800

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6615 births and 5511deaths were registered during the week ending Sept. 9th.The annual rate of mortality in these towns, which had been26-8 and 25’5 per 1000 in the two preceding weeks, furtherfell to 25-2 last week. In London the rate was 22’2 per1000, while it averaged 27-2 in the 3Z provincial towns. Thelowest death-rates in these towns were 18’1 in Birkenheadand in Leeds, 18 4 in Croydon, 19-7 in Halifax, and 20’8 inBristol; the highest rates were 33’8 in Bolton, 35-8 in New-castle-upon-Tyne, 36’4 in Wolverhampton, and 43.8 inBurnley. The 5511 deaths in these towns included 1588which were referred to the principal zymotic diseases,against 1918 and 1743 in the two preceding weeks ;of these, 1290 resulted from diarrhoea, 73 frommeasles, 68 from diphtheria, 68 from whooping-cough, 61 from fever (principally enteric), 27 fromscarlet fever, and one from small-pox. The lowest death-rates from these diseases were recorded in Birkenhead,Plymouth, and Blackburn, and the highest rates inLeicester, Bolton, and Burnley. The greatest mortality frommeasles occurred in Burnley; from whooping-cough inCardiff ; from "fever" in Sunderland; and from diarrhoeain Manchester, Norwich, Burnley, Preston, and Bolton. Themortality from scarlet fever showed no marked excess in

any of the large towns. The 68 deaths from diphtheria in-cluded 24 in London, six in Birmingham, six in

Liverpool, and five in Leicester. One fatal case ofsmall-pox was registered last week in Hull, but notone in any other of the 33 towns; and no small-poxpatients were under treatment in the Metropolitan AsylumsHospitals. The number of scarlet fever patients in thesehospitals and in the London Fever Hospital on Saturday last,Sept. 9th, was 2550, against 2612, 2547, and 2537 at the endof the three preceding weeks ; 298 new cases were admittedduring the week, against 245, 225, and 252 in the three pre-ceding weeks. The deaths referred to diseases of the

respiratory organs in London, which had been 169 and 131in the two preceding weeks, rose again last week to 170, andwere 24 above the corrected average. The causes of 42, or0’8 per cent., of the deaths in the 33 towns were

not certified either by a registered medical practitioner or bya coroner. All the causes of death were duly certified inWest Ham, Bristol, Nottingham, Leeds, and in 12 othersmaller towns ; the largest proportions of uncertified deathswere registered in Blackburn, Liverpool, and Sheffield.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased in the four preceding weeks from 17-9to 24-1 per 1000, declined again to 22-6 during the weekending Sept. 9th, and was 2-6 per 1000 below the mean rateduring the same period in the 33 large English towns. Therates in the eight Scotch towns ranged from 13’5 in Perthand 19-5 in Aberdeen to 23-5 in Leith and 31’6 in Greenock.The 689 deaths in these towns included 193 which werereferred to diarrhoea,, 10 to "fever," nine to whooping-cough,seven to scarlet fever, three to measles, and three to

diphtheria. In all, 225 deaths resulted from these principalzymotic diseases, against 197 and 217 in the two precedingweeks. These 225 deaths were equal to an annual rateof 7’4 per 1000, which almost corresponded with the meanrate last week from the same diseases in the 33 largeEnglish towns. The fatal cases of diarrhoea, whichhad increased from 70 to 181 in the four preceding weeks,further rose to 193 last week, of which 86 occurred inGlasgow, 35 in Edinburgh, 26 in Dundee, and 16 inLeith. The deaths referred to different forms of "fever,"which had been 13 and nine in the two preceding weeks, roseagain to 10 last week, of which six were recorded in Glasgowand two in Paisley. The nine fatal cases of whooping-cougbshowed a decline of four frcm the number in the precedingweek, and included six in Glasgow, where five of the sevendeaths from scarlet fever were also registered. The deathsreferred to diseases of the respiratory organs in these towns,which had been 61 and 83 in the two preceding weeks,declined to 54 last week, and were little more than half thenumber in the corresponding period of last year. The cause

of 27, or nearly 4 per cent., of the deaths in these eighttowns last week were not certified.

HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which haddeclined in the three preceding weeks from 34’9 to30’6 per 1000 rose again to 37-4 during the week endingSept. 9th. During the past four weeks the death-ratein the city has averaged 33-5 per 1000, the rate duringthe same period being 23’4 in London and 20 2 in

Edinburgh. The 251 deaths registered in Dublin duringthe week under notice showed an increase of 46 uponthe number in the preceding week, and included 72 whichwere referred to the principal zymotic diseases, against 66and 58 in the two preceding weeks; of these, 42 resultedfrom diarrhoea, 17 from measles, eight from "fever," twofrom whooping-cough, two from scarlet fever, and one fromdiphtheria. These 72 deaths were equal to an annualrate of 10 8 per 1000, the zymotic death-rate duringthe same period being 4’8 in London and 6 6 in Edin-

burgh. The fatal cases of diarrhoea, which had declinedfrom 43 to 36 in the three preceding weeks, rose again to 42last week. The deaths from measles, which had been18 and 14 in the two preceding weeks, rose again to 17 lastweek. The eight deaths referred to different forms of"fever" exceeded the number recorded in any week sinceJanuary, 1898. The 251 deaths in Dublin last week included57 of infants under one year of age, and 42 of persons agedupwards of 60 years ; the deaths of infants showed aslight decline from recent weekly numbers, while thoseof elderly persons showed a marked increase. Seven inquestcases and six deaths from violence were registered, and 102, ormore than a third, of the deaths occurred in public institu-tions. The causes of 12, or nearly 5 per cent., of thedeaths in the city last week were not certified.

VITAL STATISTICS OF LONDON DURING AUGUST, 1899.

In the accompanying table will be found summarisedcomplete statistics relating to sickness and mortalityduring August in each of the 43 sanitary areas of London.With regard to the notified cases of infectious diseasesin the metropolis, it appears that the number of personsreported to be suffering from one or other of the ninediseases specified in the table was equal to 8’6 per1000 of the population, estimated at 4,546,752 personsin the middle of this year. In the three precedingmonths the rates had been 7’3, 9-3, and 9-8 per 1000respectively. The rates were considerably below the averagein St. George Hanover-square, Hampstead, St. Giles,St. Martin-in-the-Fields, Strand, and Lee; while theyshowed the largest excess in Clerkenwell, White-chapel, St. George Southwark, Newington, Bermondsey,and Rotherhithe sanitary areas. Three cases of small-pox were notified in London during August-viz., two inthe Port of London and one in Woolwich sanitaryareas; one small-pox patient was admitted into the

Metropolitan Asylums Hospitals during August, but noneremained under treatment at the end of the month. The

: prevalence of scarlet fever in London showed a further declinefrom that recorded in the two preceding months; among thevarious sanitary areas this disease showed the highest pro-

- portional prevalence in Fulham, Clerkenwell, St. Luke,. St. Olave Southwark, Bermondsey, Rotherhithe, and, Plumstead. The Metropolitan Asylums Hospitals contained 2493 scarlet fever patients at the end of August, againsti 2172, 2372, and 2602 at the end of the three precedingi months ; the weekly admissions averaged 244, against, 229, 284, and 293 in the three preceding months.I The prevalence of diphtheria in London showed a declineifrom that recorded in the preceding month ; this’ disease was proportionally most prevalent in Shoreditch,

St. Saviour Southwark, St. George Southwark, Newington, Bermondsey, Camberwell, Greenwich, andi Lewisham sanitary areas. There were 1493 diphtheria

patients under treatment in the Metropolitan Asylum*i Hospitals at the end of August, against 1139, 1273,sand 1533 at the end of the three preceding months; the, weekly admissions averaged 179, against 152, 192, and 2N, in the three preceding months. The prevalence of enterite fever in London showed a further marked increase upon thats recorded in recent months ; among the various sanitary

801

WH

O

H

m

H0O

m

802

areas this disease showed the highest proportional prevalencein Islington, Hackney, Clerkenwell, Whitechapel, Limehouse,and St. Olave Southwark. The Metropolitan Asylums Hos-pitals contained 213 enteric fever patients at the end ofAugust, against 99, 105, and 131 at the end of the threepreceding months; the weekly admissions averaged 37,against 16, 20, and 26 in the three preceding months.Erysipelas was proportionally most prevalent in Marylebone,Holborn, St. Luke, Shoreditch, Bethnal Green, andNewington sanitary areas. The 29 cases of puerperal fevernotified in London during August included six in Islingtonand two each in Fulham, Shoreditch, Poplar, St. SaviourSouthwark, Newington, and Lambeth sanitary areas.The mortality statistics in the table relate to the deaths of

persons actually belonging to the various sanitary areas of themetropolis, the deaths occurring in the institutions of Londonhaving been distributed among the various sanitary areas inwhich the patients had previously resided. During the fiveweeks ending Sept. 2nd the deaths of 10,291 personsbelonging to London were registered, equal to an annualrate of 23-6 per 1000, against 15-8, 14-8, and 17-2in the three preceding months. The high rate in themetropolis during August was due to the very fatal

prevalence of summer diarrhoea. The lowest death-rates last month in the various sanitary areas were

13’4 in St. George Hanover-square, 13 6 in Hampstead,14’8 in Stoke Newington, 16 2 in St. James Westminster,18’8 in Wandsworth, and 19 in Paddington; the highestrates were 31’7 in Limehouse, 31’8 in Shoreditch, 31’9 inSt. Saviour Southwark, 34-4 in St. George-in-the-East, 35 7in St. Luke, and 36’0 in St. George Southwark. During thelive weeks of August 2834 deaths were referred to theprincipal zymotic diseases in London ; of these, 248resulted from measles, 34 from scarlet fever, 159 fromdiphtheria, 120 from whooping-cough, 65 from enteric fever,2208 from diarrhoea, and not one either from small-pox,typhus, or any ill-defined form of continued fever. These2834 deaths were equal to an annual rate of 6’5 per 1000,against 1-8 and 3 3 in the two preceding months. No deathfrom any of these diseases was recorded last month in St.Martin-in-the-Fields ; in the other sanitary areas they causedthe lowest death-rates in St. George Hanover-square, St.James Westminster, Hampstead, St. Giles, Strand, Holborn,and City of London; and the highest rates in Fulham,Shoreditch, Poplar, St. Saviour Southwark, Bermondsey,and Greenwich. The 248 deaths referred to measles were52 above the corrected average number in the corre-

sponding periods of the 10 preceding years; this diseasewas proportionally most fatal in St. Luke, St. Saviour

Southwark, St. George Southwark, Newington, St. Olave

Southwark, and Bermondsey sanitary areas. The 34 fatal casesn o n n

of scarlet fever were only one third of the corrected average Inumber; this disease showed the highest proportional fatalityin Clerkenwell sanitary area. The 159 deaths from diphtheriawere 41 below the corrected average number; among thevarious sanitary areas this disease was proportionally mostfatal in Islington, Shoreditch, Mile End Old Town,St. George Southwark, Newington, Bermondsey, andWoolwich. The 120 fatal cases of whooping-cough were 38below the corrected average number; this disease showedthe highest proportional fatality in Shoreditch, St. George-in-the-East, Limehouse, Mile End Old Town, Poplar, andPlumstead sanitary areas. The 65 deaths referred to entericfever were 11 above the corrected average number; amongthe various sanitary areas this disease was proportionatelymost fatal in Paddington, Kensington, and White chapel.The 2208 fatal cases of diarrhoea were nearly double thecorrected average number ; this disease showed the highestproportional fatality in Fulham, Shoreditch, Poplar,St. Saviour Southwark, St. George Southwark, and Green-wich sanitary areas. In conclusion, it may be stated thatthe aggregate mortality in London during August from theseprincipal zymotic diseases was more than 50 per cent. abovethe average, owing principally to the excessive fatality ofsummer diarrhcea.

Infant mortality in London last month, measured by theproportion of deaths of children under one year of age tobirths registered, was equal to 360 per 1000, and con-

siderably exceeded the average. Among the various sanitaryareas the lowest rates of infant mortality were recordedin St. James Westminster, Marylebone, St. Giles, St. Martin-in-the-Fields, Holborn, and White chapel ; and the highestrates in Hammersmith, Fnlham, Strand, Shoreditch, Lime-house, St. Saviour Southwark, and Lee.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.INSPECTOR-GENERAL H. D. STANISTREET and Deputy

Inspectors H. M. Ellis and E. R. H. Pollard, recently pro-moted to those ranks, are in addition to the previousestablishment, and consequently are an increase to thenumerical strength of the naval medical branch. Thetwo latter officers procure their steps after serving 24 and 21years respectively, and at a much earlier age than usuallyobtains in their department, especially the last-named,whose advancement in consequence of war services hasbeen exceptionally accelerated.The following appointments are announced :-Staff Sur-

geons : J. L. Barrington to the Medea; H. E. South to theBosacawen; J. M. France to the Barham; H. W. G. Doyneto the Lion ; W. Bowden, D.S.O., to the Collingwood;B. C. E. F. Gunn to the Hermes; and J. Dowson to theRepulse. Surgeons : E. Haines to the Terrible; A. R.Bankart to the Osborne ; M. Breton to the Hermes; ;H. W. B. Shewell to the Arrogant; and F. F. Lobb tothe Alexandra.

ROYAL ARMY MEDICAL CORPS.

Major E. Davis has taken over medical charge of the campat Okehampton. Major G. W. Brazier-Creagh has joined atWoolwich for duty. Major S. F. Lougheed and Major R. E.Kelly have rejoined at Woolwich. Major R. C. Thacker hasleft Dublin for Newbridge. Major H. J. Wyatt has arrivedin Dublin for duty and has been posted to the medicalcharge of Staff and Departments, South, and the medicalcharge of troops and their families, Marshalsea Barracks.Lieutenant W. B. Winkfield has proceeded to Canterbury.The question of the provision of a separate mess for officersof the corps is now being considered by the Governmentof India.

INDIA AND THE INDIAN MEDICAL SERVICES.Lieutenant-Colonel Adam Scott Reid is promoted to be

Colonel. Lieutenant - Colonel Charles Thomas Peters,Bombay Establishment, has retired. Major Ronald Ross,Madras Establishment, has retired. Lieutenant J. C. H.Leicester and Lieutenant C. Hudson have been appointed tothe Bengal command; Lieutenant G. King, LieutenantT. S. Ross, and Lieutenant G. P. T. Groube have beenappointed to the Madras command. Captain F. P. Maynard,officiating Civil Surgeon of Hazaribagh, is appointed to actas Civil Surgeon of Patna. Captain E. A. R. Newman,officiating Second Resident Surgeon, Presidency GeneralHospital, Calcutta, is appointed to act as First ResidentSurgeon in that institution. Captain E. E. Waters,officiating Superintendent of the Presidency Jail, is

appointed to act as Second Resident Surgeon, PresidencyGeneral Hospital, Calcutta. Captain F. R. Ozzard hasmade over charge of the duties of Superintendent of theBannu Jail to Captain J. Stephenson. Major W. A. Sykeshas made over charge of the duties of Superintendent ofthe Sialkot Jail to Captain A. Cochrane. Lieutenant J. A.

Dredge has made over charge of the duties of Superintendentof the Dera Ghazi Khan Jail to Lieutenant-Colonel S. F.

Bigger. Captain H. J. K. Bamfleld has made over chargeof the duties of Superintendent of the Kohat Jail to Lieu.tenant W. H. Kenrick. Lieutenant R. H. Price has madeover charge of the duties of Superintendent of the JhelumJail to Lieutenant H. Gidney. Captain D. T. Lane, CivilSurgeon, has resumed charge of his duties at Amritsar. On

being relieved of the duties of plague medical officer,Jullundur District, Captain 0. H. James is re-transferredto Kangra and has assumed charge of the civil medicalduties of that district. Captain M. Dick is appointed tothe officiating medical charge of the 24th Madras Infantry.Captain W. G. Pridmore is transferred from Katha to thecivil medical charge of the Bhamo District. Surgeon-GeneralR. Harvey, C.B., D.S.O., Director-General, Indian MedicalService, has returned to Simla and resumed his official

duties.The following appointments are announced :- Lientenant

, E. D. W. Greig, Lieutenant C. Dykes, Lieutenant W. E.. McKechnie, Lieutenant W. F. Harvey, Lieutenant W. C. H.

Forster, Lieutenant J. J. Urwin, Lieutenant D. McCay.; Lieutenant A. B. Fry, Lieutenant H. D. Peile, Lieutenant, D. H. F. Cowin, Lieutenant E. C G. Maddock, LieutenantW. H. Dickinson, Lieutenant M. W. Manuk, Lieutenant