1869THE SERVICES.-VITAL STATISTICS. ’

the floorings rotten, the ventilation defective, and thelighting bad; in fact, their state is such that nothingshort of demolition and complete reconstruction can bringthem up to the modern standard of sanitary require-ments." And again: "Many of the military hospitals athome ’are in a very unsatisfactory condition and are

altogether unsuited to the requirements of the sick." Thereare many factors which make the barrack question a mostdifficult one to deal with, but the health of our troops isof the greatest importance and the proper provision ofbarrack and hospital accommodation must not be delayedif our army is to be an efficient one.

This important report deserves the careful perusal ofeveryone who is interested in the British army.

THE SERVICES.

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

R. H. J. Browne to the Venerable ; J. H. Acheson to theMajestic, on recommissioning ; J. A. Keogh to the Jupiter,on recommissioning ; C. G. Matthew to the Arraphitrite andC. M. Beadnell to the Donegal, on recommissioning. StaffSurgeons : E. D. J. O’Malley to the Venerable, on recom-missioning ; J. Boyan to the Defiance ; J. P. H. Greenhalghto the Royal Arthur ; and C. H. J. Robinson to the Amphitrite,and to the Monmouth, on recommissioning. Surgeons:N.H.Mummery to the Vivid, additional, for Devonport Dockyard;E. Cameron to the Carnarvon; C. Ross to the Skipjack;H. M. Langdale to the Leviathan; W. L. Hawkins to theDwarf, on recommissioning ; A. J. Hewitt to the RoyalArthur, and to the Algerine, on commissioning ; W. P. Dyerto the Bramble; C. H. Dawe to the Britomdrt; W. P. Yettsto the Thistle; J. M. Gordon to the Moorhen; A. O. Hooperto the Waterwitch ; G. Moir to the Nightingale, on recom-missioning ; R. Willan to the Amphitrite ; A. B. Cox to theWidgeon; N. B. V. Jacob to the Woodcook; G. G. Vickeryto the Blenheim; H. D. Drennan to the Mercury, additional,for the Hazard C. V. Griffiths to the Prince George ; G.Price to the Donegal, on recommissioning ; L. Warren to theRobin; A. A. Chancellor to the Pembroke, additional;H. C. Adams to the T ictory, additional, and to the Vernon ;C. R. M. Baker to the Majestic, on recommissioning ; and R.Connell to the Jupiter, on recommissioning.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel W. B. Thomson has left for India.

INDIAN MEDICAL SERVICE.The King has approved of the following promotions among

officers of the Indian Medical Service :-Majors to beLieutenant-Colonels (dated Oct. lst, 1907): Alfred ErnestRoberts, David MacDonald Davidson, Frederic Pinsent

Maynard, John Charles Lamont, Arthur Holbrook Nott,Albert Coleman, William Westropp White, Daniel ThomasLane, Robert Charles Macwatt, William Henry EdwardWood wright, John Lloyd Thomas Jones, Walter JamesBuchanan, Joseph Kinnear Close, William Ernest Jennings,Frederick Joseph Dewes, Percy Charles Hutchison Strickland,Thomas William Stewart. Lieutenants to be Captains(dated Sept. lst, 1907): Horace Sidney Matson, DonaldSteel, Francis Hugh Stewart, Hampton Atkinson Dougan,Alexander Cameron, Alfred Henry Proctor, Robert TaitWells, Ian Macpherson Macrae, Charles Cecil ConnockShaw, Roderick Dear MacGregor, James William HerbertBabington, Alexander Spalding Mackie Peebles, FrancisBroughton Shettle. To be Lieutenant : Edmund BrodieMunro (dated Feb. 2nd, 1907).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Northern Command: Leeds Companies : Lieutenant

W. McG. Young to be Captain (dated Nov. 7th, 1907).Western Command : Manchester Companies : HenryBentley to be Lieutenant (dated Nov. 4th, 1907). CecilWilliam Hutt to be Lieutenant (dated Nov. 19th, 1907).Lieutenant H. W. Pritchard to be Captain (dated Nov. 22nd,1907). Creighton Hutchinson Lindsay to be Lieutenant(dated Nov. 25th, 1907). Sussex and Kent Bearer Company :Captain C. J. Jacomb-Hood to be Major (dated Nov. 12th,1907). Lieutenant J. A. Rooth to be Captain (datedNov. 12th, 1907).

VOLUNTEER CORPS.

Rifle : 1st Middlesex (Victoria and St. George’s) Volunteer

Rifle Corps: Surgeon-Lieutenant G. C. Steele-Perkins re-

signs his commission (dated Nov. 18th, 1907). 6th VolunteerBattalion, The Gordon Highlanders: Surgeon-Captain J.Taylor to be Surgeon-Major (dated Nov. 13th, 1907). 3rd(Renfrewshire) Volunteer Battalion, Princess Louise’s (Argylland Sutherland Highlanders) : Surgeon-Major J. Strangresigns his commission with permission to retain his rankand to wear the prescribed uniform (dated Nov. 1st, 1907).3rd (Cumberland) Volunteer Battalion, The Border Regiment:Surgeon-Lieutenant H. Dodgson to be Surgeon-Captain(dated Oct. 31st, 1907). lst Volunteer Battalion, TheHampshire Regiment: John Aston Swindale to be Surgeon-Lieutenant (dated Nov. 19th, 1907). lst Volunteer Battalion,The Northamptonshire Regiment: Surgeon-Lieutenant W. P.Thomas to be Surgeon-Captain (dated Nov. 21st, 1907).

QUEEN ALEXANDRA’S MILITARY HOSPITAL.The Army Council has approved of the following addi-

tional appointments : To be Consulting Physician : Surgeon-Major-General A. F. Bradshaw, late A.M.S. To be Con-

sulting Surgeon: Lieutenant-Colonel P. J. Freyer, lateI.M.S.

______________

VITAL STATISTICS.

VITAL STATISTICS OF LONDON DURING NOVEMBER, 1907.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 itappears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 11 4 per 1000 ofthe population, estimated at 4,758,218 persons in themiddle of the year; in the three preceding months the rateswere 8’ 2, 11’ 0, and 13’ 6 per 1000 respectively. The lowestrates last month were recorded in Paddington, the City ofWestminster, Hampstead, St. Marylebone, and Holborn;and the highest rates in Fulham, Hackney, the City of London,Bethnal Green, Stepney, and Poplar. Scarlet fever showeda slight diminution from the excessive prevalence recorded inrecent months; this disease was proportionally most prevalentin Hackney, Shoreditch, Bethnal Green, Stepney, Poplar,and Deptford. The Metropolitan Asylums hospitals con-

tained 5600 scarlet fever patients at the end of last month,against 3709, 4293, and 5395 at the end of the three precedingmonths ; the weekly admissions averaged 621, against 469,654, and 778 in the three preceding months. The prevalenceof diphtheria showed a considerable decline from thatrecorded in the previous month ; among the various boroughsdiphtheria was proportionally most prevalent in Kensington,Fulham, Chelsea, Hackney, the City of London, andLewisham. There were 1277 diphtheria patients under treat-ment in the Metropolitan Asylums hospitals on Nov. 30th,against 834, 964, and 1252 at the end of the three precedingmonths; the weekly admissions averaged 179, against 116,160, and 199 in the three preceding months. Enteric fevershowed a slightly diminished prevalence last month, comparedwith that in the two preceding months ; this disease was pro-portionally most prevalent in Hammersmith, Bethnal Green,Stepney, Poplar, Bermondsey, and Camberwell. The numberof enteric fever patients in the Metropolitan Asylums hos-pitals at the end of last month was 128, against 65, 99, and123 at the end of the three preceding months ; the weeklyadmissions averaged 18, against 15, 21, and 20 in the threepreceding months. Erysipelas was proportionally most pre-valent in Hackney, Finsbury, Shoreditch, Bethnal Green,Stepney, and Deptford. The 13 cases of puerperal fevernotified during the month included three which belongedto Islington, two in Southwark, and one each to eight otherboroughs. Seven cases of cerebro-spinal meningitis were

notified, belonging respectively to Kensington, Hammer-smith, Islington, Shoreditch, Southwark, Battersea, andWands worth.The mortality statistics in the table relate to the deaths

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

among the several boroughs in which the deceased personshad previously resided. During the four weeks endingNov. 30th the deaths of 5285 persons belonging to Londonwere registered, equal to an annual rate of 14’ 5 per 1000 ;in the three preceding months the rats were 11-2, 12’0,and 13’ 5 per 1000 respectively. The death-rates last month

1870 VITAL STATISTICS OF LONDON DURING NOVEMBER, 1907.

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1871LOOKING BACK.-NOTIFICATION OF BIRTHS ACT.

ranged from 8’ 6 in Hampstead, 9 9 in Chelsea, 11’ 2 inGreenwich, 11’8 in Lewisham, and 12-3 in Wandsworth, to18-3 in Poplar, 18.4 in Bethnal Green, 19’ 5 in Finsbury,19 7 in Southwark, 19’ 9 in Holborn, and 21 - .3 in Shore-ditch. The 5285 deaths from all causes included 456which were referred to the principal infectious diseases ;of these, 115 resulted from measles, 55 from scarletfever, 92 from diphtheria, 55 from whooping-cough,22 from enteric fever, one from ill-defined pyrexia,and 116 from diarrhoea. The lowest death-rates lastmonth from these diseases were recorded in St. Marylebone,Hampstead, Stoke Newington, Lambeth, Wandsworth,Camberwell, and Greenwich ; and the highest rates inHammersmith, Finsbury, the City of London, Shoreditch,Stepney, Poplar, and Southwark. The 115 deaths frommeasles were 19 below the corrected average number inthe corresponding periods of the five preceding years ;this disease was proportionally most fatal last month in

Paddington, Hammersmith, Holborn, Finsbury, Shoreditch,and Poplar. The 55 fatal cases of scarlet fever exceededby 18 the corrected average number ; among the variousmetropolitan boroughs this disease showed the greatestproportional mortality in Stoke Newington, Hackney,Finsbury, Shoreditch, Stepney, Poplar, and Lambeth. The92 deaths from diphtheria were 29 above the averagenumber in the corresponding periods of the fivepreceding years; the highest death-rates from thisdisease were recorded in St. Pancras, Hackney, theCity of London, Stepney, Southwark, Bermondsey,Battersea, and Greenwich. The 55 fatal cases ofwhooping-cough were nine fewer. than the correctedaverage number; this disease was proportionally most fatalin Stepney, Poplar, Battersea, Deptford, Lewisham, andWoolwich. The 23 deaths referred to " fever" were 17 belowthe average number in the corresponding periods of thefive preceding years ; of these 23 deaths three belonged tothe City of Westminster, three to Islington, three to Poplar,three to Southwark, and two each to Bethnal Green andWandsworth. The 116 fatal cases of diarrhoea exceededthe corrected average number; this disease showed thehighest proportional fatality in Paddington, Finsbury,Stepney, Poplar, Southwark, and Woolwich. In conclusion,it may be stated that the aggregate mortality in Londonlast month from the principal infectious diseases was 4’3per cent. above the corrected average. Infant mortality,measured by the proportion of deaths under one year of ageto registered births, was equal to 116 per 1000. The lowestrates of infant mortality were recorded in Chelsea, the

City of Westminster, St. Marylebone, Hampstead, Holborn,and Greenwich ; and the highest rates in Paddington, Shore-ditch, Bethnal Green, Stepney, Southwark, and Battersea.

Looking Back.FROM

THE LANCET, SATURDAY, Dec. 26th, 1829.

SINGULAR CASE OF PICA,with vomiting of immense quantities of eggs and larv&aelig; of the

common gnat.LOUISE C. aatat. 19, having been employed from her child-

hood in keeping sheep, was frequently, when in the fields,obliged to drink ditch-water, to which she at last becameso accustomed as to prefer it to any other. During the lastthree years she had been several times in the Hospital ofThouars, for ulcers of the legs and arms, which speedilyhealed, but after a few months broke out again, and one forconfluent small-pox, from which she completely recovered. Onthe first of June she was admitted a fifth time, for superficialulcers of the legs and arms. These were gradually healing, andnothing remarkable was observed in the patient till the 16thof July, when she was attacked with hiccup, nausea, andretching, which recurred almost every day for several hours,during a period of nearly two months. On the 18th, a con.siderable quantity of a yellowish limpid serum was observed toexude from the middle of the forehead, which, on the follow-ing day, was covered with very small superficial ulcers;these healed by the 23rd, and at the same time the serousexudations ceased. After a few days, however, the latter

recurred, and was observed to run a similar course succes-sively on the also of the nose, the cheeks, the chin, lowerpart of the neck, the left breast,’ epigastrium, hypo-gastrium, and the middle of the thighs and legs. Insome places no trace remained, in others the skin was leftbrown, rough, and scaly. About the middle of July,the attacks of retching began to be attended withviolent pricking, and burning pain of the stomach ; itlasted about four hours, and induced great exhaustion;nothing, however, was rejected by vomiting until the 12th ofAugust, when, after violent retching for two hours, the

patient threw out a large quantity of a watery liquid con-taining a great number of the eggs of the common gnat, aquantity of a blackish, flocculent, fetid, animal substance,and, what was most remarkable, an immense quantity ofsmall larv&aelig;, which swam about with great activity. The

quantity of this fluid, rejected on the 12 h and three follow-ing days, amounted to seventy-nine pints ! On the 16th,there was an intermission, on the 17th the vomiting returned,and then ceased for eight days, but in the evenings thepatient was attacked with general convulsions, rigidity ofthe extremities, and violent lacerating pain at the epigastricregion ; the whole fit sometimes lasted for several hours, andduring it she generally made a noise like the barking of a dog.On the 24th the vomiting again returned, and continued dailytill the 12th of September, when the cause of it was at lastfound out. The patient had been observed to go frequentlyto the water-closet, and, being watched, was discovered todrink copiously from a large cistern of dirty water, whichwas kept there for the purpose of washing down the pipes,and into which filth of various kinds was frequently thrown.Being now closely interrogated, she, with some difficulty,confessed that she had been in the habit of drinking thisdisgusting liquid daily since the middle of July, and that theflavour of it was so agreeable to her taste, that she could notabstain from it, though aware that it was the cause of hersufferings. She was, therefore, shut up and closely watched,and in a short time all the symptoms disappeared. It is veryremarkable, that during the whole course of this singularaffection, the appetite (except during the fits of retchingand vomiting) was quite voracious ; there was no emaciation,and the menstrual functions continued to be quite regular.-Extract from the Journ. Complen.

Correspondence."Audi alteram partem."

NOTIFICATION OF BIRTHS ACT.To the Editors of THE LANCET.

SIRS,-Numerous objections have been urged against theadoption of the Act many of which deal entirely with sideissues and are consequently not worth discussing.. Themembers of the profession have, however, in my opinion,raised two valid objections to the Act, and in regard to theseI desire to state in the outset that I am in entire sympathywith them. The objections I refer to are: (1) compulsionunder a penalty to do work without a fee ; and (2) the noti-fication of illegitimate births.Adequate payment for the necessary certificate would

overcome the former difficulty but I do not see how theprovision of a fee could remove the latter objection. Thatbeing the case it seems to me that nothing short of thedefinite exclusion of medical practitioners from the obliga-tions imposed by the Act can be completely satisfactory tothem. Of course, this cannot be done in reality until Parlia-ment amends the Act, but the question I wish to urge is,Will it or can it not be made to work out in practice to agreat extent in such a way ? 7 The parent is liable under a

penalty to notify the birth and I am advised that under theAct as it stands the parent is the proper person to proceedagainst for failure to do so, even in those cases where adoctor is in attendance. The local authority can surely underthis Act elect to proceed for default against the parent inpreference to the doctor, more especially as he is by lawmade primarily responsible. Surely there is no need to pro-ceed against two different persons for one offence.There is a precedent for such a procedure in the case of

the Notification of Infectious Diseases Act, under which,although the parent in that case is made responsible for