758

Public Dealth and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Uxbridge Rural District.-After making the necessarycorrections for institutions within the district, Mr. C. Robertsgives the death-rate for last year as 15’6 per 1000. Infant

death is excessive, and it is held that some legislativeinterference is needed as regards the insurance of the livesof newly born infants. The drainage of the village ofNorwood is now almost completed, and it is to be hopedthat the cesspits will be got rid of as speedily as possible.Defects as to water-supply and drainage were in Hayesfound to be associated with diphtheria and enteric fever;Ruislip still remains without proper means of drainage;and in other places, such as Cowley, difficulties in con-nexion with water-supply have been met with. The jointisolation hospital received 33 patients during the year;and it is reported that certain sanitary improvements havebeen effected generally and especially in Southall and inHarefield.

Caxton and St. Neots Combioed District. - Speakinggenerally of the water-supply of these districts, Mr. PoyntzWright states that great difficulty is met with as regardsthe rural areas; whereas, by means of the East Huntingdonwaterworks, the town of St. Neots may shortly beexpected to have an abundant and a wholesome supply.It is also to be hoped that several villages in the ruraldistricts, through which the mains run, may before longbe benefited in the same way. As to others, the differentmethods of possible supply are discussed at some length,the question being obviously an important one; and this themore so because of the frequent risk to which local wells aresubjected by reason of cesspools, leaky house drains, &c.The establishment of a small joint isolation hospital on theoutskirts of St. Neots is strongly advocated. During 1888the death-rates from all causes were as follows : Caxton andArrington rural district 14’3, St. Neots rural district 13’1,and St. Neots urban district 13’3 per 1000 living.

Ilkley Urban District.—Dr. Thomas Scott contrasts thepresent sanitary state of Ilkley with that which prevailedin 1871 as regards water-supply, sewerage, burial ground,and hospital provision, all these matters being now in anefficient state; and he may justly lay claim to a share inpromoting measures such as these, which have tendedto the health and well-being of the town. Last year thedeath-rate, after elimination of visitors, was only 10’4 per1000; the cold summer having been more favourable to thevital statistics than to the financial prosperity of this holidayresort.Teignmouth Urban District. - Though much sanitary

work is reported to have been effected in this districtduring the past year, much still remains, according toDr. Piggott, to be done. A new bore-hole for water hasbeen completed, and the supply now available is stated byDr. Frankland to be of the nrst quality. The new seweragesystem works well in all the localities to which it has beenapplied, but the internal sanitary state of a large number ofhouses remains most defective. For a town like Teignmouth,it is most discreditable to find that in 307 houses having so-called waterclosets there is no flushing apparatus whateverto the closets, and some of these structures have not un-naturally been found to be the medium of spreading thecontagium of enteric fever. A large amount of highly usefulwork is shown to have been performed in the nuisancedepartment, and disinfection is efficiently carried out bymeans of a solution of perchloride of mercury coloured withaniline blue. Making a deduction for visitors, the annualdeath-rate from all causes is given as 14’6 per 1000; theso-called zymotic rate was 0’41 per 1000; and the deaths ofinfants under one year of age were at the rate of 111 per1000 registered births.Taunton Urban District,—Dr. Alford congratulates the

borough on a low death-rate, and this especially fromzymotic diseases, which in former years were somewhatformidable. The water-supply is pure and abundant, andthe flushing of sewers is well carried out. But sewerventilation is far from satisfactory, and advice to deal withthe matter is disregarded. Dwelling accommodation has

much improved, but in some central parts of the townhouses were found to be in a deplorable state as regards.water-supply and drainage. The general mortality was15 per 1000 living, and the zymotic rate 0’5 per 1000. Thesanitary hospital, which belongs jointly to the urban and-rural authorities, received 38 patients during the year,24 being cases of scarlatina. Such enteric fever as wasfound in the district was due to the use of polluted wellwater, and seven cases of impure water are recorded as-

having been dealt with. In the Rural District the general.mortality was at the rate of 15’6, and the zymotic mortalityat the rate of 0.7 per 1000. As to villages, Dr. Alford seems.to object to systems of sewerage, preferring that everyhouseholder should deal with his own sewage on his ownpremises. But he admits that, instead of a scheme, whichis, as a rule, most difficult of proper application, thetendency is to large cesspits.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5813 birthsand 3712 deaths were registered during the week endingApril 6th. The annual rate of mortality in these towns,which had been 21-3, 20-8, and 19-9 per 1000 in the pre-ceding three weeks, rose again last week to 20’3. Duringthe thirteen weeks of last quarter the death-rate inthese towns averaged 20’9 per 1000, and was 2’8 below themean rate in the corresponding periods of the ten years1879-88. The lowest rates in these towns last week were12’9 in Brighton, 16’3 in Portsmouth, 17’3 in Leicester, and17’4 in Halifax. The rates in the other towns rangedupwards to 26’4 in Oldham, 27-8 in Manchester, 30’0 inPreston, and 30’6 in Blackburn. The deaths referred to.the principal zymotic diseases in these towns, which hadbeen 469 and 421 in the preceding two weeks, rose again lastweek to 464; they included 175 from measles, 125 fromwhooping-cough, 48 from scarlet fever, 48 from diarrhoea,47 from diphtheria, 21 from "fever (principally enteric),and not one from small-pox. These zymotic diseases.caused the lowest death-rates in Derby, Halifax, andHuddersfield; and the highest rates in Blackburn, Preston, andBolton. The greatest mortality from measles was recorded.in Bristol, Norwich, Manchesier, Preston, Blackburn, andBolton ; from whooping-cough in Birmingham, Nottingham,Wolverhampton, Plymouth, Bolton, Oldham, Bradford, andPreston; from scarlet fever in Oldham, Blackburn, andSheffield ; and from "fever" in Preston. The 47 deathsfrom diphtheria in the twenty-eight towns included 26 inLondon, 4 in Salford, 3 in Manchester, 3 in Liverpool, and2 in Sunderland. No death from small-pox was registeredin any of the twenty-eight great towns; and only 1 small-pox patient was under treatment at the end of the weekin the Metropolitan Asylum Hospitals and in the High-gate Small-pox Hospital. The number of scarlet-feverpatients in the Metropolitan Asylum and London FeverHospitals at the end of last week was 580, against 569 and579 in the preceding two Saturdays; 47 cases were admittedto these hospitals during the week, against 58 and 41 in thapreceding two weeks. The deaths referred to diseases ofthe respiratory organs in London, which had declined in thapreceding four weeks from 402 to 332, rose again last weekto 364, but were 110 below the corrected average. Thecauses of 82, or 2-1 per cent., of the deaths in the twenty-eight towns last week were not certified either by a regis-tered medical practitioner or by a coroner. All the causesof death were duly certified in Sunderland, Leicester, Bolton,and in five other smaller towns. The largest proportions.of uncertified deaths were registered in Halifax, Bradford,and Hull.

___

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 25’4,23’4, and 22’1 per 1000 in the precedingthree weeks, further declined to 21-8 in the week endingApril 6th; this rate exceeded, however, by 1’5 per 1000 themean rate during the same period in the twenty-eight largeEnglish towns. The rates in these Scotch towns ranged lastweek from 7’3 and 15’4 per 1000 in Greenock and Aberdeen,to 22-4 in Paisley and 28 -8 in Glasgow. The 558 deathsin the eight towns showed a further decline of 7 from thenumbers in recent weeks, and included 41 which were re-ferred to whooping-cough, 31 to measles, 8 to diphtheria,

759

6 to diarrhoea, 3 to "fever" (principally enteric), 1 to scarletfever, and not one to small-pox; in all, 90 deaths resultedfrom these principal zymotic diseases, against 85 and 92 inthe preceding two weeks. These 90 deaths were equal toan annual rate of 3’5 per 1000, which exceeded by 1 ’0 themean rate from the same diseases in the twenty-eightEnglish towns. The fatal cases of whooping-cough, whichhad been 31 and 37 in the preceding two weeks, furtherrose last week to 41, and included 29 in Glasgow, 5 in Edin-burgh, and 4 in Dundee. The deaths from measles, whichhad been 45, 33, and 36 in the previous three weeks, declinedlast week to 31, of which 28 occurred in Glasgow. The 8deaths referred to diphtheria showed an increase of 4 uponthe number in the previous week, and included 6 in Glasgowand 2 in Dundee. The fatal cases of "fever" and ofscarlet fever were considerably below the average ; and the6 deaths attributed to diarrhoea included 4 in Glasgow and2 in Aberdeen. The deaths referred to the principal diseasesof the respiratory organs, which had been 173, 132, and 137in the preceding three weeks, further declined last weekto 124, and were 18 below the number in the correspondingweek of last year. The causes of 62, or more than 11

per cent., of the deaths registered during the week werenot certified.

___

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 26’and 27’6 in the preceding two weeks, declined to 25’7 irthe week ending April 6th. During the thirteen weeks oilast quarter, the death-rate in the city averaged 28’6 pei1000, the mean rate during the same period being 19.5 inLondon and 19.0 in Edinburgh. The 174 deaths in Dublinshowed a decline of 13 from the number in the precedingweek; they included 2 which were referred to measles,2 to "fever," 2 to whooping-cough, 1 to diphtheria, and notone either to small-pox, scarlet fever, or diarrhoea. Thusthe deaths from these principal zymotic diseases, whichhad ranged in the previous four weeks between 15 and 8,further declined last week to 7 ; they were equal to an annualrate of 1’0 per 1000, the rates from the same diseases being2’3 in London and 1’2 in Edinburgh. The 2 deaths from"fever" showed a further decline from the numbers inrecent weeks; and the 2 from measles were fewer by 2than the number in the previous week. The fatal case ofdiphtheria was the first recorded in the city sincethe beginning of the year. The deaths of infantsshowed a marked decline from the number in the pre-vious week, while those of elderly persons exceeded thenumber in the previous week by 3. Five deaths fromviolence and 4 inquest cases were registered; and 67, ormore than a third, of the deaths occurred in public institu-tions. The causes of 15, or more than 8 per cent., of thedeaths in the city were not certified.

THE SERVICES.

ARMY MEDICAL STAFF.-Surgeon Herbert Crowley Denthas retired upon temporary half pay on account of ill healthdated March 31st, 1889).ARMY MEDICAL RESERVE OF OFFICERS.-Acting Sur-

geon Geo. Gordon Sparrow, 1st Volunteer Brigade, SouthernDivision, Royal Artillery, to be Surgeon, ranking as Captain(dated April 10th, 1889).INDIAN ARMY.—The Queen has approved of the retire-

ment of Surgeon-Major R. Crossing Thorpe, M.D., BombayMedical Establishment, being antedated to April 14th, 1883.ADMIRALTY.-In accordance with the provisions of Her

Majesty’s Order in Council of April lst, 1881, DeputyInspector-General of Hospitals and Fleets Francis WilliamDavis has been placed on the Retired List, at his ownrequest, with permission to assume the rank of Inspector-General of Hospitals and Fleets (dated April 4th, 1889).VOLUNTEER CORPS.—The London Gazette of the 9th inst.

contains the names of 341 medical men who have beengranted rank under Army Order 77 of 1889. The rank ineach case will bear date Feb. 1st, 1889. The appointmentsareas follows :-65 Surgeons-Major, ranking as Lieutenant-Colonels ; 101 Surgeons-Major, ranking as Majors; 1 Hono-rary Assistant Surgeon, promoted to the rank of Sur-geon ; and 174 Acting Surgeons, promoted to the rank of’Surgeon.

Correspondence.ROYAL COLLEGE OF SURGEONS: THE

DRAFT BILL.To the Editors of THE LANCET.

SiRS,—I have the honour to forward you the amendeddraft of the Bill to be introduced into Parliament to amendthe constitution of the Royal College of Surgeons. Theenclosed is the form finally adopted at a full meeting of theParliamentary Committee appointed by the meeting ofFellows and Members of the 28th ult., the committeemeeting having been held on Thursday, the 4th inst., Mr.T. Holmes in the chair. It is intended at once to press theBill forward in the House of Commons.

I am, Sirs, your obedient. servant,WM. ASHTON ELLIS,

Hon. Sec. to the Committee.Grosvenor-road, Westminster, April 10th, 1889.

Draft Bill to Amend the Constitution of the Royal College of Surgeons ofEngland.

Whereas it is expedient to amend the constitution and government ofthe Royal College of Surgeons of England and to declare and give effectto certain of the rights of the Members thereof, be it enacted, &c.

1. No Member of the said College shall hereafter be disqualified frombeing elected to, or holding, any place or office in the College by reasonof his not being a Fellow of the College, except as hereinafter provided.

2. The President, Vice-Presidents, and Council of the College shall beelected by the Members of the College, but the Council shall be em-powered to provide by bye-law that no Member who shall be of less thanten years’ standing shall exercise the said electoral franchise unless hehas been admitted to the Fellowship of the College.

3. The Members are and shall be entitled freely to meet togetherwithin the College at all reasonable times, to consider and resolve con-cerning the affairs of the College, and any resolutions passed at anySnch meeting by a two-thirds majority of the Members voting, concern-ng the bye-laws or the expenditure of the College, shall be binding onjhe Council.

4. Section 17 of the bye-laws of the College, and all action taken or to)e taken thereunder, is hereby declared to be invalid.

5. So soon as may be after the next annual election for the Council,he Council shall make such provision by bye-law as may be necessaryor fully carrying out the provisions of this Act, and shall have power,herein to provide that not more than a fixed number of places on thecouncil, not being less than six, shall be filled by Members who arenot Fellows of the College, and that such Members shall be of twenty’ears’ standing or of such less standing as the Council may deemufficient, and the Council shall forthwith provide by bye-law for voting,t any election by voting papers, and shall have power from time toime, by bye-law, to amend the manner of election of Examiners, and toIter the said distribution of places on the Council, and to shorten theerm of office of the members of the Council-provided always that nouch bye-law shall be binding until it shall have been adopted by aeneral meeting of the College. -

To the Editors of THE LANCET.SIRS,—At the special meeting of the Birmingham and

Midland Counties Branch of the British Medical Associa-tion, held on the 3rd inst., Mr. Lawson Tait, in moving hisresolution approving of the Bill about to be introduced intoParliament, made the following statement, which, in spite)f contradiction, was not only adhered to by him, butaccepted by very many of those present--viz., "that thenajority of the Members of the College were precluded from)btaining the Fellowship by the extra certificates requiredf them prior to admission to the examinations, includingme of two years’ extra study at a hospital recognised byhe College." In order to correct this erroneous impression,fhich, to my surprise, I found to exist in the minds ofliany who should be better informed, I ask you to kindlynsert the enclosed letter from the Secretary of the Royal;ollege of Surgeons of England.

I am, Sirs, yours faithfully,Birmingham, April 10th, 1889.

[COPY.]

Royal College of Surgeons of England, Lincoln’s-inn-FieldsLondon, W.C., 9th day of April, 1889.

MY DEAR SllR,-In reply to your letter of the 8th inst.,inquiring what are the conditions on which Members of theCollege are admissible to the examinations for the Fellow-ship, I have to refer you to Section II. of the enclosedRegulations, from which you will see that a Member of theCollege is admissible to the first professional examinationwithout the production of any certificates and to thesecond professional examination, after passing the firstexamination, on producing evidence of having been en-gaged not less than six years in the study or study and