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973 Marked constipation was common, and in many of the patients the usual symptoms of the disease were either absent or poorly developed. As was the case at Leadgate, so at Consett there was much delay (sometimes of several weeks) in notification, and, as Dr. Hill remarks, notification of that kind is practically valueless. Dr. Hill also thinks that in some cases the disease was not recognised. The value of notification has obviously limitations, and over and above the cases notified there are probably always others which remain unrecognised. 81&rrey County District.-Dr. Edward Seaton, the medical officer of health for Surrey, has been very prompt in the preparation of his report for the year 1895. The county council expressed a wish that the report should be issued in May and Dr. Seaton has been able to carry the request into effect. The report for 1894 was a very full one and intended, as Dr. Seaton points out, as "a record, a review, and a guide " ; the report for 1895 professes to be merely a record of the progress made during the year. The district reports are now presented in a better form than was the case in 1890, an improvement which is attributable to the efforts of the county council. The general death-rate for the county during 1895 was 13’5 per 1000, as against 13.7 during the six years 1889-94 ; the infantile mortality was at the rate of 113 per 1000 births, as compared with a rate of 107 during the preceding six years ; the zymotic death-rate for the year was 0’94 per 1000. The Notification Act appears now to have been adopted throughout the county of Surrey, and Dr. Seaton states that the district medical officers have cooperated heartily with him, and so enabled him to issue regularly the monthly returns. We are glad to see that systematic house inspection is being steadily proceeded with in the county, and that the better-class houses at places such as Surbiton, to which attention was drawn by Dr. Seaton in 1892, are receiving attention in this respect. Dr. Seaton does not speak hopefully of the action of district councils in respect of trade eflluents, local interest being found in practice difficult to overcome. St. Helen’s Urban Dastrict.-Considerable energy is mani- fested in St. Helen’s with respect to measles, and Dr. John Robertson insists in his current annual report on the benefit which would be derived from providing isolation accommoda- tion for that disease. Great difficulty is experienced in St. Helen’s in obtainlng early notification of measles, and during the epidemic of 1893 it was ascertained that in more than 60 per cent. of the invaded houses no medical man was called in, a fact which indicates, as Dr. Robertson observes, that even if the disease were made notifiable a large number of cases would, unless notification by the householder were rigidly enforced, fail to be discovered. During the year under review every house in which measles occurred was disinfected, and Dr. Robertson states that this course, coupled with isolation and school closure, was attended with excellent results. With regard to diphtheria, it is interesting to hear that within recent years this disease has not shown any tendency to increase in St. Helen’s. Enteric fever shows at times a very marked tendency to prevail in this district, and during 1895 there were 257 cases notified, the sickness rate per 1000 of the population being no less than 3’2. Dr. Robertson furnishes a chart in his report showing the association between the prevalence of the disease in the district and the soil temperature at a depth of four feet, the enteric fever (allowance being made for incubation) rising and falling very regularly with the earth temperature. Dr. Robertson notices several instances in which enteric fever was apparently contracted by direct infection from a previous case. An inquiry was made into each case of death from diarrhoea which occurred in St. Helen’s during 1895, and it was found that 85’16 per cent. of the deaths under three months of age were bottle-fed, as against 14’8 per cent. "breast-fed," while of the deaths between three and six months of age, 85.6 per cent. were "bottle-fed" and 14’4 per cent. were breast. fed. " Anthrax caused one death in St. Helen’s during 1895, the victim, who was employed in bone manure works, having inoculated himself while scratching a "pimple." The infection was derived, it was thought, from shoddy dust, dried blood, or dry Bombay bones. Ormskirk Rural District.-The sanitary authority of this district provided through Mr. Herbert Peck, the medical officer of health, facilities for the bacteriological examination of cases of supposed diphtheria, as also a supply of antitoxin for the treatment of such cases as proved to be diphtheria. Advantage was, Mr. Peck reports, freely taken of these opportunities and much good has, he thinks, resulted both from the antitoxin treatment and from the information afforded by bacteriological examination. The Ormskirk District Council is to be congratulated on having acquired a site for an isolation hospital, together with a building which they propose, pending the erection of a proper hospital, to use for isolation accommodation. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 5900 birth and 3178 deaths were registered during the week ending Sept. 26th. The annual rate of mortality in these towns, which had declined in the nine preceding weeks from 24.8 to 15-1 per 1000, rose again last week to 153. In London the rate was 14-9 per 1000, while it averaged 15.6 in the thirty-two provincial towns. The lowest death- rates in these towns were 9 7 in Croydon, 9-9 in Portsmouth, 11’0 in Halifax, and 11-6 in Plymouth; the highest rates were 19-3 in Manchester, 20-4 in Bolton, 21-7 in Hull, and 23’3 in Gateshead. The 3178 deaths in these towns in- cluded 405 which were referred to the principal zymotic diseases, against 487 and 417 in the two preceding weeks; of these, 118 resulted from diarrhoea, 84 from diphtheria, 60 from whooping-cough, 50 from scarlet fever, 50 from "fever" (principally enteric), and 43 from measles. The lowest death-rates from these diseases were recorded in Brighton, Derby, Bristol, and Bradford; and the highest rates in Birkenhead, Wolverhampton, Cardiff, and Hull. The greatest mortality from measles occurred in Halifax, Gates- head, and Hull; from scarlet fever in Oldham; from whooping-cough in Swansea, and Birkenhead ; from "fever " in Sunderland; and from diarrhoea in Cardiff, Liverpool, Bolton, Preston, and Wolverhampton. The 84 deaths from diphtheria included 61 in London, 7 in Birmingham, and 4 in CardifE. No fatal case of small-pox was registered last week in any of the thirty - three large towns. There were 6 cases of small-pox under treatment in the Metropolitan Asylum Hospitals and in the Highgate Small-pox Hospital on Saturday last, Sept. 26th, against 16, 12, and 7 at the end of the three preceding weeks ; one new case was admitted during the week, against 2, 1, and none in the three preceding weeks. The number of scarlet fever patients in the Metropolitan Asylum Hospitals and in the London Fever Hospital at the end of the week was 3951, against numbers increasing from 3370 to 3805 on the six preceding Saturdays ; 466 new cases were admitted during the week, against 484, 316, and 453 in the three preceding weeks. The deaths referred to diseases of the respiratory organs in London, which had been 118 and 152 in the two preceding weeks, further rose last week to 166, but were 41 below the corrected average. The causes of 43, or 1-4 per cent., of the deaths in the thirty-three towns were not certified either by a registered medical practitioner or by a coroner. All the causes of death were duly certified in Bristol, Leicester, Nottingham, Bradford, Leeds, and in fourteen other smaller towns ; the largest proportions of uncertified deaths were registered in Birming- ham, Liverpool, Manchester, and Blackburn. HEALTH OF SCOTCH TOWNS. The annual rate of mortality in the eight Scotch towns, which had been 15.9 and 17’3 per 1000 in the two preceding weeks, declined again to 14-4 during the week ending Sept. 26th, and was 09 per 1000 below the mean rate during the same period in the thirty-three large English towns. The rates in the eight Scotch towns ranged from 10-1 in Greenock and 11 2 in Leith, to 15.7 in Paisley and 15’9 in Glasgow. The 420 deaths in these towns in- cluded 43 which were referred to diarrhoea, 9 to measles, 9 to whooping-cough, 8 to scarlet fever, 5 to diphtheria. and 3 to "fever." In all, 77 deaths resulted from these principal zymotic diseases, against 77 and 88 in the two preceding weeks. These 77 deaths were equal to an annual rate of 26 per 1000, which was 0’7 above the mean rate last week from the same diseases in the thirty-three large English towns. The 43 fatal cases of diarrhoea showed a decline of 11 from the number in the preceding week, and included 28 in Glasgow and 7 in Edinburgh. The deaths referred to measles, which had been 14 and 7 in the two preceding weeks, rose
