1395PUBLIC HEALTH AND POOR LAW.-VITAL STATISTICS.

defective vision, 340 with defective hearing, 236 withabnormal conditions of the throat and nose, 262 with skineruptions, and 169 with various defects physical and mental.It would have been instructive could figures have been givenas to the number of defective children in whom the detectswere capable of actual remedy. As regards the refractivedefects, it seems that the parents are often too poor to pro-vide the necessary glasses. Apparently one afternoon ineach week is devoted to the examination of scholars inattendance at one or more schools-an arrangementby which each school in the borough is visited once

every six months. Some useful work has been carried onin Derby since 190 in the direction of investigating themethods of the feeding of children and the relation theretoof the infantile mortality in each group. Over 10,000observations have been made. Of the total number visited66 per cent. were breast-fed, 19 per cent. wholly hand-fed.and the remaining 15 per cent. were partly hand-fed andpartly breast-fed. The death-rate per 1000 among thebreast-fed was 71’ 2 as compared with 217’ among thehand-fed and 106 among those only partly breast-fed. Itis important, too, to note that from practically every causethe rates as regards the hand-fed were markedly highEr thanwere those for the breast-fed.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8307 births and 4533deaths were registered during the week ending Nov. 10th.The annual rate of mortality in these towns, which hadbeen equal to 14’ 6 per 1000 in each of the three precedingweeks, rose last week to 14 - 9. During the first six weeksof the current quarter the death-rate in these towns

averaged 15’ 2 per 1000 ; the rate during the same periodin London did not exceed 14 ’ 3. The lowest death-ratesin the 76 towns during the week under notice were 5’ 9in Burton-on-Trent, 6 - 5 in King’s Norton and in Smeth-wick, and 6’ 6 in Hornsey; the rates in the other townsranged upwards to 23 7 in Oldham, 23 8 in Burnley,23 9 in Coventry, and 27-9 9 in Tynemouth. The 4533deaths in the 76 towns showed an increase of 115 uponthe low number in the previous week, and included 441which were referred to the principal epidemic diseases,against numbers declining from 2570 to 515 in the nine

preceding weeks; of these, 167 resulted from diarrhoea,108 from measles, 67 from diphtheria, 43 from scarlet fever,36 from "fever" (principally enteric), 20 from whooping-cough, and not one from small-pox. The deaths from theseepidemic diseases were equal to a mean annual rate of 1’ 5 per1000 in the 76 towns, and to 1’1 1 in London. These

epidemic diseases caused no death last week in Bury,Bournemouth, Hastings, Hornsey, or in four other of the76 towns ; whereas the highest death-rates therefromwere 4’7 7 in Hanley, 4’9 9 in Preston, 5’2 in Oldham, and8’5 in Rotherham. The 167 deaths referred to diarrhoeashowed a further decline of 47 from the numbers returnedin the nine preceding weeks ; this disease, however, againcaused excessive rates last week in Burnley, Hanley, Preston,and Merthyr Tydfil. The 108 fatal cases of measles showeda further increase on recent weekly numbers, the highestrates of mortality occurring in Stockport, Oldham, South

Shields, and Rotherham. The 67 deaths from diphtheriawere fewer by 11 than the number in the previous week,but showed the largest proportional excess in Reading,Derby, and Hanley. The deaths referred to "fever" showeda further decline, and caused the highest rate of mortalityin St. Helens. The fatal cases of scarlet fever and ofwhooping-cough showed no marked excess in any of the 76towns. No case of small-pox was under treatment in theMetropolitan Asylums hospitals during the week, no caseof this disease having been admitted thereto since the endof June. The number of scarlet fever cases under treatmentin the Metropolitan Asylums hospitals and in the LondonFever Hospital, which had increased in the ten proceding weeks from 3042 to 4177, had declined to 4135at the end of the week under notice ; 417 new cases wereadmitted to these hospitals during the week, against548, 542, and 499 in the three preceding weeks. The deathsin London referred to pneumonia and other diseases of therespiratory organs, which had been 149, 150, and 200 in thethree previous weeks, further rose last week to 231, but wereso many as 121 below the corrected average in the cor-

refponding week of the fcur preceding years, 1902-05. The

causes of 42, or 0’9 9 per cent., of the deaths registeredduring the week were not certified either by a registeredmedical practitioner or by a coroner. All the causes of deathwere duly certified in Leeds, Bristol, West Ham, Bradford,and in 54 other of the 76 towns ; the proportion of un-certified deaths again showed, however, a considerable excessin Liverpoool, Birmingham, Sheffield, Sunderland, Preston,and South Shields.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 16’3 and 16’ 0 per1000 in the two preceding weeks, rose again to 17 0 in theweek ending Nov. 10th, and exceeded by 3’ 1 the meanrate during the same week in the 76 English towns.The rates in the eight Scotch towns ranged from 12 6and 13-6 6 in Leith and Perth to 17-0 0 in Greenock and 18-9in Glasgow. The 581 deaths in the eight towns showedan increase of 33 upon the number in the previousweek, and included 48 which were referred to the

principal epidemic diseases, corresponding with thenumber in the previous week. These 48 deaths were equalto an annual rate of 1-4 4 per 1000, which was 0’ 1 belowthe rate from the same diseases in the 76 English townp,and included 16 which were referred to diarrhoea, nine towhooping-cough, eight to "fever," seven to measles, sixto diphtheria, two to scarlet fever, and not one to

small-pox. The deaths referred to diarrhoea, which haddeclined from 56 to 19 in the four previous weeks, furtherfell to 16 last week, of which nine occurred in Glasgowand three in Dundee. Seven of the nine fatal cases of

whooping-cough and six of the eight deaths referred to"fever" were returned in Glasgow; of the six deathsreferred to "fever" four were certified as cerebro spinalmeningitis. Three fatal cases of diphtheria were recordedboth in Glasgow and in Edinburgh. Of the seven deathsfrom measles five occurred in Aberdeen and two in Dundee.The deaths in the eight towrs referred to diseases of the

respiratory organs, including pneumonia, which had been102 and 94 in the two preceding weeks, rose again to 100 lastweek, but were so many as 51 below the number returnedin the corresponding week of last year. The causes of 18, or3’1 1 per cent., of the deaths registered during the weekwere not certified ; the mean proportion of uncertified deathsin the 76 English towns during the same week did not exceed0 - 9 per 1000.

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HEALTH OF DUBLIN.

The annual death-rate in Dublin, which had beenequal to 27’4 4 and 24’9 9 per 1000 in the two precedingweeks, declined again to 24’ 9 in the week ending Nov. 10th.During the first six weeks of the current quarter thedeath-rate in the city averaged 24’2 2 per 1000, the meanrate during the same period being only 14’3 in Londonand 14 9 in Edinburgh. The 181 deaths of Dublinresidents during the week under notice showed a d(clineof 18 from the high number in the previous week, and in-cluded 12 which were referred to the principal epidemicdiseases, against numbers declining from 52 to 14 in thenine preceding weeks; these 12 deaths were equal to anannual rate of 1 - 7 per 1000, against 1’1 1 and 0’ 6respectively from the same diseases in London and

Edinburgh. These 12 deaths last week in Dublin includedsix from measles, two from whooping-cough, two fromdiarrhoea, one from "fever," one from diphtheria, and notone either from scarlet fever or small-pox. The fatal casesof measles showed a considerable increase and exceeded thenumber in any previous week of this year; while the deathsreferred to diarrhoea showed a further considerable declinefrom recent weekly numbers. Eight inquest cases and threedeaths from violence were registered ; and 77, or 42’ 5 percent., of the deaths occurred in public institutions. Thecauses of nine, or 5’ 0 per cent., of the deaths registeredduring the week were not certified ; the percentage of un-certified causes of death last week did not exceed 0’ 2 inLondon and was 4’ 4 per cent. in Edinburgh.

RUSSIAN MEDICAL MEN AND THE MINISTER OFEDUCATION.-It is announced from Odessa that the doyenof the medical faculty, Professor Medbievieff, and thesecretary of the faculty, Professor Blauberg, have resignedtheir posts on account of a conflict with the Minister ofEducation,

1396 THE SERVICES.

THE SERVICES.

SIR LAMBERT ORMSBY ON THE NAVAL MEDICAL SERVICE.IN the course of an introductory address delivered at the

Meath Hospital and County of Dublin Infirmary on Oct. 8that the opening of the winter session by Sir Lambert H.Ormsby, senior surgeon to the hospital and past President ofthe Royal College of Surgeons in Ireland, the position ofthe Naval Medical Service was reviewed in very stringentterms. Sir Lambert Ormsby said :-Only the other day one of my pupils, who is just

qualified, met me in the hospital and I asked him whathe was going to do. He answered, "I intend, sir, to havea try for the navy," but my reply to him was " Don’t enterthe service at present." Three years ago in one of mypresidential addresses at the Royal College of Surgeons Idrew attention very strongly to the grievances of the NavalMedical Service as they then existed. I deeply regretthat the grievances and defects which I enumerated atthat time have not been remedied, and in justice to ourmedical brethren in that service I must return to the

subject again. They, of course, are precluded by the King’sRegulations from mentioning or even hinting at their well-grounded grievances while in the service. I shall touch onthe points I spoke of on a former occasion.

1. Pronzoti 3n. -This question since I last addressed myselfto the subject has been satisfactorily settled, though as mustbe expected rank for rank the executive is considerablyyounger than the medical officer.

2. Foreign service.-There is room still for considerablereform in this respect ; at present there is no roster nor anymethod in the manner in which appointments are made,certain favoured officers going from one shore appointmentto another or, what is equally bad, remaining indefinitely inshore appointments. Many of these appointments are madeas a rule not for conspicuous ability but for conspicuousinfluence. Treatment of this sort disheartens those whohave as a result of the system an undue proportion of serviceafloat. It does not tend to efficiency, as instead of havingsay 12 men equally capable of doing certain work at presentonly one has an opportunity afforded him of doing it. Toomuch service afloat to men who are keen on their work ismost disheartening. The men who like the service afloat are

generally those who take no great interest in their medicalwork. If it were known that service afloat and serviceashore were fairly and equitably regulated there would belittle or no discontent on this score. At present if a navalmedical officer gets through a commission afloat satisfactorilyhe often finds that instead of a hospital he gets another ship,or else he is told he can go on half-pay.

3. Compulsory half-pay is to be regretted, but it is difficultto see how it can be avoided if there are more officers than

appointments, unless it be by putting unemployed officersthrough hospital courses or study leave.

4. Oontrol (>f the sick berth staff.-This is a very importantmatter and should be remedied without delay. The controlof the sick berth staff on shore should be entirely in thehands of the principal medical officer, who should haveprecisely the same power when serving in a naval medicalestablishment on shore as is enjoyed by his militaryconfreres in the Royal Army Medical Corps. The principalmedical officers of the Royal Naval Hospitals at presenthave no power to deal with breaches of discipline on thepart of the sick berth staff that serve under them, whetherashore or afloat. An inspector-general of hospitals and fleets,ranking with a rear admiral or with a major-general in thearmy, before he can get a man punished has to report himto the executive officer at the local depot, and much timeis wasted in making out written reports in connexion withthe case, and in sending the offender and witnesses for adistance which, in the case of Haslar, is over a mile fromthe hospital.The principal medical officer of a naval hospital should

have power to award minor punishments in hospitals andsick quarters. It is ridiculous and humiliating to the pro-fession that a senior medical officer cannot legally stopleave, award extra duty, or stop pay for misconduct amongthe staff of the hospital or sick berth of which he is thehead, more especially when we come to consider that thepunishment has often to be awarded for misconduct andneglects which took place a considerable time previously,owing to delays, of which only a naval medical officer canappreciate the significance. It is no wonder, in existing

circumstances, that so many irregularities occur in largenaval hospitals. It is most humiliating that a naval medicalofficer of distinguished rank may at any moment have tobuckle on his sword, leave his ward duties, and go to adepot to give evidence against a careless, disobedient, ordrunken sick berth attendant, the punishment of whomcould easily have been awarded by the inspector-general ifhe had the legal power on the spot when the offence wascommitted. The executive branch of the Royal Navy is

exceedingly jealous of its privileges and prerogatives, bothofficial and social. The executive board dreads the lossof these privileges and prerogatives and is loth to sanctionany power being given to anyone outside it. However,public opinion will sooner or later throw a little wholesomelight on these matters.

5. ]}[cdical guard.-It is the recognised custom in the

present day when two or more ships are in harbour togetherfor them to take in turn to keep "medical guard" and theship keeping medical guard flies a special flag for the

purpose. The medical guard has to remain on board andis always available in case a surgeon is required in anyemergency in any ship of the fleet. This excellent systemhas not as yet been embodied in the King’s Regulations andthe result is that some narrow-minded captains who cannotresist the temptation of showing their authority still insiston always having one of the two medical officers belonging tothe ship on board although there may be nothing going on inthe ship that the medical officer of the guard (close alongsideand capable of being on board within five minutes of thesignal being made) could not attend to. The result of thisis that the fleet surgeon or staff surgeon of a big battleshipof this nature may find himself worse off than a junior sur-geon on a gunboat. Another captain will insist on both thefleet surgeon and surgeon being on board when his ship ismedical guard. In other words the fleet surgeon, rankingwith a lieutenant-colonel in the Royal Army Medical Corps,is made to do the work of a surgeon ranking as a captainin the army. All this red tape is extremely galling to themedical branch of the navy, especially as no means ofredress can be obtained, for if the fleet surgeon protests heis referred by the captain by the Article in the King’sRegulations saying that he must obey all orders he mayreceive from his commanding officer. It should be clearlylaid down in the King’s Regulations that medical guard isto be recognised by the captains and commanding officersof all ships, thus putting it beyond the capricious exercise ofexecutive authority.

6. _Medical sarves.-To be an inspector-general is theambition of most naval surgeons and it is disheartening andhumiliating in the extreme to see these officers, ranking asthey do with major-generals, forced to sit at medical surveyswhich are held for purely medical purposes under the pre-sidency of a captain or commander of the executive branch.This is not only an absurdity and an indignity to the wholemedical profession but it is a direct cause of inefficiency, forthe executive officer can of his own mere motion overrulethe decision of all his medical colleagues on matters as towhich he is incompetent to form a judgment. Such a con-dition of mistrust is lamentable and is injurious not only tothe Naval Medical Service but to the whole profession, forthese executive officers, on retirement as admirals, &c., carrywith them into civil life the same wretched opinion of thestatus of the medical man as they have seen in the navy.The matter is becoming one of national importance and callsurgently for reform, and we, civil practitioners and hospitalteachers, with all the weight of our influence, are bound tospeak, write, and agitate in a forcible way, by argument andcommon sense, to remove the grievances and hardshipswhich our naval brethren suffer from. For as I have alreadysaid the naval medical officer is precluded by the King’sRegulations from publicly making known his troubles. Inthe army the medical officers not’only preside over their ownmedical boards but a medical officer sits as president, ifsenior, over all junior combatant officers, on all classes ofboards.

7. CoMy MM—When a medical officer is tried bycourt-martial for any offence, professional or otherwise, hisjudges are entirely executive officers. It is the generaldesire, and it is only right, that some of the members con-stituting the court on such occasions should be medicalofficers of high rank.

8. Salutes.-It is painful to see the neglect shown tonaval medical officers as to salutes. Junior officials con-stantly pass them by without saluting them. This breaks