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VITAL STATISTICS

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949 number of patients in excess of the proper accommodation had at this date reached the alarming figure of 115. Dr. John Richards, the medical superintendent, reports that the institution and its staff are, from an administrative point of view, taxed to the uttermost, and that it is a matter for profound thankfulness that in the face of this no great calamity has yet occurred. 135 cases were admitted during the year. Of the direct admissions, 79 were first-attack cases, and of these 36 were admitted within three months of the stated time of onset of the mental disorder. On the other hand, in 26 cases the mental disorder had existed for more than two years. In 23 cases the bodily health was good, fair in 68, and reduced in 44 cases. In 25. 5 per cent. of the direct admissions there was ascertained a history of hereditary insanity or allied disorders. Sixty-five cases were discharged, and of these 42 were recovered, the proportion of recoveries to admissions being 32-30. There were 50 deaths, and necropsies were performed in 30 cases. The proportion of deaths to the average number daily resident was 7-08 per cent. Public Health. REPORTS OF SCHOOL MEDICAL OFFICERS. Borough of Ouildford.-The medical officer, Dr. R. W. C. Pierce, reports an unusual feature-namely, an increase in the number of parents objecting to inspection of children- and suggests that inspection should be made compulsory. The circumstances of Guildford may be peculiar, but the experience of medical inspectors is usually the other way round. The school clinic opened on June 3rd, 1912, deals with nose and throat cases, eye cases, and general and dental cases. The cost of equipment was £99 2s. 7d. ; the cost of treatment up to Dec. 31st was £180 8s. 7d., of which &20 17s. 6d. were collected in fees from parents. The number of patients treated was 310, but when an inspection clinic is added and a school nurse appointed the medical officer expects that a larger number of cases will be dealt with. The small number actually treated gives the high average cost per case of 10s. 3d., and seems to point to the desirability of appointing a school nurse and developing an inspection clinic first, leaving the treatment clinic to develop to meet ascertained needs. The expense, however, is comparatively ,trifling, and even at the high figure quoted the amelioration of conditions obtained is decidedly " worth the money," apart from the more far-reaching view of social hygiene. , Borough of Richmond.-An inspection clinic in the Public Health offices has been established by Dr. J. H. Crocker, who has at his disposal the services of a school nurse who follows up untreated defective cases. Of the important defects reported for 1911 only 8 had not been attended to at the end of 1912. Of 529 defective scholars noted in 1912, 56-5 per cent. were found to have been under medical treat- ment at the first reinspection. It should be remembered that Richmond has two advantages in treatment : firstly, it is small, and secondly, very fortunate in its charitable institu- tions and allied societies. Hampshire County Council.-An interim report by Dr. R. A. Lyster and dated April, 1913, shows that during the year ended July 31st, 1912, medical inspection cost £1772 17s. 2d., and an application was made for a grant in view of the large proportion of medical inspectors’ time occupied in re-examinations and similar work for the purpose of furthering treatment. The Board approved a grant of £787 18s. 9d., leaving less than 1000 to be paid by the county. This result is, as Dr. Lyster says, very gratifying, encouraging, and should lead other authorities to more closely consider the treatment side of medical inspection work. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN the 96 English and Welsh towns, with populations exceeding 50,000 persons at the last Census and whose aggregate population at the middle of this year is estimated at 17,852,766 persons, 8465 births and 4898 deaths were registered during the week ended Saturday, Sept. 20th. The n annual rate of mortality in these towns, which had increased r. from 13’2 to 14’5 per 1000 in the four preceding weeks, e slightly declined to 14’3 per 1000 in the week under notice. During the twelve weeks of the current quarter the mean r annual death-rate in these towns averaged 12’6, against t 11.7 per 1000 in London during the same period. Among g the several towns the death-rate last week ranged from k 5’2 in Southend-on-Sea, 6. 1 in Ealing, 6- 4 in Cambridge, 6- 8 in Devonport, and 7.0 in Enfield, in Reading, and in e Swindon, to 22-9 in Sunderland, 23 8 in Aberdare, 23-9 in Blackpool, 25- 2 in Dudley, and 25’ 3 in Bootle. The 4898 deaths from all causes were 82 fewer than t. the number in the previous week, and included 1118 which )f were referred to the principal epidemic diseases, against ’e numbers steadily increasing from 281 to 1242 in the eleven n preceding weeks. Of these 1118 deaths, 983 resulted from ’e infantile diarrhoeal diseases, 44 from whooping-cough, 40 from diphtheria, 20 from measles, 18 from scarlet fever, and 13 from enteric fever, bat not one from small-pox. The mean annual death-rate from these diseases last week was equal to 3-3, against 3 - 2 and 3’6 per 1000 in the two preceding weeks. The deaths of infants (under 2 years of age) attributed to diarrhoea and enteritis, which had steadily risen from 149 to 1104 in the nine preceding weeks, declined to 983 last week ; of this number 218 were registered in London, 78 in Birmingham, 66 in Liverpool, 42 in Manchester, 32 in Hull, 24 in Sheffield, 23 in West Ham, 21 in Leeds, and 19 in Bradford. The deaths referred in to whooping-cough, which had been 50, 31, and 38 in the three preceding weeks, rose to 44 last week; 9 deaths occurred in London, 9 in Birmingham, and 2 each in le Tottenham, West Ham, Bristol, Liverpool, Manchester, Oldham, Sheffield, and Rotherham. The fatal cases of Is diphtheria, which had been 36, 45, and 36 in the three preceding weeks, rose to 40 last week, and included 8 in ae Birmingham, 5 in London, 3 in Leeds, and 3 in Sheffield. The deaths attributed to measles, which had steadily le declined from 77 to 26 in the eight preceding weeks, further on fell to 20 last week ; 4 deaths occurred in Liverpool, 3 in al Manchester, and 2 each in London, Oldham, and Blackpool It The deaths referred to scarlet fever, which had been 14, 17, )Fh and 28 in the three preceding weeks, fell to 18 last week. and included 4 in Birmingham, 3 in Manchester, and 2 in TiveT- pool. The fatal cases of enteric fever numbered 13, and were 3 in excess of the average in the earlier weeks of the is quarter ; 5 deaths occurred in Liverpool and 2 in HulL )d The number of scarlet fever patients under treatment in the Metropolitan Asylums and the London Fever Hospitals, al which had been 2115, 2112, and 2211 at the end of the three preceding weeks, rose to 2355 on Saturday ’o last; 473 new cases were admitted during the week, ,r, against 331, 298, and 346 in the three preceding weeks. 10 These hospitals also contained on Saturday last S65 It cases of diphtheria, 209 of whooping-cough, 97 of measles, to and 54 of enteric fever, but not one of small-pox. The 2, 1187 deaths from all causes in London were 4 in excess of the number in the previous week, and were equal to an annual death-rate of 13-7 per 1000. The deaths referred is to diseases of the respiratory system, which had been 124, 11- 132, and 132 in the three preceding weeks, fell to 125 last week, and were 15 below the number recorded in the ’r. corresponding week of last year. 1e Of the 4898 deaths from all causes in the 96 towns, 165 st resulted from various forms of violence and 347 were the in subject of coroners’ inquests. The causes of 30, or 06 per ne cent., of the total deaths were not certified either by a se registered medical practitioner or by a coroner after inquest. of All the causes of death were duly certified in London and lie in its 14 suburban districts, in Manchester, Sheffield, Bristol, Bradford, Hull, Nottingham, and in 55 other smaller towns. re Of the 30 uncertified causes of death, 4 were registered in Preston, 3 in Sunderland, and 2 each in West Bromwicb, Birmingham, Liverpool, Salford, and Darlington. HEALTH OF SCOTCH TOWNS. In the 16 largest Scotch towns, with an aggregate popula- ns tion estimated at 2,259,600 persons at the middle of this se year, 1035 births and 711 deaths were registered during the ed week ended Saturday, Sept. 13th. The annual rate f re mortality in these towns, which had been 14-1, 14’1, and he 16-7 per 1000 in the three preceding weeks, slightly fell
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number of patients in excess of the proper accommodationhad at this date reached the alarming figure of 115. Dr.John Richards, the medical superintendent, reports that theinstitution and its staff are, from an administrative pointof view, taxed to the uttermost, and that it is a matter for

profound thankfulness that in the face of this no greatcalamity has yet occurred. 135 cases were admitted duringthe year. Of the direct admissions, 79 were first-attackcases, and of these 36 were admitted within three monthsof the stated time of onset of the mental disorder. On theother hand, in 26 cases the mental disorder had existed formore than two years. In 23 cases the bodily health wasgood, fair in 68, and reduced in 44 cases. In 25.5 per cent.of the direct admissions there was ascertained a history ofhereditary insanity or allied disorders. Sixty-five cases weredischarged, and of these 42 were recovered, the proportionof recoveries to admissions being 32-30. There were

50 deaths, and necropsies were performed in 30 cases. The

proportion of deaths to the average number daily resident was7-08 per cent.

__ __________

Public Health.REPORTS OF SCHOOL MEDICAL OFFICERS.

Borough of Ouildford.-The medical officer, Dr. R. W. C.Pierce, reports an unusual feature-namely, an increase inthe number of parents objecting to inspection of children- and suggests that inspection should be made compulsory.The circumstances of Guildford may be peculiar, but the experience of medical inspectors is usually the other way round. The school clinic opened on June 3rd, 1912, deals with nose and throat cases, eye cases, and general anddental cases. The cost of equipment was £99 2s. 7d. ; thecost of treatment up to Dec. 31st was £180 8s. 7d., ofwhich &20 17s. 6d. were collected in fees from parents. The number of patients treated was 310, but when an inspectionclinic is added and a school nurse appointed the medicalofficer expects that a larger number of cases will be dealtwith. The small number actually treated gives the highaverage cost per case of 10s. 3d., and seems to point to thedesirability of appointing a school nurse and developing aninspection clinic first, leaving the treatment clinic to developto meet ascertained needs. The expense, however, is

comparatively ,trifling, and even at the high figure quotedthe amelioration of conditions obtained is decidedly " worththe money," apart from the more far-reaching view of socialhygiene. ,

Borough of Richmond.-An inspection clinic in the PublicHealth offices has been established by Dr. J. H. Crocker,who has at his disposal the services of a school nurse whofollows up untreated defective cases. Of the importantdefects reported for 1911 only 8 had not been attended toat the end of 1912. Of 529 defective scholars noted in 1912,56-5 per cent. were found to have been under medical treat-ment at the first reinspection. It should be remembered thatRichmond has two advantages in treatment : firstly, it is

small, and secondly, very fortunate in its charitable institu-tions and allied societies.Hampshire County Council.-An interim report by Dr.

R. A. Lyster and dated April, 1913, shows that during theyear ended July 31st, 1912, medical inspection cost£1772 17s. 2d., and an application was made for a grant inview of the large proportion of medical inspectors’ timeoccupied in re-examinations and similar work for the purposeof furthering treatment. The Board approved a grant of£787 18s. 9d., leaving less than 1000 to be paid by thecounty. This result is, as Dr. Lyster says, very gratifying,encouraging, and should lead other authorities to more

closely consider the treatment side of medical inspectionwork.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns, with populationsexceeding 50,000 persons at the last Census and whoseaggregate population at the middle of this year is estimatedat 17,852,766 persons, 8465 births and 4898 deaths wereregistered during the week ended Saturday, Sept. 20th. The

n annual rate of mortality in these towns, which had increasedr. from 13’2 to 14’5 per 1000 in the four preceding weeks,e slightly declined to 14’3 per 1000 in the week under notice.

During the twelve weeks of the current quarter the meanr annual death-rate in these towns averaged 12’6, againstt 11.7 per 1000 in London during the same period. Amongg the several towns the death-rate last week ranged fromk 5’2 in Southend-on-Sea, 6. 1 in Ealing, 6- 4 in Cambridge,

6- 8 in Devonport, and 7.0 in Enfield, in Reading, and ine Swindon, to 22-9 in Sunderland, 23 8 in Aberdare, 23-9 in

Blackpool, 25- 2 in Dudley, and 25’ 3 in Bootle.The 4898 deaths from all causes were 82 fewer than

t. the number in the previous week, and included 1118 which)f were referred to the principal epidemic diseases, against’e numbers steadily increasing from 281 to 1242 in the elevenn preceding weeks. Of these 1118 deaths, 983 resulted from’e infantile diarrhoeal diseases, 44 from whooping-cough, 40

from diphtheria, 20 from measles, 18 from scarlet fever,and 13 from enteric fever, bat not one from small-pox.The mean annual death-rate from these diseases last weekwas equal to 3-3, against 3 - 2 and 3’6 per 1000 in the twopreceding weeks. The deaths of infants (under 2 years ofage) attributed to diarrhoea and enteritis, which had steadilyrisen from 149 to 1104 in the nine preceding weeks,declined to 983 last week ; of this number 218 were

registered in London, 78 in Birmingham, 66 in Liverpool,42 in Manchester, 32 in Hull, 24 in Sheffield, 23 in WestHam, 21 in Leeds, and 19 in Bradford. The deaths referred

in to whooping-cough, which had been 50, 31, and 38 in thethree preceding weeks, rose to 44 last week; 9 deathsoccurred in London, 9 in Birmingham, and 2 each in

le Tottenham, West Ham, Bristol, Liverpool, Manchester,Oldham, Sheffield, and Rotherham. The fatal cases of

Is diphtheria, which had been 36, 45, and 36 in the three

preceding weeks, rose to 40 last week, and included 8 inae Birmingham, 5 in London, 3 in Leeds, and 3 in Sheffield.

The deaths attributed to measles, which had steadilyle declined from 77 to 26 in the eight preceding weeks, furtheron fell to 20 last week ; 4 deaths occurred in Liverpool, 3 inal Manchester, and 2 each in London, Oldham, and BlackpoolIt The deaths referred to scarlet fever, which had been 14, 17,)Fh and 28 in the three preceding weeks, fell to 18 last week. and

included 4 in Birmingham, 3 in Manchester, and 2 in TiveT-pool. The fatal cases of enteric fever numbered 13, andwere 3 in excess of the average in the earlier weeks of the

is quarter ; 5 deaths occurred in Liverpool and 2 in HulL)d The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,al which had been 2115, 2112, and 2211 at the end

of the three preceding weeks, rose to 2355 on Saturday’o last; 473 new cases were admitted during the week,,r, against 331, 298, and 346 in the three preceding weeks.10 These hospitals also contained on Saturday last S65It cases of diphtheria, 209 of whooping-cough, 97 of measles,to and 54 of enteric fever, but not one of small-pox. The2, 1187 deaths from all causes in London were 4 in excess of

the number in the previous week, and were equal to anannual death-rate of 13-7 per 1000. The deaths referred

is to diseases of the respiratory system, which had been 124,11- 132, and 132 in the three preceding weeks, fell to 125

last week, and were 15 below the number recorded in the’r. corresponding week of last year.1e Of the 4898 deaths from all causes in the 96 towns, 165st resulted from various forms of violence and 347 were thein subject of coroners’ inquests. The causes of 30, or 06 perne cent., of the total deaths were not certified either by ase registered medical practitioner or by a coroner after inquest.of All the causes of death were duly certified in London andlie in its 14 suburban districts, in Manchester, Sheffield, Bristol,

Bradford, Hull, Nottingham, and in 55 other smaller towns.re Of the 30 uncertified causes of death, 4 were registered in

Preston, 3 in Sunderland, and 2 each in West Bromwicb,Birmingham, Liverpool, Salford, and Darlington.

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns, with an aggregate popula-ns tion estimated at 2,259,600 persons at the middle of thisse year, 1035 births and 711 deaths were registered during theed week ended Saturday, Sept. 13th. The annual rate fre mortality in these towns, which had been 14-1, 14’1, andhe 16-7 per 1000 in the three preceding weeks, slightly fell

950

to 16’4 per 1000 in the week under notice. During thefirst eleven weeks of the current quarter the mean annualdeath-rate in these Scotch towns averaged 14’3, against 12’4per 1000 in the 96 large English towns. Among the severalScotch towns the death-rates in the week under review rangedfrom 7’5 in Kilmarnock, 9-5 in Hamilton, and 10-2 inMotherwell, to 19-5 in Paisley, 20-_9 in Kirkcaldy, and 21-5 5in Greenock.

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The 711 deaths from all causes were 12 fewer than thenumber in the previous week, and included 126 which werereferred to the principal epidemic diseases, against numberssteadily increasing from 61 to 121 in the six preceding weeks.Of these 126 deaths, 96 resulted from infantile diarrhoealdiseases, 12 from measles, 7 from diphtheria, 5 from whoop-ing-cough, 4 from scarlet fever, and 2 from enteric fever,but not one from small-pox. These 126 deaths from theprincipal epidemic diseases were equal to an annual death-rate of 2-9, against 3.6 per 1000 in the 96 large Englishtowns. , The deaths of infants (under 2 years of age)attributed to diarrhoea and enteritis, which had increasedfrom 21 to 89 in the six preceding weeks, further rose to 96 inthe week under notice ; of this number 56 occurred in Glasgow,9 in Greenock, 8 in Dundee, 6 in Paisley, 5 in Aberdeen,4 in Leith, and 3 in Kirkcaldy. The deaths referred to measles,which had been 15, 9, and 14 in the three preceding weeks,numbered 12, of which 8 were registered in Glasgow. Thefatal cases of diphtheria, which had been 7, 5, and 6 inthe three preceding weeks, were 7, and included 3 in Glasgowand 2 in Edinburgh. The 5 deaths attributed to whooping-cough, of which 4 were recorded in Glasgow, were 2 below theaverage in the three preceding weeks. The 4 deaths referredto scarlet fever, comprising 3 in Edinburgh and 1 in Glasgow,were slightly below the average in the three preceding weeks.One fatal case of enteric fever occurred in Glasgow and1 in Dundee.The deaths referred to diseases of the respiratory system,

which had increased from 44 to 86 in the four precedingweeks, declined to 65 in the week under notice ; 25 deathsresulted from different forms of violence, against 27, 22,and 28 in the three preceding weeks.

In the 16 largest Scotch towns 1061 births and 625deaths were registered during the week ended Saturday,Sept. 20th. The annual rate of mortality in these towns,which had been 14-1, 16-7, and 16 - 4 per 1000 in the threepreceding weeks, further declined to 14-4 per 1000 in theweek under notice. During the first twelve weeks of thecurrent quarter the mean annual death-rate in these Scotchtowns averaged 14-3, against 12-6 per 1000 in the 96

large English towns. Among the several towns thedeath-rate last week ranged from 7’3 in Clydebank, 7.6in Motherwell, and 7’8 8 in Leith and in Kirkcaldy, to 18’3 3in Ayr, 18 -6 in Dundee, and 18 - 8 in Greenock.The 625 deaths from all causes were 86 fewer than the

number in the previous week, and included 94 which werereferred to the principal epidemic diseases, against numberssteadily increasing from 69 to 126 in the seven precedingweeks. Of these 94 deaths, 62 resulted from infantilediarrhoeal diseases, 9 from measles, 9 from whooping-cough,8 from diphtheria, 4 from scarlet fever, and 2 from entericfever, but not one from small-pox. These 94 deaths fromthe principal epidemic diseases were equal to an annualdeath-rate of 2-2, against 3-3 per 1000 in the 96 largeEnglish towns. The deaths of infants (under 2 years ofage), which had risen from 21 to 96 in the seven precedingweeks, declined to 62 last week, and included 30 in Glasgow,7 in Dundee, 6 in Aberdeen, 6 in Paisley, and 3 in Kirkcaldy.The deaths referred to measles, which had been 9, 14, and 12in the three preceding weeks, fell to 9 last week, of which5 were registered in Glasgow and 2 in Leith. The fatalcases of whooping-cough, which had been 9, 6, and 5 in thethree preceding weeks, rose to 9 last week, and included 6in Glasgow. The 8 deaths attributed to diphtheria, com-prising 5 in Glasgow, 2 in Aberdeen, and 1 in Greenock,were slightly in excess of the average in the three pre-ceding weeks. Of the 4 deaths referred to scarlet fever,3 occurred in Glasgow and 1 in Ayr ; the fatal cases ofenteric fever were recorded in Glasgow and Edinburghrespectively.The deaths referred to diseases of the respiratory system,

which had been 69, 86, and 65 in the three preceding weeks,were 65 last week; 17 deaths resulted from various formsof violence, against 28 and 25 in the two preceding weeks.

HEALTH OF IRISH TOWNS.

In the 27 town districts of Ireland, with an aggregatepopulation estimated at 1,199,180 persons at the middle ofthis year, 587 births and 455 deaths were registered duringthe week ended Saturday, Sept. 20th. The annual rateof mortality in these towns, which had been 20-7, 19 - 9,and 21.per 1000 in the three preceding weeks, declined to19.8per 1000 in the week under notice. During the 12weeks of the current quarter the mean annual death-rate inthese Irish towns averaged 17 - 9 per 1000 ; in the 96 largeEnglish towns the corresponding rate did not exceed 12 - 6,while in the 16 Scotch towns it was equal to 14’ 3 per 1000.The annual death-rate last week was equal to 18-1 inDublin (against 13-7 in London and 14’9 in Glasgow),21’1 1 in Belfast, 30’6 6 in Cork, 22’9 9 in Londonderry, 10’8 8 inLimerick, and 13’3 3 in Waterford, while in the remaining 21smaller towns the mean death-rate did not exceed 18- 5 per1000.The 455 deaths from all causes were 30 fewer than

the number in the previous week, and included 120 whichwere referred to the principal epidemic diseases, againstnumbers rising from 27 to 132 in the eight preceding weeks.Of these 120 deaths, 98 resulted from infantile diarrhoealdiseases, 7 from measles, 6 from scarlet fever, 4 from diph-theria, 3 from enteric fever, and 2 from whooping-cough, butnot one from small-pox. The mean annual death-rate fromthese diseases last week was equal to 5-2 per 1000 ; in the96 large English towns the corresponding rate was 3-3,while in the 16 Scotch towns it did not exceed 2-2

per 1000. The deaths of infants (under 2 years of age)attributed to diarrhoea and enteritis, which had been 97,92, and 111 in the three preceding weeks, declined to 98last week, and included 37 in Belfast, 25 in Dublin, 13 inCork, 6 in Londonderry, and 3 in Waterford. The deathsreferred to measles, which had been 6, 10, and 2 in thethree preceding weeks, rose to 7 last week, of which 5occurred in Galway. The 6 fatal cases of scarlet fever,comprising 4 in Belfast and 2 in Dublin, were double theaverage in the preceding weeks of the current quarter. Ofthe 4 deaths attributed to diphtheria, 3 occurred in Belfastand 1 in Larne ; of the 3 fatal cases of enteric fever 2 wereregistered in Belfast and 1 in Dublin ; while the 2 deathsfrom whooping-cough were recorded in Belfast and Lisburnrespectively.The deaths referred to diseases of the respiratory system,

which had been 43, 42, and 41 in the three preceding weeks,rose to 56 in the week under notice. Of the 455 deaths fromall causes, 110, or 24 per cent., occurred in public institu-tions, and 12 resulted from different forms of violence. Thecauses of 11, or 2-4 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 last week did notexceed O. 6 per cent.

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VITAL STATISTICS OF LONDON DURING AUGUST, 1913.

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 sufferingfrom one or other of the ten diseases specified in the tablewas equal to an annual rate of 5-4 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 4-8,5-4, and 6 - 6 per 1000 respectively. The lowest rates lastmonth were recorded in Kensington, the City of West-minster, Hampstead, the City of London, and Wandsworth;and the highest rates in Stepney, Poplar, Southwark,Bermondsey, and Deptford. The prevalence of scarletfever showed a marked decline from that recorded inthe preceding month ; this disease was proportionally mostprevalent in St. Marylebone, Poplar, Southwark, Bermondsey,and Deptford. The Metropolitan Asylums Hospitals con-tained 2093 scarlet fever patients at the end of last month,against 1414, 1579, and 2093 at the end of the three pre-ceding months; the weekly admissions averaged 258,against 184, 232, and 312 in the three preceding months.Diphtheria also was considerably less prevalent than it hadbeen in the preceding month ; the greatest proportionalprevalence of this disease was recorded in St. Pancras,

951

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Shoreditch, Stepney, Southwark, Bermondsey, Lewisham,and Greenwich. There were 798 diphtheria patients undertreatment in the Metropolitan Asylums Hospitals at theend of last month, against 803, 811, and 886 at the endof the three preceding months; the weekly admissions

averaged 99, against 105, 116, and 128 in the three precedingmonths. The prevalence of enteric fever showed a slightdiminution from that in the preceding month ; this diseasewas proportionally most prevalent last month in Paddington,Chelsea, Hampstead, Holborn, Bethnal Green, and Wool-wich. The number of enteric fever patients under treatmentin the Metropolitan Asylums Hospitals, which had been 41,35, and 50 at the end of the three preceding months, haddeclined again to 37 at the end of last month; the weeklyadmissions averaged 6, against 7, 5, and 10 in the three

preceding months. Erysipelas was proportionally mostprevalent in Fulham, Shoreditch, Chelsea, Bethnal Green,Stepney, Southwark, Deptford, and Greenwich. The 24cases of puerperal fever notified during the month included 5in Poplar, 3 in Hampstead, 3 in Stepney, 3 in Wandsworth,and 2 in Islington. The 4 cases of cerebro-spinalmeningitis included 2 in Kensington; and the 20 cases ofpoliomyelitis included 4 in Islington and 2 each in Hamp-stead, St. Pancras, Hackney, Stepney, and Battersea.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 thefour weeks ending August 30th the deaths of 4097 Londonresidents were registered, equal to an annual rate of 11’ 8per 1000 ; in the three preceding months the rates had been12.9, 11.1, and 10’ 6 per 1000 respectively. The death-ratesIast month ranged from 8.0 in Wandsworth, 8.3 in the Cityof London, 8.8 in Kensington, 9’1 in Lewisham, 9.2 inChelsea, and 9-3 in Stoke Newington, to 14’5 in Holborn,15.7 in Southwark, 17’6 in Bermondsey, 17’8 in

Shoreditch, 18-2 in Poplar, and 20-0 in Finsbury. The4097 deaths from all causes included 586 which were

referred to the principal infectious diseases; of these, 36resulted from measles, 20 from scarlet fever, 20 from

diphtheria, 33 from whooping-cough, 12 from entericfever, and 465 from diarrhoea and enteritis among childrenunder two years of age. No death from any of thesediseases was recorded last month in the City of Londonor in Holborn; among the other boroughs they causedthe lowest death-rates in Hammersmith, St Marylebone,Hampstead, and Stoke Newington, and the highest ratesin Finsbury, Shoreditch, Bethnal Green, Stepney, Poplar,Southwark, Bermondsey, and Deptford. The 36 fatalcases of measles were 53 below the corrected averagenumber in the corresponding period of the five precedingyears ; this disease was proportionally most fatal in Pad-dington, Hackney, Poplar, Southwark, Bermondsey, andDeptford- The 20 deaths from scarlet fever were slightlyabove the corrected average number, and included 2 in Pad-dington, 2 in Finsbury, 2 in Steprey, 2 in Poplar, 2 in South-wark, and 2 in Camberwell. The 20 fatal cases of diphtheriawere 12 below the corrected average number; of these,3 belonged to Southwark, and 2 each to Hackney, Shoreditch,Stepney, Poplar, and Lewisham. The 33 deaths from

whooping-cough were 23 fewer than the corrected averagenumber, and included 5 in Lambeth, 5 in Deptford, 3 inFinsbury, 3 in Battersea, 2 in Bethnal Green, and 2 in

Poplar. The 12 fatal cases of enteric fever were 2 in excessof the corrected average number; 2 cases belonged toLambeth. The mortality from diarrhoea and enteritis

among children under 2 years of age was proportionallygreatest in Fulham, Finsbury, Shoreditch, Bethnal Green,Stepney, Poplar, Southwark, and Bermondsey. In conclusion,it may be stated that the aggregate mortality in London lastmonth from the principal infectious diseases, excludingdiarrhoea, was 41’ 3 per cent. below the average.

IT is announced that Dr. Edward Burnet, ofTunbridge Wells, has been selected as Liberal candidate forthe boroughs of Warwick and Leamington at the next elec-tion. Dr. Burnet was formerly medical officer of health ofLeamington.

THE SERVICES.

COMMISSIONS IN THE ROYAL ARMY MEDICAL CORPS.

AN examination for not less than 12 commissions inthe Royal Army Medical Corps will be held on Jan. 28th,1914. Applications to compete should be made to the

Secretary, War Office, not later than Jan. 19th, 1914. The

presence of candidates will be required in London fromJan. 26th, 1914. Intending candidates will find in theStudents’ Number of THE LANCET, published on August 30th,a full statement of the duties and emoluments of the service,which now offers so many opportunities to its officers.

ROYAL NAVY MEDICAL SERVICE.

The following appointments have been notified :-Fleet-Surgeons : W. Jackson to the Woolwich, on commis--sioning, and W. R. Center to the Russell. Staff-Surgeons:R. L. Jones to the Victory, for disposal, temporary, andW. E. Ormsby to the Eclipse for voyage home. Surgeons :A. S. Paterson to the Eclipse, on recommissioning, for

voyage out, and to the Egmont on arrival at Malta ; and G. B.Cockrem to the Pembroke, additional, for disposal.

ROYAL ARMY MEDICAL CORPS.

Captain Henry W. Long to be Major (dated June 27th,1913).

Colonel A. E. Tate has arrived home from India on leaveof absence.

Lieutenant-Colonel J. Donaldson has been selected for

appointment to hold charge of the Military Hospital atJubbulpore Cantonment. Lieutenant-Colonel J. Thomsonhas taken over charge at the Record Office, Royal ArmyMedical Corps Depot, Aldershot. Lieutenant-Colonel C. T.Blackwell has been granted six months’ leave of absence.Lieutenant-Colonel H. J. Pocock has joined at Murree Canton-ment. Lieutenant-Colonel 0. L. Robinson has taken upduty as Professor of Tropical Medicine at the Royal ArmyMedical College, in succession to Major W. S. Harrison.Lieutenant-Colonel R. Holyoake has been placed under ordersfor a tour of service with the Southern Army in India.

Major P. H. Henderson has been transferred from theMilitary Hospital at Portsmouth to the Royal Army MedicalCorps Camp of Instruction at Tidworth Park. Major M. C.Beatty has taken up duty at Tregantle. Major T. F.Ritchie has been appointed to the London District. MajorC. R. Evans has arrived home on leave of absence from the

Military Hospital at Malta. Major H. A. Davidson hasembarked for a tour of service in the Straits Settlements.Major C. G. Thompson has been transferred from the MilitaryHospital at Glasgow to Glencorse. Major E. C. Hayes hastaken up duty at the Military Hospital, Cosham, on transferfrom Lodmoor Camp. Major A. A. Seeds has been appointedSenior Medical Officer at Kuldana, Murree Hills District.

Major S. W. Sweetnam has been granted eight months’ leaveof absence home from India on medical certificate, with per-mission to revert to the Home establishment on its comple-tion. Major R. C. Wilson, specialist in otology at Gibraltar,has arrived home on leave of absence. Major L. L. G.

Thorpe has been placed under orders to embark for a tourof service with the Southern Army in India. Major G. Mans-field has relinquished charge of the Military Hospital atNorwich. Major W. M. B. Sparkes has been placed underorders to embark for service in the Sierra Leone Protectorate.

Major P. J. Probyn, D.S.O., has been transferred from theMilitary Hospital at York to Sheffield. Major W. E.Hudleston has been appointed to hold medical charge atWool Camp on transfer from the Military Hospital at Ports-mouth. Major S. M. Adye-Curran has arrived home on leaveof absence from the Military Hospital at Sialkot Cantonment.

Captain J. St. A. Maughan has been transferred from theRoyal Victoria Hospital at Netley to Tidworth Park.Captain H Stewart has been transferred from the MilitaryHospital at Ferozepore Cantonment to Halifax. CaptainW. Egan has been transferred from the Military Hospital atthe Curragh and placed in medical charge at Oranmore

Camp. Captain C. T. Edmunds has arrived home fromPeshawar. Captain A. T. Frost has embarked for a tour ofservice in India and on arrival will be appointed to the-Northern Army. An exchange on the roster for service-


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