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of the districts with worst housing. Out of 216 dwellingsinspected ,for the purposes of Section 17 of the Housing andTown Planning Act as many as 182 were considered to be ina state dangerous or injurious to health ; in 112 of these thedefects were remedied without the making of a closingorder; in 21 the closing order was made, and in 8 thehouses were demolished. Looking to the size of the townand to the conditions described by Dr. Jonas this seems toindicate very satisfactory progress, especially if the towncouncil accompany it by the provision of suitable new

working-class accommodation.Borough of Reigate.-In a preface to his annual report Dr.

Arthur E. Porter observes that ’’ the modern tendency ofpublic health administration appears to be to impose largeadministrative duties upon county councils, while leavingmuch of the spadework to be carried out by the constituentauthorities." He considers it arguable whether this is a

desirable arrangement in a county like Surrey, where thestandard of public health administration is relatively high.In Reigate much useless clerical work is entailed, while thereciprocal benefit received is quite negligible. Dr. Porter

goes on to criticise the Milk and Dairies Bill from this pointof view, pointing out that in Surrey reference to the countyheadquarters is singularly inconvenient for the importantdistricts situated in its eastern half. A hybrid arrangementwhereby administrative and executive duties are shared bythe larger and smaller authorities in his view cannot fail tobe accompanied by overlapping, by regrettable delays,,and unnecessary clerical and other work. Most of thehouses in the district are supplied by the East SurreyWater Company, the population of whose statutory areanow amounts to something like 90,000 persons. The

’supply, estimated at 25 to 30 gallons per head per diem inReigate, is derived from deep wells bored about 125 feet intothe chalk at Purley and Kenley, where it is softened to40 Clark or thereabouts. So long as it maintains its highdegree of purity it must be placed in the front rank of publicwater-supplies, but Dr. Porter points out that the chalkwhich forms the gathering ground is yearly becoming more,and more built over, and that while the larger centres aredrained to sewers, cesspools are attached to the more

scattered groups of dwellings. He considers that the riskthat at some future date fissures from which the

company’s wells derive their water may become pollutedby domestic drainage should be guarded against. Thisis probably more necessary now that the company hasobtained Parliamentary sanction to erect additional pumpingmachinery at their Purley station. In regard to "holidaychildren" from London Dr. Porter states that stringentmeasures have been adopted for some years to inspect thehouses to which the children are sent, and that every yearvarious societies in London are asked whether they propose tosend children to the borough, and if so to furnish a list ofthe proposed lodgings. It has been found that since this

system was adopted the number of holiday children thatcome to Reigate has been steadily reduced year by year.

REPORTS OF SCHOOL MEDICAL OFFICERS.

Dwrhaln County COlMcil.-The work of this educationdistrict extends over 622,000 acres, with a population of

707,000 (estimated middle of 1910). There were 138,303children on the roll attending at 397 schools with 694- departments. To do this work Dr. T. Eustace Hill, theschool medical officer, has the help of eight assistants, threeof whom are women, and of three school nurses. During1911, 26,885 children were inspected, 25,302 being routineand 1583 special cases. The tenor of the reports from thedifferent examinations is satisfactory. The percentage ofgirls with verminous heads was reduced from 48-7 per cent. Ito 37’4 per cent. and of boys from 1-2 per cent. to 0-69 per icent. Legal proceedings were sanctioned by the education- committee against parents whose children were persistentlyverminous. In only 8 cases out of 30 were prosecutionsajistitnted, 3 were withdrawn, 1 was dismissed on technicalgrounds, the parent getting a severe reprimand fromthe chairman of the bench, and in 4 cases convictionswere obtained and fines imposed varying from 5s. to20s., plus costs. Scabies was unfortunately very prevalentduring the year. Cases with ringworm of the head areallowed to attend school if wearing a washable linen cap.The medical officer calls special attention to the need for the

provision of facilities for treatment of this ailment. Andattention is also called to the need for reasonable encourage-ment to teachers to obtain a practical knowledge of hygiene,and further to the need for the provision of open-air classesor schools. Among special reports is one by Miss CooperHodgson, health visitor for the central district, who notesthat chronic absentees, presumably away from school "toget fresh air," are usually found "hanging about in the house,untidy, depressed-looking little drudges nursing heavybabies, scrubbing floors, or helping with the family washing,or perhaps bread-baking." Dealing with 34 verminousfamilies Miss Hodgson says in only four cases can theparents be regarded as normal," and enumerates the

’’ parental defects " in the 30. But the classification istoo sweeping and too much a matter of individual opinionto be of scientific value. Its publication gives an impressionof exactitude probably not deserved. A medical officer hasbeen appointed especially to do refraction work, and hasdealt with 366 cases from Sept. 25th, 1911, to Dec. 15th.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

Ix 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, 8960 births and 5420 deaths wereregistered during the week ended Saturday, April 19th.The annual rate of mortality in these towns, which hadbeen 16-9, 15-6, and 15-2 per 1000 in the three pre-ceding weeks, rose to 15’8 8 per 1000 in the week undernotice. During the 13 weeks of last quarter the meanannual death-rate in these towns averaged 16-9 per1000, against a corresponding rate of 17’5 in London.The death-rates last week in the several towns ranged from.4-6 in Ealing, 6-1 in Enfield, 6-6 in Ilford, 7-2 in Leyton,and 7-5 in Bournemouth, to 21-7 in Hastings, 21’8 inStoke-on-Trent and in Carlisle, 21-9 in Stockton-on-Tees,22-3 in Dewsbury, and 24’0 0 in Wolverhampton.The 5420 deaths from all causes in the 96 towns were 225

in excess of the number in the previous week, and included412 which were referred to the principal epidemic diseases,against numbers steadily declining from 464 to 394 in thefive preceding weeks. Of these 412 deaths, 203 resultedfrom measles, 74 from whooping-cough, 65 from infantilediarrhoeal diseases, 41 from diphtheria, 17 from scarlet fever,and 12 from enteric fever, but not one from small-pox. Themean annual death-rate from these diseases last week wasequal to 1-2 per 1000, and coincided with that recorded ineach of the three preceding weeks. The deaths attributedto measles, which had been 208, 215, and 213 in thethree preceding weeks, fell to 203 last week, and causedthe highest annual death-rates of 1-9 in Willesden, 2-3in Wigan, 2-6 in Bolton, 2-9 in Southend-on-Sea, 3’1in St. Helens, 3. 3 in Wolverhampton, 3.8 8 in West Bromwich,and 6’ 2 in Gloucester. The deaths referred to whooping-cough,which had steadily fallen from 83 to 50 in the five precedingweeks, rose to 74 last week, and included 26 in London and3 each in Southend-on-Sea, in Birmingham, in Manchester,in Leeds, and in Merthyr Tydfil. The fatal cases ofdiarrhoea and enteritis (among infants under 2 years of age),which had been 71, 53, and 63 in the three preceding weeks,were 65 last week; 18 deaths occurred in London and 3each in Stoke-on-Trent, in Wolverhampton, and in Middles-brough. The deaths attributed to diphtheria, which hadbeen 37, 35, and 36 in the three preceding weeks, rose to 41last week, of which number 11 were registered in London and3 each in Bradford, in Leeds, and in Stockton-on-Tees. Thedeaths referred to scarlet fever, which had been 19, 23, and’19 in the three preceding weeks, were 17 last week, and’included 5 in Birmingham, 3 in London, and 2 in St.Helens. The fatal cases of enteric fever numbered 12 lastweek, against 8, 16, and 13 in the three preceding weeks.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,which had steadily declined from 2112 to 1357 in the 16 pre-ceding weeks, had further fallen to 1334 on Saturday last;215 new cases were admitted during the week, against168, 167, and 148 in the three preceding weeks. Tbeaehospitals also contained on Saturday last 851 cases of

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diphtheria, 754 of measles, 260 of whooping-cough, and38 of enteric fever, but not one of small-pox. The 1424deaths from all causes in London were 136 in excess of thenumber in the previous week, and were equal to an annualdeath-rate of 16’ 4 per 1000. The deaths referred to diseasesof the respiratory system, which had steadily declined from453 to 285 in the seven preceding weeks, rose to 329 lastweek, and were 84 above the number recorded in the

corresponding week of last year. The deaths attributedto influenza numbered 28, against 45 in each of the twopreceding weeks.Of the 5420 deaths from all causes in the 96 towns, 171

resulted from different forms of violence, and 389 were thesubject of coroners’ inquests. The causes of 50, or 0-9 percent., of the total deaths were not certified either by aregistered medical practitioner or by a coroner after inquest.All the causes of death were duly certified in London and inits 14 suburban districts, in Leeds, Bristol, Hull, Notting-ham, Portsmouth, Salford, and in 55 other smaller towns.Of the 50 uncertified causes of death, 9 were registered inBirmingham, 7 in Liverpool, 4 in Stoke-on-Trent, 4 inWarrington, 3 in Bootle, 3 in St. Helens, and 3 in Sheffield.

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, 661 births and 481 deaths were registered duringthe week ended Saturday, April 19th. The annual rate ofmortality in these towns, which had been 23-8, 23-3, and22 - 5 per 1000 in the three preceding weeks, further declinedto 20.9 per 1000 in the week under notice. During the 13weeks of last quarter the mean annual death-rate in theseIrish towns averaged 222 per 1000 ; in the 96 large Englishtowns the corresponding rate did not exceed 16-9, whilein the 16 Scotch towns it was equal to 191 per 1000. Theannual death-rate last week was equal to 24-1 in Dublin(against 16-4 in London and 17-3 in Glasgow), 16-9 9in Belfast, 22-4 in Cork, 12-7 in Londonderry, 29-8 inLimerick, and 11-4 in Waterford, while in the remaining21 smaller towns the mean death-rate was 23.1 per 1000.The 481 deaths from all causes in the 27 Irish towns

were 36 fewer than the number in the preceding week, andincluded 42 which were referred to the principal epidemicdiseases, against 39 and 37 in the two preceding weeks. Ofthese 42 deaths, 18 resulted from measles, 10 from infantilediarrhoeal diseases, 6 from whooping-cough, 5 from diph-theria, and 3 from scarlet fever, but not one from entericfever or from small-pox. These 42 deaths from the

principal epidemic diseases were equal to an annualdeath-rate of 1-9, against 1-2 per 1000 in the 96

large English towns. The deaths attributed to measles,which had been 17, 14, and 14 in the three precedingweeks, rose to 18 last week, and included 10 in

Wexford, 4 in Belfast, and 2 in Newry. The deaths ofinfants (under 2 years of age) referred to diarrhoea andenteritis, which had been 8, 11, and 10 in the three

preceding weeks, were again 10 last week, of which number8 were registered in Dublin. The fatal cases of whooping-cough, which had been 10, 5, and 3 in the three precedingweeks, slightly rose to 6 last week, and included 5 in Dublin.Of the 5 deaths attributed to diphtheria, which were equalto the average in the five preceding weeks, 2 occurred inDublin, 2 in Londonderry, and 1 in Belfast. The 3 deathsreferred to scarlet fever were recorded in Belfast. Inaddition to the above diseases a fatal case of typhus wasregistered in Dublin.The deaths referred to diseases of the respiratory system,

which had been 122, 142, and 109 in the three precedingweeks, further declined to 92 in the week under notice. Ofthe 481 deaths from all causes, 152, or 32 per cent.,occurred in public institutions, and 8 resulted fromdifferent forms of violence. The causes of 22, or 4.6 percent., of the total deaths were not certified either by aregistered medical practitioner or by a coroner after inquest ;in the 96 large English towns the proportion of uncertifiedcauses of death last week did not exceed 0’ 9 per cent.

VITAL STATISTICS OF LONDON DURING MARCH, 1913.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

appears that the number of persons reported to be sufferingfrom one or other of the ten diseases specified in the tablewas equal to an annual rate of 4. 8 per 1000 of the popula-tion, estimated at 4,518,191 persons in the middle of theyear ; in the three preceding months the rates were 5’5,5-3, and 4.8 per 1000 respectively. The lowest rateslast month were recorded in Hammersmith, Chelsea,Hampstead, the City of London, and Shoreditch ; and thehighest rates in Southwark, Bermondsey, Battersea,Wandsworth, Camberwell, Deptford, and Lewisham. The

prevalence of scarlet fever showed a considerable declinelast month ; this disease was proportionally most prevalentin Poplar, Bermondsey, Lambeth, Battersea, Camberwell, andDeptford. The number of soarlet fever patients undertreatment in the Metropolitan Asylums Hospitals, which hadbeen 2088, 1717, and 1639 at the end of the three

preceding months, had further declined to 1436 at the endof last month ; the weekly admissions averaged 158,against 226, 196, and 189 in the three preceding months.Diphtheria was rather more prevalent than it had been in thepreceding month ; among the several metropolitan boroughsthe greatest proportional prevalence of this disease was

recorded in Paddington, St. Pancras, Stepney, /South-

wark, Bermondsey, Battersea, Wandsworth, Lewisham, andWoolwich. The Metropolitan Asylums Hospitals contained901 diphtheria patients at the end of last month, against959, 925, and 913 at the end of the three precedingmonths ; the weekly admissions averaged 122, against120, 122, and 118 in the three preceding months. Theprevalence of enteric fever showed a slight decline lastmonth ; this disease was proportionally most prevalent inPaddington, the City of Westminster, St. Pancras, BethnalGreen, and Bermondsey. There were 42 enteric feverpatie’lts under treatment in the Metropolitan AsylumsHospitals at the end of last month, against 37 and 44 atthe end of the two preceding months ; the weaklyadmissions averaged 7, against 7 and 6 in the two

preceding months. Erysipelas was proportionally most

prevalent in Chelsea, Finsbury, Bethnal Green, Stepney,Southwark, Camberwell, Deptford, and Greenwich. The 31cases of puerperal fever notified during the monthincluded 7 in Islington, 3 in the City of Westminster, 3 inFinsbury, 3 in Stepney, 2 in Fulham, and 2 in Lambeth.The 11 cases of cerebro-spinal meningitis included 5 inStepney ; and the 2 cases notified as poliomyelitis belongedrespectively to the City of Westminster and Hampstead.The mortality statistics in the table relate to the deaths of

persons actually belonging to the several boroughs, thedeaths occurring in institutions having been distributed

among the several boroughs in which the deceased personshad previously resided ; the death-rates from all causes arefurther corrected for variations in the sex- and age-constitu-tion of the populations of the several boroughs. During thefour weeks ending March 29th the deaths of 6105 Londonresidents were registered, equal to an annual rate of 18’5per 1000 ; in the three preceding months the rates had been12 ° 5, 17 - 8, and 19 - 0 per 1000 respectively. The death-rates last month ranged from 12-4 4 in Lewisham, 13-4in Hampstead, 13’6 6 in the City of London, 14’3 3 in Wands-worth, 16’1 1 in Holborn, 16 - 2 in Greenwich, and 16’ 3 inFulham, to 20’1 in Bethnal Green, 20’5 in St. Marylebone,21-2 in Islington and in Finsbury, 21.4 in Bermondseyand in Deptford, 22-2 in Southwark, and 22’7 in Shore-ditch. The 6105 deaths from all causes included506 which were referred to the principal infectiousdiseases ; of these, 284 resulted from measles, 8 fromscarlet fever, 34 from diphtheria, 93 from whooping-cough, 1 from enteric fever, and 86 from diarrhoea andenteritis among children under two years of age. Thelowest death-rates from these diseases were recorded lastmonth in Hampstead, St. Pancras, Stoke Newington,Holborn, the City of London, and Lewisham ; and thehighest rates in Hammersmith, St. Marylebone, BethnalGreen, Southwark, Bermondsey, and Battersea. The 284deaths from measles were slightly below the averagenumber in the corresponding period of the five precedingyears ; this disease was proportionally most fatal last monthin St. Marylebone, Bethnal Green, Southwark, Bermondsey,Lambeth, and Battersea. The 8 fatal cases of scarletfever showed a decline of 19 from the correctedaverage number, and included 2 in the City of West-minster. The 34 deaths from diphtheria were 15

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fewer than the corrected average number ; this diseasewas proportionally most fatal in St. Marylebone, Stepney,Deptford, and Woolwich. The 93 fatal cases of whooping-cough were 53 below the corrected average number; the

highest death-rates from this disease were recorded in

Paddington, Hammersmith, Fulham, Finsbury, Bermondsey,Camberwell, and Deptford. Only 1 death from entericfever was registered in London last month, the correctedaverage number being 10. The mortality from diarrhoea andenteritis among children under two years of age was pro-portionally greatest in Finsbury, Shoreditch, Stepney,Bethnal Green, and Bermondsey. In conclusion, it may bestated that the aggregate mortality in London last monthfrom the principal infectious diseases, excluding diarrhoea,was 19-4 per cent. below the average.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

Surgeon-General A. W. May has taken up duty in theAdmiralty Medical Department preliminary to taking overthe Director-Generalship of the Department on May llth.

Surgeon-General A. J. J. Johnston has succeeded Surgeon-general May in the medical charge of the Naval Hospital,Chatham. - - -- - -

In accordance with the provisions of His late Majesty’s Order in Council of August llth, 1903, Surgeon JohnMcCutcheon has been allowed to withdraw from HisMajesty’s Naval Service with a gratuity (dated April 13th,1913).The successful candidates at the April examination for the

Naval Medical Services, whose names were announced inTHE LANCET last week (p. 1124), have been entered as

acting surgeons and appointed to the Victory, additional,for a course of instruction at the Naval Medical School,Royal Naval College, Greenwich, and at Haslar Hospital.

’

ROYAL ARMY MEDICAL CORPS.

Captain David S. Buist is seconded for service with the

Egyptian army (dated Feb. 26th, 1913).Surgeon-General L. E. Anderson has been appointed to

the Administrative Staff of the forthcoming Irish Command- Staff tour.

Colonel H. M. Sloggett has been selected for appointmentas Assistant Director of Medical Services to the BelfastDistrict. Colonel F. J. Jencken has been granted one’month’s leave of absence.

Brevet-Colonel Sir William B. Leishman has been ap-pointed a member of the Advisory Medical and Sanitary’Committee for Tropical Africa.

Lieutenant-Colonel J. D. Ferguson, D.S.O., has beenselected for appointment to the Straits Settlements.Lieutenant-Colonel W. T. Mould has been granted three,months’ leave of absence. An exchange of positions on’the roster for service abroad has been approved betweenLieutenant-Colonel N. Manders, at the Curragh Camp,and Lieutenant-Colonel M. T. Yarr, of the LondonDistrict, who will now proceed abroad during the comingtrooping season. Lieutenant-Colonel F. W. Hardy hastaken over charge of the Military Hospital at Allahabad-Cantonment.

Major W. L. Bennett has been appointed to the Northern Command. Major H. A. Hinge has taken up duty in theAldershot Command. Major P. S. O’Reilly has been grantedeight months’ leave of absence home from India. MajorJ. F. M. Kelly has arrived home for duty from Potchefstroom.Major G. Dansey-Browning has embarked for a tour of dutyat Gibraltar. Major A. L. Scott has been transferred fromAldershot to Deepcut. Major J. Matthews has taken upduty at Secunderabad Cantonment. Major H. Herrick has.arrived home on leave of absence from India. Major R. L.Argles has been transferred from Cahir to Tralee. MajorE. F. Q. L’Estrange has been selected to command theMilitary Hospital at Cannanore. Major J. Poe has arrivedhome from South Africa. Major E. W. Siberry has beenappointed to the London District. Major J. E. Brogden hasbeen transferred to Malta from Gibraltar. Major W. P.’Gwynn has been granted eight months’ leave of absencehome from Burma.

Captain A. G. Wells has been selected as Specialist in

Operative Surgery to the Third (Lahore) Division of theNorthern Army. Captain A. C. Vidal has arrived homefor duty from South Africa. Captain A. Dawson hasbeen appointed to the Irish Command. Captain T. E.

Harty has been selected as Specialist in Dermatologyand Venereal Diseases at the Military Hospital, York.

Captain J. A. Clark has been selected for service with theEgyptian Army. Captain J. L. Wood has arrived home onleave of absence from Naini Tal. Captain H. Harding hastaken up duty in the Eastern Command. Captain E. H. M.Moore has been transferred from the Military Hospital atChatham to Shoeburyness. Captain G. De la Cour has beenappointed to the Dublin District. The following Captainshave been notified that they will be required for serviceabroad during the coming trooping season : L. Cotterill,J. McKenzie, A. H. Hayes, H. J. Crossley, R. Storrs, R. L. V.Foster, J. A. Turnbull, J. G. Bell, T. S. Coats, and J. C. G.Carmichael. Captain F. R. Laing has embarked for a tourof service in India. Captain M. B. H. Ritchie has beentransferred from the Military Hospital at Campbellpore toMhow Cantonment. Captain F. A. McCammon has been

appointed to the Irish Command. Captain G. B. Churchillhas taken up duty at the Military Hospital, BulfordCamp. Captain A. W. Bevis has taken up duty in the BelfastDistrict. Captain A. H. Bond has been transferred fromthe Military Hospital at Fermoy to Queenstown for duty.Captain W. Davis has taken up duty at the Military Hos-pital, Meerut Cantonment. Captain R. F. O’T. Dickinsonhas arrived home on leave of absence from Bareilly Canton-ment. Captain G. A. K. H. Reed has been selected as

Specialist in Physical Training to the Aldershot Command.Captain H. Stewart, Captain C. T. Edmunds, and CaptainE. J. Kavanagh have been appointed for duty on board thetransport s.s. Plassy.

Lieutenant R. B. Phillips has taken up duty in the CorkDistrict. Lieutenant J. S. Levack has embarked for a tourof service in India. Lieutenant B. H. H. Spence has beentransferred from the Royal Herbert Hospital to the RoyalArmy Medical College. Lieutenant G. 0. Chambers hasleft Lichfield for a tour of service in Egypt. Lieutenant B.

Biggar has been transferred from London to Windsor.Lieutenant J. M. Elliott has taken up duty at the MilitaryHospital, Hilsea.

INDIAN MEDICAL SERVICE.Lieutenant-Colonel E. Wilkinson has been granted leave

of absence from India for one year and nine months. Lieu-tenant-Colonel G. A. W. Hall has been selected for theincreased rate of pay under Article 7 of the Royal Warrantfor Pay and Promotion. Lieutenant-Colonel F. J. Deweshas returned to duty in Burma. Lieutenant-Colonel B. H.Deare has taken up temporary duty as Officiating Principalof the Medical College at Calcutta. Lieutenant-ColonelD. T. Lane has been appointed Civil Surgeon at Ambala.Major R. Bryson has been selected for appointment as

Officiating Surgeon to the First District Madras and Super-intendent of the Royapuram Medical School in Madras City.Major F. V. O. Beit, on relief by Lieutenant-Colonel F. J.Dewes, has been selected as Civil Surgeon at MeiktilaCantonment, Burma, in succession to Captain H. W. Fare-brother, R.A.M.C. Major L. E. Gilbert has been selectedfor appointment by the Government of Burma. MajorW. H. Kenrick has been granted leave of absence homefrom India. Major C. A. Sprawson has been selected forappointment as Professor of Obstetrics on the staff of KingGeorge’s Medical College at Lucknow. Major Bhola Nauthhas arrived in London on leave of absence. Major R. B. B.Foster has been selected as District Medical Officer atMalabar and Superintendent of the Lunatic Asylum atCalicut.

Captain L. Hirsch has been granted combined leave ofabsence home, with study leave, for one year and a half.Captain R. D. Saigol has been appointed Ophthalmic Surgeonto the General Hospital, Rangoon, during the absence ofCaptain E. A. Walker. Captain E. T. Harris has been trans-ferred to Bassein. Captain J. Woods has arrived home onleave of absence. Captain S. C. Poe has been selected asSubstantive Medical Officer to the 108th Regiment of NativeInfantry, stationed at Bombay, in succession to Major W. H.Cox, D.S.O. Captain N. S. Simpson has been appointed tothe Benares District as Plague Medical Officer, in successionto Captain J. S. O’Neill. Captain C. F. Marr has beengranted an extension of his leave of absence.