1801

cases in two classes in the girls’ department that proximityin the matter of seating may have been a determining factorin the spread of the disease as it was found that 13 out of17 children attacked sat next to one another in class. As,however, there were only 29 girls in one class and 22 in the INother, it is clear that on the basis of probability there must deat’have been some infected children sitting near to one Theanother. However, this proximity has been observed in fromother school outbreaks and there is probably ground for furt]the opinion expressed by Dr. Allan. In order to assist in thereducing the infantile mortality obtaining in this district ratethe City of Westminster Health Society has arranged with duricertain general and lying-in hospitals in Westminster by dealwhich it is supplied from time to time with lists of im- in Cpending maternity cases, and the health visitors are by this Easmeans enabled to visit the potential mother prior to con- 18’finement. Subsequently to confinement a monthly visit is 20’ .

paid during the first three months and afterwards quarterly. deaDr. Allan quotes from the report of the health visitors 111which was drawn up after 400 cases had been visited. It is 365stated that out of 400 births 120 of the mothers had some agaoccupation which necessitated the premature weaning of the preoffspring, and the following table purports to put the case 104statistically and to show the advantage qua survival of sca

being born of a non-working mother. (prDeath-rate Delicate infants deaper cent. per cent. an

Working ............ 9°1 ............ 25 disNon-working ......... 75 ............ 82 th(

Among 282 breast-fed babies there were 18 deaths as against So

14 deaths among 100 bottle-fed infants. As regards the otlhealth of the mothers themselves it was found that 60 hosuffered more or less from ill-health or general debility, a Re

circumstance for which the strain of pregnancy and lacta- Mi

tion was largely responsible. Drink or poverty was not de

frequently assigned as the cause of maternal ill-health. Nor fu:did insufficient food during pregnancy appear to have ca

promoted the observed condition. In the opinion of 2’the visitors, ignorance, lack of cleanliness, and irregu- Wlarity of feeding and of habits were the principal causes be

of infantile ill-health and death. In this connexion it may fe

be mentioned that an infants’ hospital has been estab- dilished in Vincent-square, Westminster, its object being to B,

carry out the study and treatment of infantile mal- 4nutrition and to afford medical practitioners and medical tt

students an opportunity for detailed study of the factors itgoverning infantile nutrition. Certainly, this hospital, aif it carries out its programme, should do some cl

useful work. Pulmonary tuberculosis is notifiable in avoluntary sense in Westminster, and Dr. Allan furnishes t]

some instances where infection may have been contracted dfrom a relative. Having regard, however, to the recent vreport of the Royal Commission on Tuberculosis, from which o

Dr. Allan quotes, it does not follow that a tuberculous Erelative was in actual fact the source of a child’s infection ; ftuberculous milk of bovine source may very well have been I

the cause of both cases, and the interval between the two (J

attacks an illustration of latency. During 1906 there were I78 notifications of pulmonary tuberculosis received. 1

Borough of Portsmouth.-At the beginning of 1906 the 1

water supplied to Portsmouth by the water company evinced lconsiderable cloudiness, indicating apparently that in times lof heavy rain the water, which is, it seems, derived from <

springs, carries with it considerable material in suspension. (The precise source of this opacity is not dealt with in the lreport before us, but the presence of vegetable matter is clearly an indication of the desirability of filtration, more espe-cially as the springs are, we believe, not far distant from the ’town of Havant. An Act has, therefore, been passed whichenacts inter alia that the company shall forthwith commencefiltration works. The filtration clause is not to apply towater" drawn from borings or wells or adits driven there-from," a proviso which seems to suggest that some of thecloudiness which has been observed in the water on severaloccasions may be due to surface washings or, at any rate, towater from the superficial strata. Otherwise it is difficult tounderstand the exemption referred to. Possibly, however,the chalk hereabouts is so well covered with impermeablestrata that if the upper portion of a well is properlyprotected from surface pollution the risk of specific con-

tamination is regarded as negligible. In any circumstancesthe medical officer of health is to be congratulated onhaving, after some years of fighting, succeeded in providingfor filtration. t

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8733 births and 3915deaths were registered during the week ending June 22nd.The annual rate of mortality, which had steadily declinedfrom 17’ 9 to 13 . 1 per 1000 in the previous 11 weeks,further fell to 12’7 in the week under notice. Duringthe first 12 weeks of the current quarter the death-rate has averaged 15’3 per 1000, the rate in Londonduring the same period being 14’ 8. The lowest annualdeath-rates in the 76 towns during the week were 5’7in Croydon, 7’ 0 in Hastings, 7’ 5 in Hornsey, and 7’ 6 inEast Ham and in Kings Norton ; the highest rates were18 5 in Grimsby, 20’ 5 in Middlesbrough, 20’ 6 in Oldham,20 9 in Huddersfield, and 24’ in Wigan. The 3915

deaths in the 76 towns showed a further decrease of111 from the numbers in recent weeks, and included365 which were referred to the principal epidemic diseases,against numbers decreasing from 510 to 430 in the five

preceding weeks; of these, 139 resulted from measles,104 from whooping-cough, 53 from diarrhoea, 32 fromscarlet fever, 27 from diphtheria, and 10 from "fever" "

(principally enteric), but not any from small-pox. Thedeaths from these principal epidemic diseases were equal toan annual rate of I - 2 per 1000, the rate from the samediseases in London being 1’ 3. No death from any ofthese epidemic diseases was registered last week in

j Southampton, Birkenhead, Stockport, Hornsey, or in 12 other of the 76 towns ; the annual death-rates therefrom,) however, ranged upwards to 2’ 5 5 in Derby and in

L Rotherham, 48 8 in Bolton, 5’ 9 in Wigan, and 6’1 1 in- Middlesbrough. The fatal cases of measles, which hadt, declined from 214 to 172 in the five preceding weeks,r further decreased to 139 in the week under notice, and3 caused death-rates ranging upwards to 2’ 5 in Derby,f 2’ 9 in Bolton, 4’1 1 in Middlesbrough, and 4 - 7 in

. Wigan. The defths from whooping-cough, which hads been 130 and 124 in the two previous weeks, further

9 fell to 104 last week ; the highest death-rates from this,- disease were 1’ in St. Helens, 1 - 2 in Wigan, and I - 4 ino Bolton. The fatal cases of diarrhaea, which had been 47,l- 49, and 50 in the three preceding weeks, increased to 53 in1 the week under notice, but the mortality was not excessive- g in any of the towns. The 32 deaths from scarlet fever showed1 a decline from the number in the previous week, and in-ke eluded 10 in London, three in Liverpool, three in Manchester,a two in Leeds, and two in Newport (Mon.), the annual rate ingg the last-named town being 1’4 per 1000. The fatal cases of

d diphtheria, which had been 48 and 36 in the two precedingat weeks, further declined to 27 in the week under notice ; 10;h of the deaths occurred in London, four in Hull, two in

us Portsmouth, and two in Middlesbrough. Of the 10 deaths1. from "fever," two were registered in Liverpool, two in

en Leeds, and one in each of six other towns. The number’10 of scarlet fever cases in the Metropolitan Asylums,rc Hospitals and the London Fever Hospital, which had

increased from 2658 to 2936 in the six preceding weeks,he had further risen to 2986 at the end of last week ;ed 414 new cases were admitted during the week, againstles 437, 368, and 389 in the three preceding weeks. The

)m deaths in London referred to pneumonia and other diseasesm. of the respiratory organs, which had continuously decreasedihe from 412 to 149 in the preceding 11 weeks, rose againis to 156 in the week under notice, and were slightly above

pe- the corrected average number in the corresponding periodihe of the five previous years. The causes of 33, or 0 8 perich cent., of the deaths registered in the 76 towns during theace week were not certified, either by a registered medical prac-to titioner or by a coroner. All the causes of death were dulyre- certified in Leeds, Bristol, West Ham, Bradford, and in 53the other towns ; the proportion of uncertified deaths, however,:ral showed a marked excess in Birmingham, Sheffield, and

to Bootle. -

b to

ver, HEALTH OF SCOTCH TOWNS.

able The annual rate of mortality in eight of the principalerly Scotch towns, which had been equal to 19’ 0 and 17’ 2ion- per 1000 in the two preceding weeks, was 17 3 per 1000ices in the week ending June 22nd, and WRS 4 6 in excess of theon rate during the same period in the 76 English towns. The

ling rates in the eight Scotch towns ranged from 10 - 5 in Perthand 13’ 2 in Greenock to 18’1 1 in Leith and 21’ 7 in

1802

Dundee. The 600 deaths in the eight towns showed !increase of one over the number in the previous weeand included 84 which were referred to the principepidemic diseases, against 109 and 83 in the two precedeweeks. These 84 deaths were equal to an annual rate2 - 4 per 1000, which exceeded by 1 2 per 1000 the rate frothe same diseases in the 76 English towns ; they include37 which were referred to whooping-cough, 23 to diarhoea, 14 to "fever," eight to measles, and two 1

diphtheria, but not any to small-pox or to scarlet feveThe fatal cases of measles, which had been 57 and 4in the two previous weeks, further declined last week 1

37, of which 19 occurred in Glasgow, five in Aberdeen, fouin Edinburgh, four in Dundee, and three in Paisley. Tb23 deaths from diarrhoea exceeded by 15 the number ithe preceding week, and included 12 in Glasgow, five i

Dundee, three in Edinburgh, and two in Leith. Th- deaths referred to " fever," which had been 26 and 2in the two preceding weeks, further fell to 14 in thweek under notice ; 12 of these deaths were from cerebrcspinal meningitis, of which five were registered in Glasgowfive in Edinburgh, and one each in Paisley and LeithThe eight fatal cases of measles were three in excess othe number in the preceding week, and included four &Iacute;J

Glasgow and two in Edinburgh. The deaths in the eightowns referred to diseases of the respiratory organsincluding pneumonia, which had been 106 and 91 in thjtwo previous weeks, further decreased to 86 last week, buwere 17 above the number in the corresponding period of lastyear. The causes of 24, or 4 per cent., of the deaths regiq-tered during the week were not certified or not stated ; thEproportion of uncertified deaths in the 76 English townsduring the same week did not exceed 0 - 8 per cent.

HEALTH OF DUBLIN.

The annual death-rate in Dublin, which had been equal to23 1, 23 - 9, and 24’ 3 per 1000 in the three preceding weeks,declined again to 20 - 8 per 1000 in the week endingJune 22nd. During the past 12 weeks the death-rate hasaveraged 25’ 9 per 1000, the rates in the same period being14 - 8 in London and 17 4 in Edinburgh. The 156 deaths ofDublin residents registered during the week under noticewere 26 fewer than the number in the preceding week, andincluded 19 which were referred to the principal epidemicdiseases, against 13, 11, and 12 in the three precedingweeks ; of these, nine resulted from measles, five fromwhooping-cough, two from diarrhoea., and one each fromscarlet fever, from diphtheria, and from "fever." These19 deaths were equal to an annual rate of 2’ 5 per1000, the death-rates during the same period from the prin-cipal epidemic diseases being 1-3 3 in London and l’ 5 inEdinburgh. The fatal cases of measles, which had been sixand three in the two previous weeks, rose to nine in theweek under notice, while the deaths from whooping-coughdeclined to five, having been successively eight, four,and eight in the three preceding weeks. The 156 deathsfrom all causes in Dublin last week included 26 of childrenander one year of age and 42 of persons aged upwards of 60years ; the deaths both of infants and of elderly personswere slightly below the respective numbers in the previousweek. One death from violence and two inquest caseswere registered ; and 63, or more than 40 per cent., of theleatbs occurred in public institutions. The causes of three, I)r 2 per cent., of the deaths in Dublin were not certified;n London only one uncertified death was registered, whilen Edinburgh the percentage was 3’ 9. The 131 deaths

egistered in Belfast during the week under notice included!0 which were referred to cerebro-spinal fever or cerebro-spinal meningitis.

THE SERVICES.

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

general : J. Porer, C.B., to Royal Naval Hospital, Haslar.-Fleet Surgeons : J. F. Hall to the President, additional, tem-porary, for London Recruiting Headquarters ; and R. C.

Munday to the 1’ornaidable. Staff Surgeons : M. C. Lang-ford to the Abo?t4,ir; N. Ireland-Smith to the Leander,’ G. R.MacMahon to the -Blale - and E. S. Miller to the President,ifor three months’ hospital course at West London Hospital.,Surgeons: H. Hunt to the -Blahe; J. J. H. Rooney to the

an Leander; and F. E. Anley to the Viatory, additional, forek, Portsmouth Dockyard.ral ROYAL ARMY MEDICAL CORPS.

ing Major Alexander Y. Reily retires on retired pay (datedof June 22nd, 1907).led INDIAN MEDICAL I::3ERVICE.ar- The King has approved of the following promotions amongto officers of the Indian Medical Service :-To be Surgeon-er. General : Colonel Henry Hamilton, C.B., V.H S. (dated43 March 25th, 1907). To be Colonel: Lieutenant-Colonelto Douglas ffrench-Mullen (dated March 25th, 1907). Majorsur to be Lieutenant-Colonels (dated March 31st, 1907): Charleshe Hardwick Louw Meyer, William Henry Wilson Elliot,in D.S.O., Letterstedt Frederick Childe, William Ronaldsonin Clark, George Frederick William Braide, Robert John Marks,he Charles Edward Sunder, Malcolm Albert Ker, Herbert24 Herbert, Thomas David Collis Barry, Andrew Buchanan,he Lewis Gordon Fischer, William Vost, John Garvie, Clarenceo- Edwin Lloyd Gilbert, Gerard Beatty Irvine, Frederick Jamesv, Orawford, Robert Robertson. To be Lieutenant : Frankh. Phillips Wernicke (dated Feb. 1st, 19C6).of The King has approved of the retirement of the under-in mentioned officer-Major Charles Louis Williams (datedit March 19th, 1907).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).South Yorkshire Bearer Company : Lieutenant G. H. L.

3t Hammerton to be Captain (dated April 10th, 1907).1- VOLUNTEERS CORPS.

Le Royal Garrison Artillery (Voluntee’rs): : lst Forfarshire :sLloyd Turton Price to be Surgeon-Lieutenant (dated

May 22nd, 1907). 1st Renfrew and Dumbarton : FrancisWilliam Squair to be Surgeon-Lieutenant (datedMayl7th,1907).

o Royal -Zcc r<M’K!’).’ 1st (Sheffield) Yorkshirei, (West Riding): Sargeon-Lieutenant A. C. Turner to beir Surgeon-Captain (dated May 7th, 1907).s

Correspondence."Audi alteram partem."

INSURANCE AGAINST SICKNESS.1’0 the Editors of THE LANCET.

SIRS,-The Compensation Act, 1906, has given new life toa very important branch of business-that of insurance.

Employers are under an obligation to the insurance officesfor mitigating the terrors of that Act, and so, too, are theiremployees. It is obvious that the first tendency of suchlegislation is to dispose employers to reduce the number ofthose whom they employ and to employ younger and more-nimble servants rather than those who are otherwise. Theinsurance offices serve an admirable purpose in counteractingthis tendency and enabling employers to take a morefavourable view of legislation that without seriously hurtingthem tends immensely to diminish the many hardships ofthe working-classes when overtaken by accident in thecourse of their employment.

It is gratifying to find that the insurance offices,apparently stimulated by the Compensation Act, haveformulated proposals for insurance by employers againstsickness in their employees not having any legal claim onthem for such aid. This is of special interest and value inthe case of household servants. The acceptance of suchproposals, with or without cooperation of servants, wouldbe greatly to the advantage of this class when overtaken byserious ailments or disease. Its generous adoption by mastersor mistresses would probably do more than anything elseto mitigate the "servant question" that so worries ladies.But-and this is one of my principal objects in asking thehospitality of your columns-it is necessary to point out thatthe present list of diseases against which the offices offerinsurance is very defective and does not include thosediseases in servants which are the most anxious and trouble-some. I would name three which are conspicuous by theirabsence from any list which I have seen and which are ofcommon occurrence among domestic servants-ulcer of thestomach, appendicitis, and influenza. There is nothing