986 T

London Mounted Brigade Field Ambulance: CaptainWilliam B. Thomas to be temporary Major.3rd East Anglian Field Ambulance: John Norman

Robins to be Lieutenant.3rd Lowland Field Ambulance: Lieutenant Archibald C.

McMaster to be Captain.2nd Eastern General Hospital: Harold Harris Elborough

Scatliff (late Captain, Sussex Royal Garrison Artillery) to beCaptain, whose services will be available on mobilisation(temporary).Attached to Units other than Medical Units.-Lieutenant

Louis B. Stringer resigns his commission.

INDIAN MEDICAL SERVICE COMMISSIONS.

An examination for not less than 10 Commissions in HisMajesty’s Indian Medical Service will be held in London onJuly 12th, 1915, and the five following days. Particulars andforms of application can be obtained from the MilitarySecretary, India Office, London, S.W.

JOURNAL OF THE ROYAL ARMY MEDICAL CORPS.

The current number of this journal, dated January, givesfirst place to a preliminary note on the treatment of

anaerobe-infected wounds with lactic acid. While engagedin the study of the flora of septic wounds it occurred toMajor L. W. Harrison, D.S.O., the author of the note, thatsince anaerobes of the gas-brand and malignant oedemaseries degenerate, fail to spore, and do not liberate toxin ina distinctly acid culture medium, wounds might be treatedin a manner which would make the discharge distinctly acidto litmus. Two severe cases are described in which woundswere treated with lactic acid, and, although one patientdied, Major Harrison believes that the activity of theanaerobes was hampered more than by other modes of treat-ment. He has no evidence, however, that lactic acid is of anyuse against cocci. In a joint paper by Major E. A. Bourke,Lieutenant Idris D. Evans, and Lieutenant Sydney Rowlandson Preliminary Observations on the Use of an AutogenousLiving Vaccine in the Treatment of Enteric Fever theauthors describe six cases in which the employment ofautogenous living vaccine produced satisfactory results, andthe writers hope that the method of treatment will be givena more extensive trial. Major M. F. Foulds has an interest-ing note on the use of tincture of iodine in the prevention ofvenereal diseases. Among other contents of the journal isthe description of the conversion of a railway porter’s truckinto a carrying chair for the wounded and of a form offolding trestle for the conversion of a stretcher into animprovised bed, both useful devices.

VITAL STATISTICS.

VITAL STATISTICS OF LONDON DURING MARCH, 1915.

IN the accompanying table will be found summarisedcomplete statistics relating to sickness and mortality inthe 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 besuffering from one or other of the 10 diseases specifiedin the table was equal to an annual rate of 6’6 per1000 of the population, estimated at 4,516,612 persons ;in the three preceding months the rates were 9-2,7-4, and 7’4 per 1000 respectively. The lowest rates lastmonth were recorded in Kensington, Chelsea, Hampstead,Poplar, and Bermondsey; and the highest rates in BethnalGreen, Holborn, Deptford, Greenwich, and Woolwich.’Two cases of small-pox, both belonging to Greenwich,were notified during the month. The prevalence of scarletfever showed a marked decline from that recorded inother recent months; this disease was proportionally mostprevalent in Hammersmith, Holborn, Bethnal Green,Greenwich, and Woolwich. The Metropolitan AsylumsHospitals contained 2514 scarlet fever patients at the endof the month, against 4431, 3609, and 2989 at the endof the three preceding months ; the weekly admissionsaveraged 278, against 445, 317, and 324 in the three precedingmonths. Diphtheria was less prevalent than in the pre-vious month; among the several boroughs the greatestproportional prevalence was recorded in Holborn, the Cityof London, Bethnal Green, Stepney, and Deptford. Thenumber of diphtheria patients under treatment in the Metro-politan Asylums Hospitals, which had been 1663,1621, and1562 at the end of the three preceding months, had furtherdeclined to 1362 at the end of the month the weeklyadmissions averaged 142, against 177, 160 ,and 172 in thethree preceding months. Enteric fever was very much lessprevalent than it had been in the preceding month; thegreatest proportional prevalence was recorded in South-wark, Bermondsey, Deptford, and Woolwich. The Metro-politan Asylums Hospitals contained 46 enteric fever

patients at the end of the month, against 68, 50, and 64at the end of the three preceding months; the weeklyadmissions averaged 8, against 10, 6, and 13 in the threepreceding months. Erysipelas was proportionally mostprevalent in Hackney, Shoreditch, Bethnal Green, South-wark, and Woolwich. The 21 cases of puerperal fevernotified during the month included 2 each in Islington,Hackney, Poplar, Bermondsey, Wandsworth, and Camber-well. The cases of cerebro-spinal meningitis numbered 154,this disease being proportionally most prevalent inHammersmith, Shoreditch, Greenwich, and Woolwich.The 4 cases of poliomyelitis included 2 in Islington and2 in Wandsworth.The mortality statistics in the table relate to the deaths of

persons actually belonging to the several boroughs, the deathsoccurring in institutions having been distributed amongthe boroughs in which the deceased persons had previouslyresided; the death-rates from all causes are further correctedfor variations in the sex and age constitution of the popula-tions of the several boroughs. During the five weeks endingApril 3rd the deaths of 9181 London residents were regis-tered, equal to an annual rate of 21-2 per 1000; in the threepreceding months the rates were 16’7, 19’6, and 20-7 per1000. The death-rates during the month ranged from 15’5 inLewisham, 16’8 in Hampstead, 17’7 in Fulham, 18’1 inWandsworth, and 18-3 in Hackney, to 25’1 in Finsbury,25-2 in Chelsea, 26-1 in the City of London, 26-5 inSouthwark, and 29-1 in Bermondsey. The 9181 deathsfrom all causes included 1073 which were referred to theprincipal infectious diseases; of these, 666 resulted frommeasles, 38 from scarlet fever, 71 from diphtheria, 188from whooping-cough, 12 from enteric fever, and 98 fromdiarrhoea and enteritis among children under 2 yearsof age. The lowest death-rates from these diseasesin the aggregate were recorded in Chelsea, Hackney, theCity of London, Shoreditch, and Lewisham; and thehighest rates in Paddington, Kensington, Bethnal Green,Bermondsey, and Battersea. The 666 deaths from measleswere more than double the corrected average number inthe corresponding period of the five preceding years; thisdisease was proportionally most fatal in Paddington,Kensington, Fulham, Bethnal Green, Bermondsey, andBattersea. The 38 fatal cases of scarlet fever were 17 inexcess of the corrected average number, and included 4in Lambeth and 3 each in Hammersmith, St. Pancras,Stepney, Battersea, and Wandsworth. The 71 deaths fromdiphtheria were 19 above the corrected average number;this disease showed the greatest proportional mortality inPaddington’, St. Pancras, Hackney, Holborn, Bethnal Green,Stepney, Poplar, and Deptford. The 188 deaths fromwhooping-cough exceeded the corrected average by22; the highest death-rates from this disease were

recorded in Holborn, Finsbury, Bethnal Green, Poplar,Bermondsey, Battersea, Deptford, and Greenwich. The 12deaths referred to enteric fever were 4 above-the correctedaverage, and included 2 in Paddington, 2 in Poplar,and 2 in Deptford. The mortality from diarrhœa andenteritis among children under 2 years of age was propor-tionally greatest in Holborn, Bethnal Green, Poplar, South-wark, Bermondsey, Greenwich, and Woolwich. In con-

clusion, it may be stated that the aggregate mortality inLondon during the month from the principal infectiousdiseases, excluding diarrhoea, was nearly 79 per cent. abovethe average. -

HEALTH OF ENGLISH TOWNS.

In the 96 English and Welsh towns with populationsexceeding 50,000 persons at the last Census, 8952 births and6022 deaths were registered during the week ended Saturday,May lst. The annual rate of mortality in these towns,which had been 19-9, 19-0, and 17-4 per 1000 in the threepreceding weeks, further fell in the week under noticeto 17-3 per 1000 of their aggregate population, estimated at18,134,239 persons at the middle of last year. During thefirst four weeks of the current quarter the mean annualdeath-rate in these towns averaged 18-4, against a corre-sponding rate of 19-6 per 1000 in London. Among the severaltowns the death-rate last week ranged from 8-4 in Blackpool,8-9 in Carlisle, 9-2 in Norwich, 9-3 in Southend-on-Sea, and10-2 in Enfield to 23-8 in St. Helens, 23-9 in Sunderland,24-0in West Bromwich, 25’6 in Wigan, and 30-5 in Middles-brough.The 6022 deaths from all causes were 41 fewer than the

number in the previous week, and included 711 which werereferred to the principal epidemic diseases, against numbersdeclining from 826 to 689 in the four preceding weeks. Ofthese 711 deaths, 392 resulted from measles, 142 from whoop-ing-cough, 73 from infantile diarrhoeal diseases, 56 from diph-theria, 34 from scarlet fever, 12 from enteric fever, and 2 fromsmall-pox. The mean annual death-rate from these diseaseswas equal to 2-0 per 1000, and coincided with that recordedin the previous week. The deaths attributed to measles,which had declined from 495 to 389 in the four preceding weeks

987

988

slightly rOEe to 392 last week, and caused the. highest annual- death-rates of 3-4 in Sunderland, 3.7 in Edmonton, 3-8 inWolverhampton, 4-0 in Barrow-in-r’urness, 4-1 in Middles-brough, 4-3 in Merthyr Tydfil, 5-0 in Walsall, 5-3 in WestBromwich, and 6-9 in Northampton. The deaths referredto whooping-cough, which had been 167, 151, and 149 in thethree preceding weeks, further fell to 142 last week; thehighest recorded death-rates from this disease were 1-3 in

: Southampton, 1-5 in Walthamstow, 1-6 in Middlesbrough,1-8 in Great Yarmouth, 2-0 in Wakefield, 2-4 in Rotherham,

: :2’6 in St. Helens, 3-5 in Stockton-on-Tees, and 5-7 in Wigan.The fatal cases of diarrhœa and enteritis (among infantsunder 2 years), which had been 67, 63, and 65 in the three pre-’ceding weeks, further rose to 73 last week, and included 17 inLondon, and 4 each in Leicester and Middlesbrough. The- deaths attributed to diphtheria, which had been 49, 55,and 49 in the three preceding weeks, rose to 56 last week,

. -of which 12 were registered in London, 5 in Stoke-on-Trent,.3 each in Leyton, Birmingham, and Bradford. The deathsreferred to scarlet fever, which had increased from 16 to.29 in the four preceding weeks, further rose to 34 last week,.and included 9 in London, 3 each in Manchester and Sheffield,.and 2 each in Willesden, Stoke-on-Trent, Birmingham,Bradford, and Gateshead. The fatal cases of enteric fever,which had been 7, 11, and 8 in the three preceding weeks,

..rose to 12 last week, and included 3 in Salford and 2 each inLondon, Stoke-on-Trent, and Leeds. The 2 deaths fromsmall-pox belonged to Bristol.The number of scarlet fever patients under treat-

ment in the Metropolitan Asylums Hospitals and theLondon Fever Hospital, which had steadily declined from5036 to 2359 in the 22 preceding weeks, had risento 2377 on Saturday last; 316 new cases were admittedduring the week, against 275, 263, and 259 in thethree preceding weeks. These hospitals also containedon Saturday last 1230 cases of diphtheria, 274. of measles, 62of enteric fever, and 16 of whooping-cough, but not one ofsmall-pox. The 1575 deaths from all causes in London were44 fewer than in the previous week, and correspondedto an annual death-rate of 18-2 per 1000. The deathsreferred to diseases of the respiratory system, which’had been 466, 469, and 392 in the three preceding weeks,further fell to 347 in the week under notice, but were162 in excess of the number in the corresponding week oflast year. The deaths from influenza numbered .3tJ, against46, 39, and 27 in the two preceding weeks.Of the 6022 deaths from all causes in the 96 towns 215

resulted from different forms of violence and 408 were thesubject of coroners’ inquests, while 17D3 occurred in publicinstitutions. The causes of 35, or 0-6 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest. All the causesof death were duly certified in London and in 13 of its 14

’.suburban districts, in Leeds, Bristol, Bradford, Hull, New-castie-on-Tyme. and in 56 other smaller towns. Of the 35uncertified causes of death, 5 were registered in Birming-ham, 4 in Liverpool, 3 each in West Bromwich and Gates-head, and 2 each in Stoke-on-Trent, Preston, and Sheffield.

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns with an aggregate popula-tion estimated at 2,345,500 persons at the middle of this year,1285 births and 909 deaths were registered during the weekended Saturday, May lst. The annual rate of mortality inthese towns, which had been 20-8, 20-9, and 18-5 per 1000 inthe three preceding weeks, rose to 20-2 per 1000 in theweek under notice. During the first four weeks of thecurrent quarter the mean annual death-rate in these townsaveraged 20-1, against a corresponding rate of 18-4 per 1000in the large English. towns. Among the several towns the Ideath-rate last week ranged from 12-8 in Kirkcaldy, 12-9 in I,Clydebank, and 14-9 in Hamilton, to 21-3 in Coatbridge, 23-3in Leith, and 25-0 in Dundee.The 909 deaths from all causes were 75 in excess of

the number in the previous week, and included 150which were referred to the principal epidemic diseases,against numbers declining. from 181 to 128 in the four pre-ceding weeks. Of these 150 deaths, 82 resulted fromwhooping-cough, 36 from measles, 12 from diphtheria, 11from scarlet fever, and 9 from infantile diarrhoeal diseases,but not one from enteric fever or from small-pox. Themean annual death-rate from these diseases was equal to3-3, against a corresponding rate of 2-0 per 1000 in thelarge English towns. The deaths attributed to whooping-cough, which had been 75, 90, and 75 in the three pre-ceding weeks, rose to 82 last week, and included42 in Glasgow, 14 in Dundee, 8 in Edinburgh, and4 each in Paisley and Greenock. The deaths re-

ferred to measles, which had been 41, 19, and 26 in thethree preceding weeks, further rose to 36 last week, of which25 were registered in Glasgow and 9 in Aberdeen. The fatal

.’ cases of diphtheria, which had been 11, 7, and 6 in the

.. three preceding weeks, rose,to 12.last week, and included

2 each in Glasgow, Leith, and -Motherwell. The deathsattributed to scarlet fever, which had been 6, 7, and 7 inthe three preceding weeks, further rose to 11 last week, ofwhich 3 occurred in Glasgow, and 2 each in Leith andClvdebank. The fatal cases of diarrhoea and enteritis(among infants under 2 years), which had been 18,10, and12 in the three preceding weeks, fell to 9 last week, andincluded 2 in Leith and 2 in Kilmarnock.The deaths referred to diseases of the respiratory system,

which had been 182, 178, and 145 in the three precedingweeks, rose to 153 in the week under notice, and were 63 inexcess of the number in the corresponding week of lastyear. The deaths attributed to violence numbered 25,against 21 and 30 in the two preceding weeks.

HEALTH OF IRISH TOWNS.

In the 27 town districts of Ireland, with an aggregatepopulation estimated at 1,212,380 persons at the middle ofthis year, 658 births and 444 deaths were registered duringthe week ended Saturday, May lst. The annual rate ofmortality in these towns, which had been 238, 22’1, and22-4 per 1000 in the three preceding weeks, fell to 19-1per 1000 in the week under notice. During the first fourweeks of the current quarter the mean annual death-rate inthese towns averaged 21’9, against corresponding rates of18-4 and 20-1 per 1000 in the English and Scotch townsrespectively. The death-rate last week was equal to 19-0in Dublin (against 18’2 in London and 21-1 in Glasgow),19-8 in Belfast, 17-7 in Cork, 24-0 in Londonderry, 19’0 inLimerick, and 17-1 in Waterford, while in the 21 smallertowns the mean death-rate was 17-8 per 1000.The 444 deaths from all causes were 77 fewer than the

number in the previous week, and included 35 whichwere referred to the principal epidemic diseases, against30 and 41 in the two preceding weeks. Of these 35 deaths,11 resulted from measles, 10 from infantile diarrhoea]diseases, 9 from whooping-cough, 3 from diphtheria, and2 from scarlet fever, but not one from enteric fever or fromsmall-pox. The mean annual death-rate from these diseaseswas equal to 1-5, against corresponding rates of 2-0and 3-3 per 1000 in the English and Scotch townsrespectively. The deaths attributed to measles, whichhad been 16, 5, and 13 in the three preceding weeks,fell to 11 last week, and included 7 in Belfast and2 in Dublin. The deaths of infants (under 2 years)referred to diarrhoea and enteritis, which had been3, 5, and 5 in the three preceding weeks, further rose

to 10 last week, of which 4 were registered in Dublinand 2 each in Belfast and Lisburn. The fatal cases

of whooping-cough, which had been 15, 11, and 20 in thethree preceding weeks, fell to 9 last week, and included 5in Belfast and 2 in Dublin. Of the 3 deaths attributed todiphtheria, 2 occurred in Dublin and 1 in Newtownards. The2 fatal cases of scarlet fever were recorded in Belfast andWaterford.The deaths reterred to diseases of the respiratory system,

which had been 158,119, and 104 in the three preceding weeks,further declined to 84 in the week under notice. Of the,444 deaths from all causes,131, or 30 per cent., occurred inpublic institutions, and 8 resulted from various forms ofviolence. The causes of 10, or 2-3 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest; in the large ’.

English towns the proportion of uncertified causes did notexceed 0-6 per cent.

GLASGOW LOCK HOSPITAL.-The 109th annualreport of this institution (for the year 1914) shows that’300 patients were admitted to the hospital, as against240 in 1913 and 251 in 1912. The number- of patientswho left irregularly, or before their cure had beencompleted, was 15. Of the total number of patientsadmitted during the year 205 were received for thefirst time, 69 for the second, 23 for the third, 2 for thefourth, and 1 for the eighth time. The 384 out-patients.made 1070 visits, as compared with 217 out-patientswith 501 visits in 1913. The out-patients of 1914had all at one time been in-patients. The averageperiod of sojourn in the hospital was 42 days, andthe average age of the patients 24 years. The patientsincluded infants and girls of most ages between 2 and 16.The financial statement shows the ordinary income to havebeen £1301 19s. 6d., and the ordinary expenditure 61500 7s.,leaving a deficiency of £198 7s. 6d ,which compares with adeficit of .64 10s. 3d. in 1913. The extraordinary incomeconsisted of legacies amounting to 6131, and after deductingspecial expenditure there is a debit balance of £390 15s. 10d.to be carried to capital.