421VITAL STATISTICS.

not be lost sight of. The relation of the manure and othernuisances to the prevalence of non-diphtheritic sore-throat isanother matter to which Dr. Mivart draws attention. Itshould be observed that the case mortality during theepidemic in 1903 in Rainham was low-less than 3 percent.-and it would be interesting to know how farthis may be attributed to the use of diphtheria antitoxin.In reviewing the condition of the whole of the Romfordrural district Dr. Mivart points to a number of objectionableand dangerous sanitary conditions to which the responsiblelocal authority should give immediate attention. The needfor supervision of the cowsheds in the place, which supplythe London market, seems to be specially great and the con-tamination of milk in local dairies by means of flies isanother important point on which stress is laid. Many ofthe dwelling houses in Romford seem to be dilapidated andexceptionally damp.On the General Sanitary Ciremorstances and Administration

of the Whittlesey Urbccn and Rural Districts, by Dr. S.MONCKTON COPEMAN. 2-The village and urban district of

Whittlesey, with a population of just below 4000, is situatedon what was formerly an island in the fen country about sixmiles south-east of Peterborough. It is mainly a collectionof small houses and many of the inhabitants are brickmakers.Dr. Copeman points out a large number of insanitaryconditions, several of which could be remedied withoutmuch expense by a satisfactory local authority. The most

pressing need of the village is a wholesome water-supplyand apparently this could be secured at a comparativelysmall cost, either by extension of the Peterborough mains orfrom the Wisbech waterworks. The district, however, has alocal Act by which no greater rate than 3s. 6d. in the poundcan be raised in any one year without the sanction of a

town’s meeting and the inhabitants have hitherto invariablyrefused to sanction any additional rating for water or forother sanitary purposes. It is to be hoped that this attitudewill be changed now that Dr. Copeman has shown thefeasibility of a satisfactory scheme of water-supply, whichis needed also for certain villages in the adjoining ruraldistrict.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8748 births and 4793deaths were registered during the week ending July 30th.The annual rate of mortality in these towns, which hadbeen 13’ 5, 13’ 7, and 14 ’ 1 per 1000 in the three precedingweeks, further rose last week to 16 4 per 1000. In Londonthe death-rate was 16’ 0 per 1000, while it averaged 16’ 5per 1000 in the 75 other large towns. The lowest death-rates in these towns were 2’ 6 in Smethwick, 4’ 5 inHornsey, 7’ 0 in King’s Norton, 7’ 4 in Northampton, 8’ 0 inRotherham, and 8’ 7 in Croydon and in Handsworth, Staff ; ;while the highest rates were 22-1 in West Ham, 22’ 6in Birmingham, 24’ 7 in Rhondda, 25’ 8 in Stockport,27.1 in St. Helens, and 29-8 in Liverpool. The 4793deaths in these towns last week included 1255 whichwere referred to the principal infectious diseases, against500, 506, and 792 in the three preceding weeks ; of these1255 deaths, 947 resulted from diarrhoea, 156 from measles,57 from whooping-cough, 35 from diphtheria, 33 fromscarlet fever, 22 from "fever" (principally enteric), andfive from small-pox. No death from any of these diseases wasregistered last week in Hornsey, Hastings, Bournemouth,King’s Norton, Smethwick, or West Hartlepool ; whilethe highest death-rates from the principal infectiousdiseases were recorded in West Ham, Leyton, Birming-ham, Aston Manor, Nottingham, Stockport, Liverpool,Bootle, and St. Helens. The greatest proportional mor-tality from measles occurred in Hanley, Grimsby,Birkenhead, St. Helens, Huddersfield, and Hull; fromscarlet fever in Great Yarmouth and Barrow-in-Furness ;from whooping-cough in Burton-on-Trent and St. Helens ;from diphtheria in Reading; and from diarrhoea in Totten-ham, West Ham, Leyton, Birmingham, Aston Manor,Nottingham, Stockport, Liverpool, and Bootle. The mor-

tality from " fever" showed no marked excess in any ofthe large towns. Of the five fatal cases of small-poxregistered in these towns last week, two belonged to London

2 Ibid., price 4d

and one each to Warrington, Manchester, and Newcastle-upon-Tyne. The number of small-pox patients in the Metro-politan Asylums hospitals at the end of last week was 46,against 71, 62, and 51 at the end of the three precedingweeks ; seven new cases were admitted during the week,against ten, seven, and six in the three preceding weeks. Thenumber of scarlet fever cases in these hospitals and inthe London Fever Hospital, which had been 1685, 1698, and1754 on the three preceding Saturdays, had increasedto 1784 on Saturday last, July 30th ; 243 new cases wereadmitted during the week, against 269, 229, and 234 inthe three preceding weeks. The deaths in London referredto pneumonia and diseases of the respiratory system, whichhad been 135, 155, and 120 in the three preceding weeks,fell again last week to 118, but were eight above thenumber in the corresponding period of last year. The causesof 50, or 1 - 0 per cent., of the deaths registered in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in West Ham, Bristol, Leicester, Nottingham,Salford, Leeds, Newcastle-upon-Tyne, and in 45 othersmaller towns ; while the largest proportions of uncertifieddeaths were registered in Birmingham, Sheffield, Liverpool,Bootle, and Manchester.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principal Scotchtowns, which had been 15 ° 8, 14’8, and 15 - 7 per 1000 inthe three preceding weeks, declined to 14’ 1 per 1000 duringthe week ending July 30th, and was 2’3 3 per 1000 belowthe mean rate during the same period in the 76 largeEnglish towns. The rates in the eight Scotch towns

ranged from 9’0 in Greenock and 10 °8 in Aberdeen to16 - 6 in Dundee and 19-9 in Paisley. The 466 deathsin these towns included 24 from diarrhoea, 19 from

whooping-cough, seven from measles, four from "fever,"two from scarlet fever, and two from diphtheria. Inall, 58 deaths resulted from these principal infectiousdiseases last week, against 64, 53, and 68 in the threepreceding weeks. These deaths were equal to an

annual rate of 1’8 per 1000, which was 2’5 per 1000below the mean rate last week from the same diseasesin the 76 large English towns. The fatal cases of diarrhoea,which had been 20, 19, and 23 in the three precedingweeks, were 24 last week. 13 occurred in Glasgow, threein Dundee, and three in Aberdeen. The deaths fromwhooping-cough, which had been 24, 21, and 22 inthe three preceding weeks, fell to 19 last week, andincluded 12 in Glasgow and three in Edinburgh.The fatal cases of measles, which had been six and12 in the two preceding weeks, fell last week to

seven, of which four occurred in Edinburgh. Thedeaths from scarlet fever, which had been two andthree in the two preceding weeks, were two last week.

These two deaths were registered in Glasgow. The fatal

cases of " fever," which had been three in each of the twopreceding weeks, were four last week, of which two occurredin Dundee. The deaths referred to diseases of the respiratoryorgans in these towns, which had been 88, 49, and 75 inthe three preceding weeks, fell last week to 55, and were44 below the number in the corresponding period of lastyear. The causes of 13, or more than 3 per cent., of thedeaths in these eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 17’ 9, 19’ 3,and 17’5 per 1000 in the three preceding weeks, rose

again to 17’ 9 per 1000 during the week ending July 30th.During the past four weeks the death-rate has averaged 18 ’ 2per 1000, the rates during the same period being 14’2 inLondon and 14-4 in Edinburgh. The 130 deaths ofpersons belonging to Dublin registered during the weekunder notice showed an increase of three ov er the numberin the preceding week and included 12 which were referredto the principal infectious diseases, against ten, 18,and 15 in the three preceding weeks ; of these, fourresulted from measles, four from diarrhoea, two fromwhooping-cough, one from "fever," and one from diph-theria, but not any from small-pox or scarlet fever.The 12 deaths were equal to an annual rate of 1’7

per 1000, the death-rates last week from the prin-cipal infectious diseases being 4’ in London and 1-6in Edinburgh. The fatal cases of measles, which had been

422 VITAL STATISTICS.-THE SERVICES.

two, ten, and five in the three preceding weeks, declinedagain last week to four. The deaths from diarrhoea, whichhad been five, two, and five in the three preceding weeks,declined to four last week. The fatal cases of whooping-cough, which had been three in each of the two precedingweeks, were again two last week. There was one deathfrom " fever," as against two in the preceding week.The 130 deaths in Dublin last week included 35among children under one year of age and 18 amongpersons aged 60 years and upwards ; the deaths of infantsshowed a considerable increase, while those of elderlypersons were fewer than in any week during the presentyear. Six inquest cases and four deaths from violencewere registered ; and 50, or over 38 per cent., of the deathsoccurred in public institutions. The causes of seven, or

nearly 6 per cent., of the deaths registered in Dublin lastweek were not certified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet Sur-

- geon R. Miller to the Terror on recommissioning and forBermuda Yard. Surgeons : J. C. Durston and G. E. Duncanto the President for hospital course.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel G. T. Trewman, half-pay, retires on

retired pay (dated August 3rd, 1904). Major R. H. Clementretires on retired pay (dated August 3rd, 1904). MajorG. B. Russell retires on retired pay (dated August 3rd,1904). Major L. R. Colledge retires on retired pay (datedAugust 3rd, 1904). Major S. Butterworth retires on retiredpay (dated August 3rd, 1904). Captain H. H. Norman isplaced on temporary half-pay on account of ill-health (datedJuly 25th, 1904).

IMPERIAL YEOMANRY.

Oxfordshire (Queen’s Own Oxfordshire Hussars) :Archibald Henry Hogarth to be Surgeon-Lieutenant (datedJuly 30th, 1904).

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Captain W. A. Atkinson to be Surgeon-Major(dated July 23rd, 1904). Surgeon - Lieutenant J. R.Williams to be Surgeon-Captain (dated July 20th, 1904).Captain A. R. Badger, Worcester and Warwick BearerCompany, Royal Army Medical Corps Volunteers, to be

Surgeon-Captain (dated August 3rd, 1904).VOLUNTEER CORPS.

Royal Garrison Artillery ( Volunteers) : lst Cornwall(Duke of Cornwall’s): Edwyn Graved Andrew to beSurgeon-Lieutenant (dated July 30th, 1904). 2nd Hamp-shirt : Surgeon-Lieutenant-Colonel G. G. Sparrow resignshis commission and is granted the honorary rank of Sur-geon-Colonel, with permission to wear the prescribeduniform (dated July 30th, 1904),

Rifle: 3rd Volunteer Battalion the Devonshire Regiment :Surgeon-Lieutenant E. R. Tweed to be Surgeon-Captain(dated May 15th, 1904). 5th (The Hay Tor) VolunteerBattalion the Devonshire Regiment : Surgeon-Major E.

Haydon resigns his commission and is granted the honoraryrank of Surgeon-Lieutenant-Colonel, with permission towear the prescribed uniform (dated July 30th, 1904).lst Volunteer Battalion the Suffolk Regiment: Brigade-Surgeon-Lieutenant-Colonel G. S. Elliston is seconded whilstholding the appointment of Senior Medical Officer of theHarwich Volunteer Infantry Brigade (dated July 30th,1904). 2nd Volunteer Battalion the Worcestershire Regi-ment : Surgeon-Lieutenant H. B. Emerson resigns his com-mission (dated July 30th, 1904). lst Volunteer Battalionthe Duke of Cornwall’s Light Infantry: Surgeon-Lieu-tenant F. Chown to be Surgeon-Captain (dated July 30th,1904). lst Volunteer Battalion the King’s (Shropshire LightInfantry) : Surgeon-Major F. K. Pigott to be Surgeon-Lieu-tenant-Colonel (dated July 30th, 1904). lst Herefordshire :Surgeon-Major J. W. Hinings resigns his commission and isgranted the honorary rank of Surgeon-Lieutenant-Colonel,with permission to wear the prescribed uniform (datedJuly 30th, 1904).

DEATHS IN THE SERVICES.Staff Surgeon Henry Scanlan, R.N. (retired), at Kerswell,

Broadclyst, Devonshire, on July 31st, aged 55 years. Heentered the Royal Navy as surgeon in 1872, became staffsurgeon in 1884, and retired in 1885. He served with theRoyal Marine Battalion at Suakin during the operations inthe Eastern Sudan in 1884-85. (Egyptian medal and claspand Khedive’s bronze star.)

THE NEW ARMY SCHEME.Mr. Arnold-Forster’s new army scheme will probably come

before the House of Commons for discussion again onMonday next, when it may be hoped that some further in-formation will be afforded and some additional light will bethrown upon the exact nature and extent of the new

proposals.MALTA FEVER.

We learn from India that a special commission is investi-gating Malta fever, the occurrence of which in India is

becoming more recognised. A special committee is also in-vestigating anti-typhoid inoculation.FIFTY YEARS’ MEDICAL SERVICES TO THE RUSSIAN FLEET.The 20th of July was the fiftieth anniversary of Dr.

V. S. Kudrina’s official services as Chief Medical Inspectorto the Russian Fleet and the occasion was taken by theMilitary Medical Academy to present him with a con-

gratulatory address.THE WAR IN THE FAR EAST.

Denatured spirit is finding a use at the seat of war. Thechief Russian Military Medical Council has acquired anumber of spirit lamps for the field hospitals fitted withspecial burners and giving a clear light. A parcel of theselamps has already been sent to the Manchurian army.

Lieutenant-General Linivitch says that he visited on

July 24th the Nijnigorod and the Nijninovgorod hospitalsat Chabarovsk in the Far East and found everything therea pattern of order and comfort. The hospitals are

luxuriously furnished. He feels it his duty to thank thetwo towns on behalf of the army under his orders and toconvey to the towns interested the expression of satisfactiontheir generosity has caused the soldiers. He gives unstintedpraise to the staff, especially the two chief medical officers,Dr. Kossereff and Dr. Oschmana. General Kuropatkin,likewise, writes in praise of the Red Cross arrangements,especially mentioning the efficiency of the hospital furnishedby the Kharkoff Zemstvo (local council) which he hadpersonally visited between Lyao-yang and Saimatze.The members of the St. Petersburg Society of Dental

Doctors are arranging with their provincial colleagues withthe object of opening at their common expense dentalconsulting and operating-rooms for the army in Kharbin,Mukden, Lyao-yang and other depots of the Manchurian

army.The situation in the Far East changes from day to day,

and we may at any moment hear of some great and strikingsuccess on one side or the other which may alter the aspect ofthe war. There has been heavy fighting south of Haichengand at the present time the Japanese field forces are makinga great and general advance; three of their armies are

engaged and the Russians are probably hard pressed, whilethe position at Port Arthur has entered upon a very acute andperhaps final stage. As regards the general sweepingmovement of the Japanese armies almost everything now

. depends on the success or failure of the first army in closingthe net from the north-east. General Kuropatkin’s

’

position must be causing keen anxiety at St. Petersburg atthe present time. The first official announcement from

- Tokio regarding the siege operations was made at the end oflast month when the general staff announced that fiveofficers had been killed and 41 wounded in the then recentfighting around Port Arthur, but the losses in men were notstated. As far as can be gathered from non-official reports all

-

the public buildings inside Port Arthur are used as hospitals.The sick and wounded are stated to be well cared for byvolunteer nurses. The wounds inflicted by the Japaneserifle fire are described as not dangerous except in vital spots.Hundreds of men after being badly wounded have quicklyrecovered and are now back in the firing line. The latestreports of the progress of the siege are not only very meagrebut contradictory and untrustworthy. The Russian casualtiesat the battle of Tashichao are estimated by General Oku at2000, while those of the Japanese in the entire engagementare put down at 1000, but little reliance can, as a rule, beplaced in estimates formed in this way during a war. It is

, stated that there is much dissatisfaction in Russia at