, additional, for thepanker S. Bradbury to Plymouth Hospital, H. E. Perkinsto Chatham Hospital, and L. C. E. Murphy to Royal MarineDivision, temporary.

ARMY MEDICAL SERVICE.Colonel Edmund J. E. Risk retires on retired pay (dated

August 20th, 1913).ROYAL ARMY MEDICAL CORPS.

The undermentioned to retire on retired pay :-Lieutenant-Colonel Walter C. Beevor, C.M.G. (dated August 20th, 1913),and Captain John C. Hart (dated August 20th, 1913).

Lieutenant Noel T. Whitehead, from the Seconded List, isrestored to the establishment (dated July 26th, 1913).The undermentioned Lieutenants are confirmed in their

rank :-Walter W. Pratt, Cuthbert J. H. Little, Edward P. A.Smith, James B. A. Wigmore, Charles C. Jones, ArthurA. M. Davies, Leslie Dunbar, Henry Beddingfield, FrederickC. Davidson, John F. O’Connell, Stanley D. Large, CyrilHelm, William 0. W. Ball, John Crocket, HumfreyN. Sealy,Albert Jackson, Edward C. Beddows, Conyngham V.Thornton, John Rowe, William P. Croker, Arthur H. Bridges,Aubrey G. Brown, and Robert Hemphill.The undermentioned to be Lieutenants (on probation)

(dated July 25th, 1913) :-Ernest Wentworth Wade, Bernard

Woodhouse, William Kenneth Morrison, Edgar Percival, andHenry Charles Deans Rankin.The undermentioned Lieutenants are seconded under the

provisions of Article 300, Royal Warrant for Pay and Pro-motion, 1909 (dated July 25th, 1913) :—Ernest W. Wade,Bernard Woodhouse, William K. Morrison, and EdgarPercival.

Lieutenant-Colonel J. J. Gerrard, senior medical officer,West Africa, has arrived home on leave of absence from theSierra Leone Protectorate. Lieutenant-Colonel T. Du B.Whaite, senior medical officer at the Royal Arsenal,Woolwich, has been placed under orders for a tour of servicein India during the coming trooping season, and on arrivalwill be appointed for duty with the Northern Army.Lieutenant-Colonel 0. L. Robinson’ has been grantedfive months’ leave of absence. Lieutenant-Colonel H. D.Rowan, at present in charge of the Military Hospitalat Tidworth, Salisbury Plain, has been ordered to join theDublin District on Oct. lst next to take over charge of theKing George V. Military Hospital at Arbor Hill, insuccession to Lieutenant-Colonel W. C. Beevor, C.M.G.Lieutenant-Colonel T. B. Winter has rejoined at Colchester.Lieutenant-Colonel G. D. Hunter, D.S.O., Commandant atthe Royal Army Medical Corps School of Instruction,Aldershot, has been placed under orders for a tour of serviceabroad. Lieutenant-Colonel H. J. Pocock has been trans-ferred from the Military Hospital at Campbellpore Canton-ment to Murree Cantonment and appointed Senior MedicalOfficer.

Major J. A, 0. MacCarthy has been transferred from theMilitary Hospital at Hounslow to the Woolwich District andappointed to the Royal Herbert Military Hospital. MajorH. K. Palmer has taken up duty in the Aden Brigade ontransfer from the Fifth (Mhow) Division. Major L. Woodhas left Hyderabad, Sind, for duty at Quetta. MajorA. W. N. Bowen has arrived home on leave of absence fromthe Military Hospital at Kirkee Cantonment. Major G. B.Crisp, at present employed on recruiting duty in the LondonDistrict, has been placed under orders for a tour of servicein the South China Command during the coming troopingseason. Major W. A. Woodside has been transferred fromthe Military Hospital at Agra Cantonment to Chakrata.Major T. E. Fielding has taken up duty in the DevonportDistrict on the termination of leave of absence. Major J. L.Robinson has been transferred from the Military Hospitalat Peshawar Cantonment to Cherat. Major C. E. Fleminghas joined the Military Hospital at Pretoria on transferfrom Potchefstroom. Major M. W. Falkner has arrivedhome on leave of absence from Bermuda. Major H. W. H.O’Reilly, in menical charge of the Detention Barracks andeffective troops at Colehester, has been placed under ordersfor a tour of duty with the Southern Army in India.

Captain J. H. Campbell has joined the Scottish Commandfor a tour of duty. Captain R. G. Meredith has been placedunder orders for a tour of service in Ceylon. Captain G. G.Tabuteau has been selected for appointment as Specialist inOperative Surgery to the Cork District in succession to

Captain W. F. H. Vaughan, whose tenure of the appoint-ment has expired. Captain D. Ahern has arrived home onleave of absence from the Military Hospital at Cairo.Captain G. B. Edwards has been appointed to the NorthernCommand. Captain A. E. S. Irvine has taken up duty in theBelfast District on the expiration of leave of absence.Captain H. Stewart has arrived home for duty from

Ferozepore. Captain A. Dawson has joined the CurraghCamp. Captain J. G. Bell has been placed under orders toproceed to the Straits Settlements for a tour of duty,embarking on Sept. 3rd. Captain D. F. McKenzie has beengranted an extension of his Indian tour of service for oneyear. Captain D. Coutts has been transferred from theMilitary Hospital at Bareilly Cantonment to Ranikhet.Captain R. G. Anderson has arrived home on leave of absencefrom the Egyptian Army. Captain R. A. Bryden has beenappointed to the Western Command. Captain P. Powerhas been appointed to the Southern Army in India,embarking on Sept. 24th. Captain J. J. O’Keefe has beentransferred from Meerut Cantonment to Naini Tal. CaptainV. T. Carruthers has been appointed to the Eastern Com-mand for a tour of duty. Captain L. Cotterill, Instructor inMusketry at the Royal Army Medical Corps Depot, has beenplaced under orders for a tour of duty with the NorthernArmy in India. Captain E. J. Kavanagh has been appointed