710 Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT. REPORTS OF MEDICAL OFFICERS OF HEALTH. Chelsea Sanitary District.-Dr. Louis Parkes has turned - his attention to the recent manifestations of scarlet fever and - of diphtheria in the eight parishes constituting western London, and he furnishes in his annual report for 1897 two tables and some charts based upon the notifications of each .of these diseases for 1890 to 1897. In dealing with Chelsea the district of Kensal Town has been very properly omitted .as its topographical relations to Chelsea proper are obviously but remote. The lessons which Dr. Parkes draws from the tables are (1) that in the case of diphtheria fluctuations in ’its prevalence are much less marked than is the case with scarlet fever; (2) that the prevalence or absence of diphtheria is a much more local circumstance than is the prevalence or .absence of scarlet fever, a disease which apparently possesses .a greater diffusive power than does diphtheria. For instance, in dealing with diphtheria it is common to find it highly pre- walent in one parish and but little prevalent in adjoining parishes, whereas scarlet fever has a greater tendency to .diffuse itself over wider areas ; the infection, however, of .diphtheria is much more persistent in an invaded area than is that of scarlet fever. Dr. Parkes does not regard the future quâ diphtheria prevalence as discouraging, for the figures would seem to indicate that the wave of diphtheria pre- valence which has passed over London since 1892 is now on the decline. As Dr. Parkes observes, the precise factors which may favour the persistence of diphtheria are but very imperfectly understood and it may be that social circum- stances such as overcrowding :and poverty are at least as potent for harm as are purely insanitary conditions ; in "other words, the extent of the prevalence of diphtheria is largely governed by opportunities for infection. Assuming, ’however, the diphtheria wave to be on the decline in London, what we have to do is to render both the social and sanitary condition of the population such that a wave of equal ’virulence will when it comes reap a smaller harvest. Plymouth Urban District.-In advocating the erection of swimming baths Mr. F. M. Williams points out how very important it is in a place like Plymouth where there is a large seafaring population that every facility for learning to swim should be afforded. It seems that in the elementary schools of Plymouth only eight of the boys are able to swim. The number of articles disinfected during 1897 affords a .capital illustration of the amount of labour which the arrival of an infected vessel necessitates. Many of our readers will remember the circumstances connected with the - S.S. Nubia, which brought cases of cholera to Plymouth in .January of last year, and they will read with interest that of ’31,000 articles disinfected during 1897 no less than 27,000 "came from the infected vessel. In dealing with the preva- lence of disease, Mr. Williams deplores the extension of - syphilis amongst the military, naval, and civil populations of our great centres, and in commenting thus he has doubtless in mind circumstances with which he is familiar in a garrison town like Plymouth. The repeal of the Contagious Diseases Act has, Mr. Williams states, been most disastrous as regards the moral and physical well-being of the young in great naval and military centres. It is certainly well that the medical officer of health should regard this question as -distinctly a branch of preventive medicine. Whilst dealing with the subject of cattle inspection and milk-supply attention is called to the necessity for the inspection by a veterinary surgeon of all milch cows yielding milk for the people of Plymouth, and as a step in the right direction Mr. Williams has apparently prevailed upon the principal dairy company to set up a filtering and sterilising plant. Br-ighton Urban Distriet.-The population of Brighton in 1897 was estimated at 121,401, and for the year in question the general death-rate was but 15-3 per 1000-the lowest yet recorded for Brighton. Under the heading of small-pox Dr. Newsholme furnishes a series of diagrams illustrating very clearly the altered age incidence of fatal small-pox side by side with the extension or diminution of the practice of vaccination. With the decrease of vaccination which has taken place within recent years we see a tendency for small- pox to revert to its pre-vaccination incidence on the infantile population, and we much fear that the next decade will witness a marked accentuation of this tendency. As regards enteric fever, Dr. Newsholme reports that detailed investiga- tion was made into the circumstances connected with the 88 cases which originated in Brighton during 1897, and it appeared from the evidence procurable that in 47 cases no shellfish had been eaten within three weeks of attack ; in 11 cases there was doubt as to the point, and in 27 cases shellfish derived from a sewage - contaminated source had been consumed at a time consistent with their having been the cause of the attack. In the 3 remaining cases the patients were intimately connected with the sale or storage of shellfish. It would seem, therefore from this that some 27 or 30 cases of enteric fever may have derived their infection from specifically contaminated shellfish; indeed, from the details with regard to certain illustrative cases, a thesis of this nature would appear to be the best and most reasonable explanation. Unfortunately we cannot well ascertain the incidence of enteric fever on the shellfish- eating community as compared with that upon the non- shellfish-eating community, and in all questions of this nature the decision must be arrived at by building up the best chain of evidence possible from the links available. It is to be deplored that ere this we have not had legislation in reference to this question of shellfish culture and disease, and it is to be hoped that Mr. Chaplin may early next session be able to introduce his long-expected and much- needed measure. Dr. Newsholme gives an interesting account of the means taken in Brighton to control the spread of measles, and he expresses the opinion that notification of this disease would only be successful if dual notification were rigidly enforced, and if only the first case in a household outbreak should require to be notified by the medical practitioner. He would, however, have the parent notify every case. Blackpool Urban District.-There were but 50 cases of enteric fever notified in Blackpool during 1897 a,s against 66 in the previous year, but as there were 15 deaths in 1897 and only 13 in 1,896 Dr. Jasper Anderson regards it as probable that a number of slight cases are not reported-. We expect this is a very common feature in every town, but it may obviously obtain in some years more than in others according as to whether the type of the disease is well or ill developed. One death from typhus fever-infection introduced from Liverpool-occurred in Blackpool during 1897. ____________ VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. Tn thirty-three of the largest English towns 6583 births and 4988 deaths were registered during the week ending August 27th. The annual rate of mortality in these towns, which had increased in the six preceding weeks from 14’7 to 22-0 per 1000, further rose to 23-2. In London the rate was 21’5 per 1000, while it averaged 24’3 in the thirty- two provincial towns. The lowest death-rates in these towns were 13’7 in Huddersfield, 16’5 in Oldham, 16’8 in Notting- ham, and 16’9 in Swansea; the highest rates were 30’9 in Liverpool, 32-3 in Preston, 35’2 in Sunderland, and 38’5 in Wolverhampton. The 4988 deaths in these towns included 1541 which were referred to the principal zymotic diseases, against 1127 and 1250 in the two preceding weeks; of these, 1321 resulted from diarrhoea, 84 from whooping- cough, 53 from measles, 45 from diphtheria, 19 from "fever" " (principally enteric), and 19 from scarlet fever. The lowest death-rates from these diseases were recorded in Swansea, Oldham, Burnley, Huddersfield, and Halifax ; and the highest rates in Wolverhampton, Salford, Preston, and Sheffield. The greatest mortality from measles occurred in Wolverhampton and Norwich; from whooping- cough in Sheffield, Sunderland, and Swansea: and from diarrhoea in Liverpool, Birkenhead, Leicester, Salford, Wolverhampton, Preston, and Sheffield. The mortality from scarlet fever and from "fever" showed no marked excess in any of the large towns. The 45 deaths from diphtheria included 21 in London, 4 in Liverpool, and 3 in West Ham. No fatal case of small-pox was registered last week in any of the thirty-three large towns, and only 2 small-pox patients welle under treatment in the Metropolitan Asylum Hospitals on Saturday, August 27th. The number of scarlet fever patients in these hospitals and in the London Fever Hospital at the end of
Transcript
710
Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.
REPORTS OF MEDICAL OFFICERS OF HEALTH.
Chelsea Sanitary District.-Dr. Louis Parkes has turned- his attention to the recent manifestations of scarlet fever and- of diphtheria in the eight parishes constituting westernLondon, and he furnishes in his annual report for 1897 twotables and some charts based upon the notifications of each.of these diseases for 1890 to 1897. In dealing with Chelseathe district of Kensal Town has been very properly omitted.as its topographical relations to Chelsea proper are obviouslybut remote. The lessons which Dr. Parkes draws from thetables are (1) that in the case of diphtheria fluctuations in’its prevalence are much less marked than is the case withscarlet fever; (2) that the prevalence or absence of diphtheriais a much more local circumstance than is the prevalence or.absence of scarlet fever, a disease which apparently possesses.a greater diffusive power than does diphtheria. For instance,in dealing with diphtheria it is common to find it highly pre-walent in one parish and but little prevalent in adjoiningparishes, whereas scarlet fever has a greater tendency to.diffuse itself over wider areas ; the infection, however, of.diphtheria is much more persistent in an invaded area than isthat of scarlet fever. Dr. Parkes does not regard the future
quâ diphtheria prevalence as discouraging, for the figureswould seem to indicate that the wave of diphtheria pre-valence which has passed over London since 1892 is now onthe decline. As Dr. Parkes observes, the precise factorswhich may favour the persistence of diphtheria are but veryimperfectly understood and it may be that social circum-stances such as overcrowding :and poverty are at least as
potent for harm as are purely insanitary conditions ; in"other words, the extent of the prevalence of diphtheria islargely governed by opportunities for infection. Assuming,’however, the diphtheria wave to be on the decline in London,what we have to do is to render both the social and sanitarycondition of the population such that a wave of equal’virulence will when it comes reap a smaller harvest.
Plymouth Urban District.-In advocating the erection ofswimming baths Mr. F. M. Williams points out how veryimportant it is in a place like Plymouth where there is alarge seafaring population that every facility for learning toswim should be afforded. It seems that in the elementaryschools of Plymouth only eight of the boys are able to swim.The number of articles disinfected during 1897 affords a.capital illustration of the amount of labour which thearrival of an infected vessel necessitates. Many of ourreaders will remember the circumstances connected with the- S.S. Nubia, which brought cases of cholera to Plymouth in.January of last year, and they will read with interest that of’31,000 articles disinfected during 1897 no less than 27,000"came from the infected vessel. In dealing with the preva-lence of disease, Mr. Williams deplores the extension of- syphilis amongst the military, naval, and civil populations ofour great centres, and in commenting thus he has doubtless inmind circumstances with which he is familiar in a garrisontown like Plymouth. The repeal of the Contagious DiseasesAct has, Mr. Williams states, been most disastrous as regardsthe moral and physical well-being of the young in greatnaval and military centres. It is certainly well that themedical officer of health should regard this question as
-distinctly a branch of preventive medicine. Whilst dealingwith the subject of cattle inspection and milk-supply attentionis called to the necessity for the inspection by a veterinarysurgeon of all milch cows yielding milk for the people ofPlymouth, and as a step in the right direction Mr. Williamshas apparently prevailed upon the principal dairy companyto set up a filtering and sterilising plant.
Br-ighton Urban Distriet.-The population of Brighton in1897 was estimated at 121,401, and for the year in questionthe general death-rate was but 15-3 per 1000-the lowest yetrecorded for Brighton. Under the heading of small-poxDr. Newsholme furnishes a series of diagrams illustratingvery clearly the altered age incidence of fatal small-pox sideby side with the extension or diminution of the practice ofvaccination. With the decrease of vaccination which hastaken place within recent years we see a tendency for small-pox to revert to its pre-vaccination incidence on the infantile
population, and we much fear that the next decade willwitness a marked accentuation of this tendency. As regardsenteric fever, Dr. Newsholme reports that detailed investiga-tion was made into the circumstances connected with the 88cases which originated in Brighton during 1897, and itappeared from the evidence procurable that in 47 cases noshellfish had been eaten within three weeks of attack ; in11 cases there was doubt as to the point, and in 27cases shellfish derived from a sewage - contaminatedsource had been consumed at a time consistent with theirhaving been the cause of the attack. In the 3 remainingcases the patients were intimately connected with the sale orstorage of shellfish. It would seem, therefore from this thatsome 27 or 30 cases of enteric fever may have derived theirinfection from specifically contaminated shellfish; indeed,from the details with regard to certain illustrative cases, athesis of this nature would appear to be the best and mostreasonable explanation. Unfortunately we cannot wellascertain the incidence of enteric fever on the shellfish-
eating community as compared with that upon the non-shellfish-eating community, and in all questions of thisnature the decision must be arrived at by building up thebest chain of evidence possible from the links available. Itis to be deplored that ere this we have not had legislationin reference to this question of shellfish culture and disease,and it is to be hoped that Mr. Chaplin may early nextsession be able to introduce his long-expected and much-needed measure. Dr. Newsholme gives an interestingaccount of the means taken in Brighton to control thespread of measles, and he expresses the opinion thatnotification of this disease would only be successful ifdual notification were rigidly enforced, and if only the firstcase in a household outbreak should require to be notified bythe medical practitioner. He would, however, have theparent notify every case.
Blackpool Urban District.-There were but 50 cases ofenteric fever notified in Blackpool during 1897 a,s against 66in the previous year, but as there were 15 deaths in 1897and only 13 in 1,896 Dr. Jasper Anderson regards it as
probable that a number of slight cases are not reported-. Weexpect this is a very common feature in every town, but itmay obviously obtain in some years more than in othersaccording as to whether the type of the disease is well orill developed. One death from typhus fever-infectionintroduced from Liverpool-occurred in Blackpool during1897.
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VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
Tn thirty-three of the largest English towns 6583 birthsand 4988 deaths were registered during the week endingAugust 27th. The annual rate of mortality in these towns,which had increased in the six preceding weeks from14’7 to 22-0 per 1000, further rose to 23-2. In London therate was 21’5 per 1000, while it averaged 24’3 in the thirty-two provincial towns. The lowest death-rates in these townswere 13’7 in Huddersfield, 16’5 in Oldham, 16’8 in Notting-ham, and 16’9 in Swansea; the highest rates were 30’9 inLiverpool, 32-3 in Preston, 35’2 in Sunderland, and 38’5 inWolverhampton. The 4988 deaths in these towns included1541 which were referred to the principal zymotic diseases,against 1127 and 1250 in the two preceding weeks; ofthese, 1321 resulted from diarrhoea, 84 from whooping-cough, 53 from measles, 45 from diphtheria, 19 from"fever" " (principally enteric), and 19 from scarletfever. The lowest death-rates from these diseases wererecorded in Swansea, Oldham, Burnley, Huddersfield, andHalifax ; and the highest rates in Wolverhampton, Salford,Preston, and Sheffield. The greatest mortality from measlesoccurred in Wolverhampton and Norwich; from whooping-cough in Sheffield, Sunderland, and Swansea: and fromdiarrhoea in Liverpool, Birkenhead, Leicester, Salford,Wolverhampton, Preston, and Sheffield. The mortality fromscarlet fever and from "fever" showed no marked excessin any of the large towns. The 45 deaths from diphtheriaincluded 21 in London, 4 in Liverpool, and 3 inWest Ham. No fatal case of small-pox was registeredlast week in any of the thirty-three large towns, andonly 2 small-pox patients welle under treatment in the
Metropolitan Asylum Hospitals on Saturday, August 27th.The number of scarlet fever patients in these hospitalsand in the London Fever Hospital at the end of
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the week was 2178, against 2326, 2293, and 2241 on thethree preceding Saturdays; 182 new cases were admitted-during the week, against 224, 201, and 187 in the threepreceding weeks. The deaths referred to diseases of the
respiratory organs in London, which had been 171 and196 in the two preceding weeks, declined again to 135, andwere 24 below the corrected average. The causes of 54, or1’1 per cent., of the deaths in the thirty-three towns werenot certified either by a registered medical practitioner or by.a coroner. All the causes of death were duly certified inPortsmouth, Cardiff, Nottingham, Oldham, and in eleven- other smaller towns; the largest proportions of uncertifieddeaths were registered in Bristol, Leicester, Liverpool, andPreston.
In thirty-three of the largest English towns 6749 births.and 5242 deaths were registered during the week endingSept. 3rd. The annual rate of mortality in these towns,which had increased in the seven preceding weeks from 14’7to 23-2 per 1000, further rose last week to 24-4. In Londonthe rate was 22-0 per 1000, while it averaged 26-0 in thethirty-two provincial towns. The lowest death-rates in thesetowns were 15’1 in Halifax, 15’3 in Huddersfield, 17’2 in’Oldham, and 17’3 in Portsmouth; the highest rates were.31-1 in Bolton, 31’2 in Gateshead, 36-7 in Wolverhampton.and in Salford, and 37’0 in Sunderland. The 5242 deaths inthese towns included 1646 which were referred to the
,principal zymotic diseases, against 1250 and 1541 inthe two preceding weeks ; of these, 1438 resultedfrom diarrhcea, 75 from whooping-cough, 43 from diphtheria,’.40 from "fever" (principally enteric), 30 from measles,19 from scarlet fever, and 1 from small-pox. The lowest-death-rates from these diseases were recorded in Plymouth,Oldham, Huddersfield, and Halifax; and the highest rates’in Wolverhampton, Salford, Bolton, Preston, and Sunder-land. The greatest mortality from whooping-cough occurredin Croydon, Halifax, and Sunderland ; and from diarrhoeain Wolverhampton, Leicester, Salford, Bolton, Preston, Sheffield, Hull, and Sunderland. The mortality from
measles, from scarlet fever, and from "fever" showed nomarked excess in any of the large towns. The 43 deathsfrom diphtheria included 19 in London, 5 in Swansea, 4 inLeeds, 3 in Birkenhead, and 3 in Liverpool. One fatal- case of small - pox was registered in Gateshead, but.not one in London or in any other of the thirty-three large towns ; and only 2 small - pox patientswere under treatment in the Metropolitan Asylum Hospitals- on Saturday last, Sept. 3rd. The number of scarlet feverpatients in these hospitals and in the London Fever Hospital.at the end of last week was 2240, against 2293, 2241, and.2178 on the three preceding Saturdays ; 238 new cases were. admitted during the week, against 201, 187, and 182 in thethree preceding weeks. The deaths referred to diseases ofthe respiratory organs in London, which had been 196 and: 135 in the two preceding weeks, further declined to 127 last’week, and were 16 below the corrected average. The causesof 44, or 0’8 per cent. of the deaths in the thirty-three townswere not certified either by a registered medical practitioneror by a coroner. All the causes of death were duly certified.in West Ham, Bristol, Nottingham, Bradford, and in thirteenother smaller towns; the largest proportions of uncertified’deaths were registered in Leicester, Liverpool, Huddersfield,.and Sheffield.
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HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in the eight Scotch towns,,which had been 19-8 and 18’1 per 1000 in the two preceding’weeks, rose again to 18’4 during the week ending August 27th,but was 4’8 per 1000 below the mean rate during the same.period in the thirty-three large English towns. The rates inthe eight Scotch towns ranged from 11-9 in Perth and 13°0in Leith to 26-4 in Greenock and 28-9 in Paisley. The 556- deaths in these towns included 89 which were referred to’diarrhoea, 27 to whooping-oough, 9 to "fever," 8 to measles,.5 to scarlet fever, and 2 to diphtheria. In all, 140 deathsresulted from these principal zymotic diseases, against 136..and 118 in the two preceding weeks. These 140 deathswere equal to an annual rate of 4’6 per 1000, which was.2’6 below the mean rate last week from the same diseasesin the thirty-three large English towns. The fatalcases of diarrhoea, which had been 80 and 70 in thetwo preceding weeks, rose again to 89 last week, andincluded 44 in Glasgow, 11 in Paisley, 9 in Edinburgh, and 9in Dundee. The 27 deaths from whooping-cough showed aslight further inerease upon recent weekly numbers, and
included 8 in Glasgow and 8 in Aberdeen. The deathsreferred to different forms of " fever," which had increasedfrom 1 to 9 in the three preceding weeks, were again 9 lastweek, of which 8 occurred in Glasgow. The 8 fatal cases ofmeasles exceeded by 2 the number registered in the precedingweek, and included 3 in Glasgow, where 2 of the 5 deathsfrom scarlet fever were also recorded. The deaths referredto diseases of the respiratory organs in these towns, whichhad been 71 and 80 in the two preceding weeks, declinedagain to 64, and were 14 below the number in the corre-sponding period of last ’year. The causes of 24, or morethan 4 per cent., of the deaths in these eight towns were notcertified.The annual rate of mortality in the eight Scotch towns,
which had been 18’1 and 18’4 per 1000 in the two precedingweeks, further rose to 19-8 during the week ending Sept. 3rd,but was 4’6 per 1000 below the mean rate during the sameperiod in the thirty-three large English towns. The rates inthe eight Scotch towns ranged from 13’6 in Perth, and 17’4.in Aberdeen to 27-9 in Leith and 28-9 in Greenock. The 596deaths in these towns included 81 which were referred todiarrhoea, 22 to whooping-cough, 9 to 11 fever," 5 to measles,5 to scarlet fever, and 2 to diphtheria. In all, 124 deathsresulted from these principal zymotic diseases against 118and 140 in the two preceding weeks. These 124 deathswere equal to an annual rate of 4’1 per 1000, which was3’5 below the mean rate last week from the same diseasesin the thirty-three large English towns. The fatal cases ofdiarrhoea, which had been 70 and 89 in the two precedingweeks, declined to 81 last week, of which 39 occurred inGlasgow, 12 in Edinburgh, 9 in Leith, and 7 in Greenock.The 22 deaths from whooping-cough showed a decline of5 from the number in the, preceding week, and included 13in Glasgow and 5 in Aberdeen. The deaths referred todifferent forms of " fever," which had been 9 in each of thetwo preceding weeks, were again 9 last week, of which 5occurred in Glasgow and 2 in Paisley. The 5 fatal cases ofscarlet fever also corresponded with the number recorded inthe preceding week, and included 3 in Edinburgh and 2 inGlasgow. The deaths referred to diseases of the respiratoryorgans in these towns, which had been 80 and 64 in the twopreceding weeks, rose again to 72 last week, and slightlyexceeded the number in the corresponding period of last
year. The causes of 34, oi nearly 6 per cent. of the deathsin these eight towns last week were not certified.
I HEALTH OF DUBLIN.’ The death-rate in Dublin, which had been 25-5 and 21’8per 1000 in the two preceding weeks, rose again to 22-4during the week ending August 27th. During the four weeksending on that date the death-rate in the city averaged23-4 per 1000, the rate during the same period being 21-0 inLondon and 17’1 in Edinburgh. The 150 deaths registeredin Dublin during the week under notice showed a slightincrease upon the number in the previous week, and included29 which were referred to the principal zymotic diseases,against 31 and 28 in the two preceding weeks ; of these, 24resulted from diarrhoea, 3 from " fever," 2 from diphtheria,but not one either from small-pox, measles, scarlet fever, orwhooping-cough. These 29 deaths were equal to an annualrate of 4-3 per 1000, the zymotic death-rate during the sameperiod being 6’4 in London and 2-5 in Edinburgh. The fatalcases of diarrhoea, which had increased from 4 to 22 in thefive preceding weeks, further rose to 24. The deaths referredto different forms of "fever," which had been 3 in each ofthe two preceding weeks were again 3 during the week undernotice. The 2 fatal cases of diphtheria exceeded the numberrecorded in any recent week. The 150 deaths in Dublinincluded 51 of infants under one year of age, and 29 of
persons aged upwards of sixty years; the deaths of infantsshowed a slight further increase upon recent weekly numbers,while those of elderly persons showed a decline. Four
inquest cases and 4 deaths from violence were registered,and 51, or rather more than a third, of the deaths occurredin public institutions. The causes of 10, or nearly seven percent. of the deaths in the city were not certified.The death-rate in Dublin, which had been 21’8 and 22’4
per 1000 in the two preceding weeks, further rose to 27’6during the week ending Sept. 3rd. During the four weeksending on Saturday last the rate of mortality in the cityaveraged 24-3 per 1000., the rate during the same period being21-9 in London and 17-1 in Edinburgh. The 185 deaths
registered in Dublin during the week under notice showed an
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increase of 35 upon the number in the preceding week, andincluded 39 which were referred to the principal zymoticdiseases, against 28 and 29 in the two preceding weeks ; ofthese, ‘33 resulted from diarrhoea, 4 from whooping-cough,1 from measles, 1 from "fever," but not one eitherfrom small-pox, scarlet-fever, or diphtheria. These39 deaths were equal to an annual rate of 5’8 per1000, the zymotic death-rate during the same periodbeing 5’9 in London and 3’2 in Edinburgh. The fatal casesof diarrhoea, which had increased in the five preceding weeksfrom 9 to 24. further rose to 33 last week. The 4 deathsreferred to whooping-cough exceeded the number recorded inany recent week, while the mortality from " fever " showed adecline. The 185 deaths in Dublin last week included 62 ofinfants under one year of age, and 33 of persons agedupwards of sixty years; the deaths both of infants and ofelderly persons showed a further increase upon thoserecorded in recent weeks. Seven inquest cases and 8 deathsfrom violence were registered; and 53, or more than a fourthof the deaths occurred in public institutions. The causes of
16, or nearly 9 per cent. of the deaths in the city last weekwere not certified.
THE SERVICES.
NEW WARRANT FOR THE INDIAN MEDICAL SERVICE.THE following is the text of the Warrant published in the
London Gazette of Friday, August 26th, granting new titlesto the Indian Medical Service :- ,
India Office, August 26th, 1898.VICTORIA, R.I.
Whereas We have deemed it expedient to alter the Ranksof the Officers of Our Indian Medical Service :Our Will and Pleasure is that the following alterations
Officers above the rank of Surgeon-Colonel shall in futurebe styled Surgeon-Generals (ranking as Major-Generals), andthe title of Surgeon-Major-Generals now serving shall bealtered accordingly.
It is further Our Will and Pleasure that the followingalterations shall be made in the honorary rank of the SeniorAssistant Surgeons of the Subordinate Medical Departmentin India:
Present Honorary Ranks. New Honorary Ranks.Surgeon-Major ......... Major.Surgeon-Captain ......... Captain.Stirgeon-Lieutenant ...... Lieutenant.Given at Our Court at Osborne, this tenth day of August,
one thousand eight hundred and ninety-eight, in thesixty-second year of Our reign.
By Her Majesty’s Command._____
GEORGE HAMILTON.
ROYAL NAVY MEDICAL SERVICE.
Staff-Surgeon Horace Ximenes Browne has been pro-moted to the rank of Fleet-Surgeon in Her Majesty’sFleet. Staff-Surgeon Charles William Buchanan-Hamiltonhas been promoted to the rank of Fleet-Surgeon in HerMajesty’s Fleet Staff-Surgeon Arthur William May hasbeen promoted to the rank of Fleet-Surgeon in Her
Majesty’s Fleet. Staff-Surgeon Charles Hazlitt Upham hasbeen allowed to withdraw from Her Majesty’s Service witha gratuity.The following appointments are notified:--Fleet-Surgeons :
John Lyon to the President; ; William R. White to the
Magnificent; and George W. Bell to the Hannibal. Staff-
Surgeons : John Lowney to the Proserpine ; Daniel J. P.McNabb to the Northampton ; Hamilton Meikle to thePearl; E. G. Swan to the Collingwood; and F. J. Burnsto the Boscawen. Surgeons: Herbert Holyoake to thePt-,,7ib,i-o7ee, additional; Harold G. T. Major to the Victory;Shirley H. Birt to the Victory; Henry W. Finlayson to the
Vivid; ; Robert S. Bernard James, W. W. Stanton, andArthur E. Kelsey to Haslar Hospital ; William Hackett toPlymouth Hospital; Joseph C. Wood to the -Britannia: :and Charles R. Sheward to the Vivid.
ROYAL ARMY MEDICAL CORPS.The under-mentioned officers retire on retired pay : Colonel
Charles F. Pollock and Major Arthur Harding, half-pay. Lieutenant-Colonel H. Charlesworth has assumedthe duties of Recruiting and Embarking Medical Officer(Portsmouth). Major T. G. Lavie has embarked for Egypt.
ARMY MEDICAL RESERVE OF OFFICERS.
Surgeon-Captain Robert Stirling, M.D., 4th VolunteerBattalion the Black Watch (Royal Highlanders), to be
Surgeon-Captain.MILITIA MEDICAL STAFF CORPS.
Surgeon-Captain W. W. Lake to be Surgeon-Major.’ VOLUNTEER CORPS.
Artillery: 8th Lancashire : Surgeon-Major A. R. Hopperto be Surgeon-Lieutenant-Colonel. lst Shropshire andStaffordshire: Surgeon-Captain R. P. Mackenzie, M.B.,resigns his commission. lst Sussex : Surgeon-LieutenantG. A. Skinner resigns his commission. Rifle 9th Lanark-shire : The under-mentioned Surgeon-Lieutenants to be
Surgeon-Captains : A. Campbell, 1VLB., and J. Bradford.2nd Volunteer Battalion the Royal Fusiliers (City of LondonRegiment) : Surgeon-Captain E. D. Berton, M.B., to be
Surgeon-Major. 3rd Volunteer Battalion the King’s (Liver-pool Regiment) : Surgeon-Captain F. F. Moore resigns hiscommission ; also is granted the rank of Surgeon-Major, withpermission to continue to wear the uniform of the battalionon his retirement. 2nd (Berwickshire) Volunteer Battalionthe King’s Scottish Borderers : Alexander John Campbell,M.B., to be Surgeon-Lieutenant.
THE ROYAL ARMY MEDICAL CORPS IN THE SOUDAN.
The following are the arrangements in detail :-The principles and methods laid down in the regulations
for the provision of hospital and medical services in the fiel’àhave, been followed in the late Soudan expedition, with suchadditions and modifications as were considered necessary tobest adapt them to the climate, to the nature of the expedi-tion, and to the work which had to be fulfilled. A medicalofficer accompanied every corps unit ; brigades were furnishedwith sectional field hospitals and these were also attachedto the cavalry and artillery ; the wounded and sickwere transported from the front by the Nile to Atbara imbarges specially fitted up as temporary hospitals. The water-carriage of wounded is, it may be remarked, about the bestand most comfortable transport which can be devised for thepurpose. Large stationary hospitals, which are equippedwith all practicable conveniences and comforts, are locatedat Atbara, Abadia, Wady Halfa, and Shellal. Two sets of
Roentgen ray apparatus have also been provided.The citadel hospital at Cairo is a very fine, well-
placed and well-ventilated building; the weakest pointabout it is the conservancy accommodation ; but the dryearth system is, or was, in use and is most carefullysupervised and worked. .
Principal Medical Officer--Surgeon-General Taylor.Secretary-Major Wilson, C.M.G.Principal Medical Officer of the British Division of two
Senior Medical Officer-Lieutenant-Colonel Sloggett.Warwickshire Regiment-Major Irwin.Lincolnshire Regiment-Major Adamson.Cameron Highlanders-Captain Mathias.Seaforth Highlanders-Lieutenant Bliss.Five sectional field hospitals of 25 beds each are attached
to this brigade :-No. 1 Sectional Field Hospital-Major Myles.No. 2 Sectional Field Hospital-Major Webb.No. 3 Sectional- Field Hospital-Major Robinson.No. 4 Sectional Field Hospital-Major Wardrop.No. 5 Sectional Field Hospital--Major Dodd.
Second Brigade.Senior Medical Officer--Lieutenant-Colonel Hughes.lst Battalion Grenadier Guards--Major Kilkelly and
