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London. From the public health standpoint it is importantthat persons arriving here from "infected," or even sus-pected," ports should be prevented from going ashore untilthe vessels have been medically inspected. The regulationsof the Local Government Board do not prohibit the landingof anyone at our ports unless the ship actually contains acase of plague, cholera, or yellow fever. But Dr. Williamsinsists that these regulations need strengthening so as toprevent the landing of anyone on our shores without pre-vious inspection of the ship by the Customs officers or thelocal medical officer of health. Among the reported casesof infectious disease may be noted 61 of enteric fever, 34 ofsmall-pox, 37 of diphtheria, and 10 of scarlet fever. Thelist now includes for the first time pulmonary tuberculosis,of which disease 71 cases were notified last year. Asevidence of the care with which preventive measures arecarried out by modern sanitarians, it is worthy of note thatwith a view of controlling the spread of infection by meansof passengers possibly incubating, though not manifestlysuffering from infectious disease, the names and addressesof all passengers and crews of infected vessels are promptlynotified to the sanitary authorities of the districts in whichthe travellers reside.

Plague.Nine cases of plague, or suspected plague, among pas-

sengers from abroad were notified in the course of last year,details of which are given in a special table. Amongrats in the Port of London plague has appeared in everyone of the last five years. In this connexion the followingweighty remarks by the medical officer of health deserveattention. " Plague is now epidemic in so many parts ofthe world with which the Port of London is in constantcommunication that vessels arriving thence must be con-sidered as potential means of conveying infection to thiscountry." He points out the necessity of rendering abso-lutely 11 rat proof " all buildings used for the storage offood-stuffs, as well as of fumigating vessels with lethal gasat intervals not exceeding six months for the destruction ofrats on board. In the interests of public health the bac-teriological examination of rats has been systematicallypursued by the port sanitary authority in order that theearliest occurrence of plague among rats may be detected. ,

Cholera. ’

Only two cases of actual or suspected cholera were reportedlast year at the Port, although the disease was very pre-valent in India. There was not much cholera anywhere inEurope. At the International Sanitary Conference in Parisearly in the year the question of procedure in the case ofcholera germ carriers was seriously discussed, several ofthe delegates pressing for the bacteriological examinationof all contacts or suspected persons.

Diphtheria.Twenty-seven cases of diphtheria (none of which were

fatal) occurred on the training ship Warspite at irregula,rintervals during the year. More than 200 boys are ordi-narily accommodated in this ship. Careful examination ofthe sanitary arrangements of the vessel is being carried out,and the belief is entertained that the continuance of thedisease must be due to some small local cause, the exactnature of which has not as yet been determined.

Tuberculosis.

Seventy cases of pulmonary tuberculosis were reportedamong the crews of incoming ships during the year. Dr.Williams remarks that the conditions under which seamenlive on board many of the ships are extremely favourableto the spread of infection. The occupants of some of theseamen’s quarters he describes as " troglodytic," for many ofthese places are similar to caves, dark, overcrowded, andventilated by an iron pipe, which is generally blocked

up, thus allowing the entrance of fresh air only through thedoor. As illustrative of the danger of infection which maypossibly arise from persons on board suffering from pul-monary tuberculosis, he gave an example of a baker on asteamer carrying a large number of passengers who was work-ing on board ship for six months when he was found to besuffering from pulmonary tuberculosis, and was then put offduty.

Food Inspection.Last year the quantity of food-stuffs seized in the Port

of London was larger than in any previous year. More than

3758 tons of unsound food of various kinds were seized anddestroyed or so disposed of as to prevent its use for humanconsumption. Large quantities of beef and mutton were

imported from Australia, New Zealand, and South America.For the most part the meat was in good condition, theproportion condemned as unsound being exceedingly small.Of the pork seized, most of which came from Australia, 19’carcasses were condemned as affected with tuberculosis, andtherefore unfit for food.

VITAL STATISTICS.

i HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns, with populationsexceeding 50,000 persons at the last Census, and whoseaggregate population at the middle of this year is estimatedat 17,852,766 persons, 9021 births and 3774 deaths were

registered during the week ended Saturday, July 26th.The annual rate of mortality in these towns, which hadbeen 11-2, 11’ 4, and 11-3 per 1000 in the three precedingweeks, further declined to 11’0 per 1000 in the week undernotice. During the first four weeks of the current quarterthe mean annual death-rate in these towns averaged 11-2,against 10-7 per 1000 in London during the same period.Among the several towns the death-rate ranged from2- 6 in Enfield, 2-9 in Eastbourne, 3-6 in Hornsey, 4-8 in,Gillingham, and 5. 1 in Southampton, to 16’2 in Rother-ham, 16. 7 in Walsall, 17,2 in Dudley, 17’4 in Dewsbury,and 18’ 3 in Great Yarmouth.The 3774 deaths from all causes in the 96 towns were

97 below the number in the previous week, and included394 which were referred to the principal epidemic diseases,against 344 and 343 in the two preceding weeks. Of these394 deaths, 214 resulted from infantile diarrhoeal diseases,77 from measles, 50 from whooping-cough, 31 from diph-theria, 15 from scarlet fever, and 7 from enteric fever, but.not one from small-pox. The mean annual death-rate fromthese diseases in the week under notice was equal to 1-2,.against 1’ 0 per 1000 in each of the two preceding weeks.The deaths of infants (under two years of age) attributedto diarrhoea and enteritis, which had been 107, 155,and 149 in the three preceding weeks, rose to 214, andincluded 55 in London, 15 in Birmingham, 15 inBirkenhead, 14 in Liverpool, 11 in Sheffield, and 8.in West Ham. The deaths referred to measles, whichhad declined from 81 to 68 in the four preceding weeks,slightly rose to 77 in the week under notice, and caused the-highest annual death-rates of 1.7 in Sunderland, 2’2 inWalsall, 2-6 in Stoke-on-Trent, 3-0 in Aberdare, and 5-0 inDudley. The fatal cases of whooping-cough, which had been53, 55, and 62 in the three preceding weeks, fell to 50 ; ofthis number 15 occurred in London, 6 in Birmingham, 4 inLiverpool, 3 in Manchester, and 3 in Hull. The deaths.attributed to diphtheria, which had been 24, 34, and 35 in thethree preceding weeks, declined to 31, and included 8 inBirmingham, 6 in London, 4 in Sheffield. and 3 in Notting-ham. The deaths referred to scarlet fever, which had been13, 17, and 20 in the three preceding weeks, fell to 15;. ;.3 deaths were registered in St. Helens and 2 each in

Birmingham, in Liverpool, and in Leeds. The fatal casesof enteric fever, which had been 9, 14. and 9 in the threepreceding weeks, further declined to 7 in the week undernotice, of which 2 occurred in London.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,which had steadily increased from 1418 to 1978 at the endof the six preceding weeks, had further risen to 210()on July 26th; 346 new cases were admitted duringthe week, against 314, 315, and 357 in the threepreceding weeks. These hospitals also contained on thedate mentioned 885 cases of diphtheria, 290 of measles,266 of whooping-cough, and 45 of enteric fever, butnot one of small-pox. The 918 deaths from all causes inLondon were 17 in excess of the number in the previousweek, and corresponded to an annual death-rate of 10.6per 1000. The deaths referred to diseases of the respiratorysystem, which had been 106, 137,. and 115 in the three

preceding weeks, declined to 107, and were 4 below thenumber recorded in the corresponding week of last year.Of the 3774 deaths from all causes in the 96 towns, 152

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resulted from various forms of violence and 307 were

the subject of coroners’ inquests. The causes of 25, or0 ’7 per cent., of the total deaths were not certified either bya registered medical practitioner or by a coroner after

inquest. All the causes of death were duly certified in

Manchester, Sheffield, Leeds, Bristol, West Ham, Hull, andin 69 other smaller towns. Of the 25 uncertified causes ofdeath, 4 were registered in Birmingham, 2 in London, and asingle case in each of 19 other towns.

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns, with an aggregate popula-tion estimated at 2,259,600 persons at the middle of this

year, 1068 births and 566 deaths were registered during theweek ended Saturday, July 26th. The annual rate ofmortality in these towns, which had steadily declined from14-9 to 13’ 2 per 1000 in the three preceding weeks, furtherfell to 13. 1 per 1000 in the week under notice. During the4first four weeks of the current quarter the mean annual death-rate in these Scotch towns averaged 13’ 4, against 11 2 per1000 in the 96 large English towns. Among the severaltowns the death-rates ranged from 7’1 in Leith, 8.5 in’Clydebank, and 8’8 8 in Falkirk, to 14-7 in Glasgow, 14-9 inHamilton, and 15-7 7 in Dundee.The 566 deaths from all causes were 4 fewer than the

number in the previous week, and included 64 which werereferred to the principal epidemic diseases, against numbersdeclining from 89 to 61 in the three preceding weeks. Ofthese 64 deaths, 24 resulted from infantile diarrhoealdiseases, 18 from measles, 15 from whooping-cough, 3 fromscarlet fever, 2 from enteric fever, and 2 from diphtheria,but not one from small-pox. These 64 deaths from theprincipal epidemic diseases corresponded to an annualdeath-rate of 1-5, against 1-2 per 1000 in the 96 largeEnglish towns. The deaths of infants (under 2 years of age)attributed to diarrhcea and enteritis, which had been 21, 17,and 13 in the three preceding weeks, rose to 24 in theweek under notice, and included 19 in Glasgow and 2 inEdinburgh. The deaths referred to measles, which had been38, 27, and 28 in the three preceding weeks, declined to 18,of which number 16 were recorded in Glasgow. The fatalcases of whooping-cough, which had been 20, 16, and 11 inthe three preceding weeks, rose to 15, and included 9 in

Glasgow. The 3 deaths attributed to scarlet fever, all ofwhich occurred in Glasgow, were slightly below the averagein recent weeks. The fatal cases of enteric fever were regis-tered in Glasgow and Greenock respectively, and those ofdiphtheria in Dundee and Kirkcaldy respectively. Inaddition to the above, a death from typhus was recorded in’Glasgow.The deaths referred to diseases of the respiratory system,

which had been 71, 79, and 71 in the three precedingweeks, further declined to 63 ; 31 deaths resulted fromdifferent forms of violence, against 30 and 23 in the twopreceding weeks. -

HEALTH OF IRISH TOWNS.

In the 27 town districts of Ireland, with an aggregatepopulation estimated at 1,199,180 persons at the middle ofthis year, 699 births and 378 deaths were registered duringthe week ended Saturday, July 26th. The annual rate of

mortality in these towns, which had declined from 16’ 7 to15-2 per 1000 in the four preceding weeks, increased to 16-4per 1000 in the week under notice. During the first four weeksof the current quarter the mean annual death-rate in these Irishtowns averaged 15’ 9per 1000 ; in the 96 large English towns thecorresponding rate did not exceed 11-2, while in the 16 Scotchtowns it was equal to 13-4 per 1000. The annual death-ratefor the week was equal to 15-1 in Dublin (against 10-6 6 inLondon and 14’7 7 in Glasgow), 15’8 8 in Belfast, 25’2 2 in Cork,12-7 in Londonderry, 19-0 in Limerick, and 19-0 inWaterford, while in the remaining 21 smaller towns themean death-rate was 16 . 9 per 1000.The 378 deaths from all causes were 29 in excess of the

number in the previous week, and included 27 which werereferred to the principal epidemic diseases, against 36 and28 in the two preceding weeks. Of these 27 deaths, 15resulted from infantile diarrhoeal diseases, 5 from measles,4 from whooping-cough, 2 from enteric fever, and 1 fromscarlet fever, but not one from diphtheria or from small-pox. The mean annual death-rate from these diseases

in the week under notice was equal to 1-2 per 1000, andcoincided with that recorded in the 96 large Englishtowns, while in the 16 Scotch towns it averaged 1’5 per1000. The deaths of infants (under 2 years of age)attributed to diarrhoea and enteritis, which had been

9, 15, and 16 in the three preceding weeks, were 15,and included 6 in Dublin and 6 in Belfast. The deathsreferred to measles, which had been 5, 4, and 4 inthe three preceding weeks, were 5, and comprised 4 inWaterford and 1 in Newry. The 4 fatal cases of whooping-cough, of which 3 occurred in Dublin and 1 in Belfast, wereslightly in excess of the average in recent weeks. The 2deaths referred to enteric fever were registered in Belfastand Limerick respectively, and the fatal case of scarlet feverin Belfast. In addition to the above deaths a fatal case oftyphus was recorded in Cork.The deaths referred to diseases of the respiratory system,

which had been 54, 52, and 56 in the three precedingweeks, fell to 41 in the week under notice. Of the378 deaths from all causes, 119, or 32 per cent., occurred inpublic institutions, and 10 resulted from different forms ofviolence. The causes of 10, or 2-7 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest; in the 96 largeEnglish towns the proportion of uncertified causes of deathdnring the week did not exceed 0-7 per cent.

THE SERVICES.

ROYAL ARMY MEDICAL CORPS.THE undermentioned Majors are placed on retired pay

(dated July 29th, 1913): Charles G. Spencer and Ernest M.Williams.The undermentioned Lieutenants to be Captains (dated

July 28th, 1913): John Gilmour, Wilfred W. Treves,John T. Simson, Campbell Robb, and Eric T. Gaunt.

Colonel W. W. Pike, D.S.O., has been appointed toofficiate as Deputy Director of Medical Services to the Sixth(Poona) Division of the Southern Army in India during theabsence on six months’ leave of Surgeon-General T. M.Corker.

Lieutenant-Colonel R. Caldwell has taken up duty in theSouthern Command on return from the South AfricanCommand. Lieutenant-Colonel G. H. Barefoot has been

appointed to hold charge of the Queen Alexandra MilitaryHospital at Grosvenor-road, in succession to Lieutenant-Colonel J. Maher. Lieutenant-Colonel C. A. Lane has takenover charge of the Military Hospital at Madras. Lieutenant-Colonel W. T. Mould, senior medical officer at Fyzabad, hasbeen granted three months’ leave of absence. Lieutenant-Colonel J. B. Wilson has taken up duty as Senior MedicalOfficer at Jamaica, and has been appointed to commandNo. 29 Company Royal Army Medical Corps stationed atUp Park Military Hospital.Major W. H. S. Nickerson, V.C., has been ’trans-

ferred from Rawal Pindi to Murree Cantonment. An

exchange of position on the roster for service abroad hasbeen approved between Major F. S. Walker, serving atQueenstown Harbour, and Major H. A. Davidson, stationedat the Curragh Camp, Kildare; the latter officer will nowproceed abroad instead of the former. Major R. L. Arglesstationed at the Military Hospital, Cork, has been placedunder orders to embark for service in India about Sept. 12th.Major E. A. Bourke has been transferred from the MilitaryHospital at Chester to Carlisle. Major W. B. Winkfield hastaken up duty at the Military Hospital, Meiktila, on transferfrom Maymyo Cantonment, Upper Burma. Major H. Simson,surgical specialist at Poona Cantonment, has been appointedto hold charge of the Military Hospital at Muttra Canton-ment. Major A. Chopping has been transferred from theRoyal Herbert Military Hospital at Woolwich to Netley.Major J. Poe has joined for duty at Shorneliffe. MajorL. L. G. Thorpe, serving at the Military Hospital, Cosham,has been placed under orders for a tour of foreign service.Major P. H. Collingwood has been transferred from Devon-port and appointed to hold medical charge at Honiton Camp.

Captain G. S. Wallace has been transferred from theMilitary Hospital at Woking to Aldershot. Captain A. W. A.Irwin has joined at Cork. Captain C. E. L. Harding hasbeen granted an extension of Indian tour of service for one