1040

certified midwives who only attended cases with medical menought to notify their intention to practise was postponed.

After the SECRETARY had read the financial statement, Dr.SINCLAIR urged that in future the accounts should be madeup seven days before the meeting of the Board and thenprinted and sent out with the agenda. Dr. Sinclair pointedout that it was difficult to discuss adequately figures read atthe meeting.At the request of the CHAIRMAN the SECRETARY then

read Rule 18 regulating the proceedings of the Board asfollows: -

At every ordinary meeting of the Board the secretary shall present astatement in writing showing the receipts and expenditure of theBoard, including balances brought forward since the last ordinarymeeting, and showing the existing balance, if any, to the credit of theBoard and the existing liabilities.

Miss WILSON suggested that the Board should wait for theattendance of Mr. J. H. Johnstone.

Dr. SINCLAIR did not think it should be thought that theBoard must wait for the attendance of Mr. J. H. Johnstonebefore deciding on such a common-sense matter.

After some discussion the CHAIRMAN ruled that the methodfollowed by the secretary was according to the regulations.The Board adjourned to Oct. 27th.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8401 births and 4571deaths were registered during the week ending Oct. lst.The annual rate of mortality in these towns, which hadbeen 17 5, 17’ 0, and 16’ 0 per 1000 in the three precedingweeks, further declined last week to 15’ 6 per 1000. InLondon the death-rate was 14’ 3 per 1000, while it averaged16’2 per 1000 in the 75 other large towns. The lowestdeath-rates in these towns were 6’ 4 in Hornsey, 7’ 5 inKing’s Norton, 7’ 9 in Willesden, 8-6 6 in Smethwick, 8 - 7in Handsworth (Staffs.), 9’ 4 in Leyton, and 9’ 6 in Reading ;while the highest rates were 21’ 0 in Stockton-on-Tees, 22’ 1in Salford, 22’ 6 in Liverpool and in West Hartlepool,23’ 3 in Blackburn, 23-5 5 in Sunderland, 23’ 6 in Black-burn, 25-7 in Wigan. and 26-5 in St. Helens. The 4571deaths in these towns last week included 837 whichwere referred to the principal infectious diseases, against1512, 1192, and 971 in the three preceding weeks ; of these837 deaths, 568 resulted from diarrhoea, 72 from diphtheria,66 from measles, 45 from whooping-cough, 43 from scarletfever, 42 from "fever" (principally enteric), and one

from small-pox. No death from any of these diseasesoccurred last week in Hornsey or in Handsworth (Staffs) ;in the other towns they caused the lowest death-rates iu

Bournemouth, Devonport, King’s Norton, and Aston Manor;and the highest rates in Liverpool, Warrington, Bolton,Salford, Burnley, Blackburn, Preston, Hull, Stockton-on-Tees, and Sunderland. The greatest proportional mortalityfrom measles occurred in Grimsby, Liverpool, and Tyne-mouth ; from scarlet fever in Northampton and Hudders-field ; from diphtheria in Portsmouth, Salford, Huddersfield,Stockton-on-Tees, and Swansea ; and from diarrhoea in

Warrington, Bolton, Burnley, Blackburn, Preston, Stockton-on-Tees, and Sunderland. The mortality from whooping-coughand from "fever" showed no marked excess in any of the

large towns. One fatal case of small-pox was registered inGateshead but none in any other of the large towns. Thenumber of small-pox patients in the Metropolitan Asylumshospitals, which had been five at the end of each of thetwo preceding weeks, had declined to three at the end oflast week; no new cases were admitted during the week,against two, one, and none in the three preceding weeks.The number of scarlet fever cases in these hospitals and inthe London Fever Hospital on Saturday last, Oct. 1st, was2158, against 1816, 1929, and 1969 on the three precedingSaturdays ; 406 new cases were admitted during the week, Iagainst 234, 340, and 284 in the three preceding weeks.The deaths in London referred to pneumonia and diseases Iof the respiratory system, which had been 129, 141, and169 in the three preceding weeks, declined again lastweek to 167, but were five above the average number in thecorresponding period of the preceding year. The causes of45, or 1-0 per cent., of the deaths registered in the 76towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were

duly certified in West Ham, Bristol, Leicester, Salford,Newcastle-on-Tyne, and in 45 other smaller towns; thelargest proportions of uncertified deaths were registered inBirmingham, Liverpool, Bootle, St. Helens, Blackburn,Preston, Halifax, Sheffield, and Gateshead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 15’7, 16’5, and 16’0 per1000 in the three preceding weeks, rose again to 16’6 6per 1000 during the week ending Oct. lst, and was 1’Oper1000 in excess of the mean rate during the same period in the76 large English towns. Among these Scotch towns thedeath-rates ranged from 13’ 6 in Paisley and 14’ 8 in Edin-burgh to 20 - 0 in Perth and 26 - 2 in Greenock. The 550deaths in these towns included 58 which were referred todiarrhoea, 23 to whooping-cough, 11 to "fever," fourto scarlet fever, four to diphtheria, and one to measles. In

all, 101 deaths resulted from these principal infectiousdiseases last week, against 86, 103, and 87 in the three

preceding weeks. These 101 deaths were equal to an

annual rate of 3’ 1 per 1000, which was 0’ 2 per 1000above the mean rate last week from the same diseases inthe 76 large English towns. The fatal cases of diarrhoea,which had been 52, 69, and 60 in the three precedingweeks, further declined last week to 58, of which 28 wereregistered in Glasgow, nine in Edinburgh, nine in Dundee,four in Aberdeen, four in Leith, and three in Paisley. Thedeaths from whooping-cough, which had been 17, 13, and17 in the three preceding weeks, further rose to 23 last week,and included 15 in Glasgow and five in Edinburgh.The fatal cases of " fever," which had been five, eight, andthree in the three preceding weeks, increased again last weekto 11, of which seven occurred in Greenock and three in

Glasgow. The deaths from scarlet fever, which had beentwo, two, and three in the three preceding weeks, furtherrose to four last week, and included three in Glasgow. Thedeaths referred to diseases of the respiratory organs inthese towns, which had been 58, 55, and 66 in the threepreceding weeks, further rose to 75 last week, but were 13below the number in the corresponding period of last year.The causes of 12, or more than 2 per cent., of the deathsregistered in these eight towns were not certified.

HEALTH OF DUBLIN.

The annual death-rate, which had been 20’8, 16’8, and25’ 9 per 1000 in the three preceding weeks, declined againto 19’0 0 per 1000 during the week ending Oct. 1st.

During the 13 weeks of the quarter ending on that datethe death-rate averaged 20’7 per 1000, the rates duringthe same period being 16’ 4 in London and 14’ 7 in

Edinburgh. The 138 deaths of persons belonging toDublin registered during the week under notice showeda decline of 50 from the number in the preceding weekand included 19 which were referred to the principalinfectious diseases, against 32, 17, and 34 in the three

preceding weeks ; of these, 16 resulted from diarrhoea,two from "fever," and one from whooping-cough, butnot any from small-pox, measles, scarlet fever, or diph-theria. These 19 deaths were equal to an annualrate of 2’ 2 per 1000, the death-rates last week fromthe principal infectious diseases being 1’ 6 in Londonand 2’ 4 in Edinburgh. The fatal cases of diarrhoea, whichhad been 26, 14, and 28 in the three preceding weeks,declined again last week to 16. The 138 deaths in Dublinlast week included 37 among children under one year ofage and 27 among persons aged 60 years and upwards ;the deaths both of infants and of elderly persons showed amarked decline from the respective numbers recorded in thepreceding week. Eight inquest cases and five deaths fromviolence were registered, and 50, or more than a third, ofthe deaths occurred in public institutions. The causes offive, or nearly 4 per cent., of the deaths registered in Dublinlast week were not certified.

VITAL STATISTICS OF LONDON DURING AUGUST, 1904.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 it

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was equal to an annual rate of 6’ 0 per 1000 of the popula-tion, estimated at 4,648,950 persons in the middle of theyear. In the three preceding months the rates had been 5’9,5’4, and 6 - 1 per 1000. The rates were considerably belowthe average in Kensington, Chelsea, the City of Westminster,Hampstead, Lambeth, Wandsworth, and Lewisham; while theyshowed the largest excess in St. Pancras, Hackney, BethnalGreen, Stepney, Poplar, and Deptford. The notified cases of

small-pox, which had been 87, 60, and 32 in the three precedingmonths, further declined to four, and included one each inHackney, Stepney, Camberwell, and the district of the sani-

tary authority for the Port of London. The MetropolitanAsylums hospitals contained six small-pox patients at theend of August, against 118, 74, and 46 at the end of thethree preceding months ; the weekly admissions averagedone, against 23, 13, and eight in the three precedingmonths. Scarlet fever was slightly less prevalent duringthe month under notice than it had been during the pre-ceding month ; this disease was proportionally most prevalentin St. Pancras, Bethnal Green, Stepney, Deptford, andWoolwich. The number of scarlet fever patients in theMetropolitan Asylums hospitals, which had been 1632,1599, and 1764 at the end of the three precedingmonths, had risen again to 1801 at the end of August;the weekly admissions averaged 214, -against 219, 206,and 214 in the three preceding months. The prevalenceof diphtheria showed a considerable increase over thatrecorded in the preceding month ; among the various metro-politan boroughs diphtheria was proportionally most prevalentin Hackney, Bethnal Green, Stepney, Poplar, and Greenwich.The Metropolitan Asylums hospitals contained 818 diphtheriapatients at the end of August, against 755, 681, and 763 atthe end of the three preceding months; the weekly ad-missions averaged 119, against 113, 95, and 124 in the threepreceding months. Enteric fever was more prevalent than inany previous month during the year ; this disease showed thegreatest proportional prevalence in St. Pancras, Hackney,Stoke Newington, Stepney, and Poplar. The number ofenteric fever patients in the Metropolitan Asylums hospitals,which had been 51, 62, and 67 at the end of thethree preceding months, had increased to 135 at the end ofAugust ; the weekly admissions averaged 29, against ten, 12,and 15 in the three preceding months. Erysipelas was pro-portionately most prevalent in Hammersmith, St. Mary-lebone, Holborn, Finsbury, Bethnal Green, Stepney, andPoplar. The 26 cases of puerperal fever notified during themonth included four in Camberwell, three in Hammersmith,three in Lambeth, and two each in Islington, StokeNewington, and Deptford.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various metropolitanboroughs, the deaths occurring in public institutions havingbeen distributed among the several boroughs in which thedeceased persons had previously resided. During the fiveweeks ending Sept. 3rd the deaths of 8494 personsbelonging to London were registered, equal to an annualrate of 19’1 1 per 1000 ; in the three preceding months therates had been 13 9, 12’ 5, and 13’ 6 per 1000 respectively.The lowest death-rates in London during the monthunder notice were 9’ 5 in Hampstead, 12’ 7 in the City ofWestminster, 14’ 1 in Stoke Newington, 14’ 4 in Lewisham,14’ 6 in Paddington, 15’ 2 in Kensington, 15’ 6 in the City ofLondon, and 15 - 9 in Holborn ; the highest rates were 22’ 3in Stepney, 22’7 in Bethnal Green, 23’6 in Poplar, 23’9 9 inBermondsey, 24’ 5 in Southwark, 26’ 6 in Finsbury, and27’9 in Shoreditch. The 8494 deaths from all causes

included 3126 which were referred to the principal infectiousdiseases; of these, two resulted from small-pox, 154 frommeasles, 31 from scarlet fever, 53 from diphtheria, 104 fromwhooping-cough, 30 from enteric fever, and 2752 from diar-rhoea. The lowest death-rates from these diseases wererecorded in Kensington, Chelsea, the City of Westminster,St. Marylebone, Hampstead, Stoke Newington, and theCity of London ; and the highest rates in Fulham,Shoreditch, Poplar, Southwark, Bermondsey, and BethnalGreen. The two fatal cases of small-pox both belongedto Shoreditch. The 154 deaths from measles were 17below the average ; among the various metropolitanboroughs this disease was proportionately most fatal in

Islington, Holborn, Shoreditch, Poplar, and Greenwich.The 31 fatal cases of scarlet fever were less than one-half of the average number in-the corresponding periods ofthe ten preceding years; the highest proportional mortalityfrom this disease was recorded in St. Pancras, Islington,

Finsbury, Stepney, Poplar, Bermondsey, and Lewisham. Thedeaths from diphtheria numbered 53, the corrected averagenumber being 162; among the various metropolitan boroughsthis disease was proportionately most fatal in Stoke Newing-ton, Hackney, Holborn, Stepney, and Woolwich. The 104fatal cases of whooping-cough showed a decline of 38 fromthe average number in the corresponding periods of the tenpreceding years ; the highest proportional mortality from thisdisease occurred in Hammersmith, Fulham, Chelsea, Poplar,and Lambeth. The 30 deaths referred to enteric fever were 27fewer than the corrected average number ; among the variousmetropolitan boroughs this disease was proportionally mostfatal in Paddington, St. Pancras, Hackney, Holborn,Bermondsey, and Greenwich. The 2752 deaths fromdiarrhoea were 1240 in excess of the average number in the

corresponding periods of the ten preceding years; the greatestproportional mortality from this disease was recorded in

Fulham, Hackney, Shoreditch, Poplar, Southwark, Ber-

mondsey, and Deptford. In conclusion, it may be statedthat the aggregate mortality from these principal infectiousdiseases was nearly 49 per cent. above the average.

Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 313 per 1000. The lowest rates of infant mor-tality were recorded in the City of Westminster, St. Mary-lebone, Hampstead, Stoke Newington, Holborn, and the

Citv of London; and the highest rates in Hammersmith,Fulham, St. Pancras, Hackney, Shoreditch, and Southwark.

THE SERVICES.

ROYAL NAVAL VOLUNTEER RESERVE.THE undermentioned has been appointed Surgeon :-Elliot

Wilson Woodbridge (dated Sept. 27th, 1904).ROYAL ARMY MEDICAL CORPS.

Lieutenant-Colonel W. T. Johnston, Acting PrincipalMedical Officer at Belfast, is ordered to Canterbury to takeup duty there. Major E. McK. Williams is posted to theHome District for duty. Major H. A. Cummins, C.M.G., isheld in readiness for service in India.

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).The Glasgow Companies : The undermentioned Lieu-

tenants to be Captains :-G. H. Edington (dated Oct. 5th,1904), M. Dunning (dated Oct. 5th, 1904), S. M. Sloan (datedOct. 5th, 1904), H. W. Thomson (dated Oct. 5th, 1904), A.Young (dated Oct. 5th, 1904), and F. J. Charteris (datedOct. 5th, 1904). The London Companies : The resignationof Major T. H. Openshaw, C.M.G., which was announced inthe London Gazette of Sept. 2nd, 1904, is cancelled. DevonBearer Company : Captain H. W. Webber resigns his com-mission (dated Oct. 5th, 1904).

ACCIDENT TO SURGEON-GENERAL J. A. CLERY.A serious accident occurred to Surgeon-General J. A.

Clery, C.B., A.M.S., medical officer of the 2nd Army Corps,belonging to the headquarters staff at Salisbury, who, incompany with Colonel Heath, was returning home from acycle ride in the neighbourhood of Salisbury on Sept. 26th.When nearing home he was thrown from his bicycle and runover by a motor-car. Assistance was at once rendered andSurgeon-General Clery was conveyed home by motor-car,when it was found that he had sustained a fracture of threeribs and some scalp wounds ; it is also feared that the spinehas received some injury.

DEATHS IN THE SERVICES.

Brigade-Surgeon William Ashton, A.M.S. (retired), recently,at his residence, Marlborough Lawn, Cheltenham, in hisseventieth year. He entered the medical service of thearmy in 1857 and served in the Indian Mutiny campaign of1858-9 and was present with the 79th Highlanders at thestorming and capture of Rampole Cassie and the passage ofthe Gogra at Fyzabad, and with the 53rd Regiment at theaction of Toolsepore (Indian medal). He retired from thearmy in 1888.

Brigade-Surgeon Edwin Wilson, A.M.D. (retired), sud-denly on Sept. 27th, aged 78 years. He became assistantsurgeon in 1855 and reached the rank of surgeon in 1868,surgeon-major in 1873, and retired in 1884 with the honoraryrank of brigade-surgeon. He served in the 71st Highlanderswith the Central India Field Force under Sir Hugh Rose in