1711

in many schools constitutes one of the greatest difficulties ofthe medical inspector. This will be heartily re-echoed byevery school medical officer, and is one of the main reasonswhich make it advisable to have a special medical inspectionroom. Again in this subsection of the report attention iscalled to conditions of dirt and nasal catarrh, and handker-chief drill strongly suggested. It’ would seem urgentlynecessary. Dr. Grahame Skinner also calls attention to the

poor feeding, due to bad arrangements, of very manychildren. In many mining villages no mid-day meal is pro-vided, as the main meal is at 5 P,1BI. on return from work.The few parents present at the examination is noticed in allthe reports, and one wonders what local peculiarities ofcustom or of psychology account for this. -

Heston and Islenorth Distriat.-Dr. George F. Buchansupplies a report dealing with the medical examination of973 children, of whom 399 were defective. No medicaltreatment was obtained in 229 cases, and the necessity for aschool clinic is strongly urged. Definite treatment is

required in a large number of cases, and the main reason

given for not obtaining medical aid by the parents was thatthey could not afford it. Many of these cases were those ofdental caries, and the report includes rules for the preventionof dental caries based on Dr. Sim Wallace’s book. Theadministration of the Education (Provision of Meals) Act iscarried out with the close cooperation of the school medicalofficer, every child for whom an application is made beingmedically examined and a report sent to the canteen sub-committee ; 312 children were examined, and in 217 -casesthe applications were granted. The canteen subcommitteealso asks for a report from the teacher as to the educationalprogress of the child and a report from the attendanceofficer as to the social circumstances. The method seemsto be a very good one. Dr. Buchan has drawn up asynopsis of 20 lessons on infant care and managementand home nursing, six of which are practical demonstra-tions. For 27 mentally deficient children a special class issuggested, and an open-air recovery school for the physicallydefective. The school to accommodate 40 "P.D." childrenwould, it is suggested, be the right size to begin on. A

special class for nine hard of hearing" children is also sug-gested, and with regard to the erection of a new school theimportance of the provision of a bath is urged, and also of aspecial medical inspection room.

-Rad,no,r.qhire County Council.-Dr. Laurence W. Pole reportson the Radnorshire schools during 1911. These schools are51 in number, of which 14 are council schools’. The averageattendance during the year was 3079, 1163 of these beingexamined during the year. 394 parents were present at theinspection. Considerable space is given to dealing withmeasles and Dr. Newsholme’s memorandum on this subject.Copies of I I Notes on the Infectious Diseases for the Use ofHead Teachers were circulated during the year. The

report suggests that 11 slight defect of vision is common Iamong the younger children in whom the developmentof the eyeball is not yet complete, and is also dueto the fact that the brain is not sufficiently educatedto correctly interpret what is seen with the eye." Thesehindrances normally disappear with growth, but may be

responsible for the popular notion that the child " will growout of it." But even in these physiological cases permanentdefect may supervene as the result of bad conditions. Withregard to the speech defects it is stated that in some casesthe language of the children is hardly to be understood exceptby those who are on terms of more or less intimacy withthem. It is possible that in a good many of these cases theinitial defect would be found to be in the home training.Ansemia was found to be twice as common among boys asamong girls. The authority has decided to conduct experi-ments in a number of schools with the object of obtaining agreater degree of cleanliness ; a series of special applicationsto floor surfaces are being tried, and two other methods ofcleansing.

BO’J’ough of Ta1mton.-Dr. Henry J,; Alford’s report dealswith the ten schools in Taunton, the average attendance atwhich is 2923. The number of "leavers" examined appears,for some reason, to have been left to the teachers, and theactual number present in the school not specified to theschool doctor. A school nurse has been appointed ; theteachers give all the assistance they can, and it is stated thatarrangements have been recently made to be more in touchwith the school attendance officer. These remarks do not

indicate a very closely knit organisation. The treatment ofdefects is not considered but it is suggested that a clinicwill have to be established. A presentation to the committeeof a plan for school clinics has been followed by usefuldiscussion, and in some cases by their establishment. The

report points out the use which may be made of breathingexercises and the great advantage of open-air schools.

VITAL STATISTICS.

REGISTRAR-GEiv’ER9L’S NEIY‘ QUARTERLY RET CRN.IN’the Registrar-General’s return for the first quarter of

the current year, which has recently been issued, we note anew, and from a statistical point of view an important,departure from the practice of the department in recent c

years. The tables in the quarterly returns have hithertoshown for the several registration subdistricts of Englandand Wales the mortality from the chief infectious diseases,according to the method devised in 1871 by Sir John Simon,the medical officer of the Local Government Board, for thepurpose of furnishing his department .with information

respecting the local prevalence of dangerous infectiousdisease. It will, of course, be understood that the countryhad not at that time been divided into administrative

sanitary areas. In the present return, which in this

respect may be regarded as the first of a new

series, the information concerning registration districtshas been suppressed, although the familiar tables relatingto the chief towns of England and Wales are stillretained.The Registrar-General ’justifies this curtailment on the--

following grounds. In the first place it has been feltthat the retention in the quarterly returns of birth and deathstatistics for the registration areas in which they were re-corded would be somewhat of an anomaly at a time when theadministration area in which the deceased person, or the

parents of the newly born child were resident, has beenadopted as the basis of arrangement in the annual report.Moreover, the reason for the form of tabulation hitherto inuse has now ceased to be operative, for in the year 1911 theLocal Government Board commenced to publish returns, notof the deaths, but of the attacks of infectious diseases

reported under the Notification Act of 1889 in all the--administrative areas of the country. As mentioned ina recent number of THE LANCET these returns are nowissued in great detail annually by the Local GovernmentBoard. With reference to the fact that the scope of thereturns does not include measles and whooping-oough, the--deaths from which were shown in the tables now sup-pressed, it is contended that as the information derivablefrom compulsory notification has not, in the case of thesediseases, been found worth the cost of collection, themore tardy, scanty, and indefinite information concerning’ rthem, which was formerly given in these reports, cannothave much practical value. Moreover, information regarding .the prevalence of these diseases is now generally obtained

from an entirely different source.16 one particular, at all events, we trust that no departure

from precedent will be made in future returns. We referto the long-established practice of inserting in the returnfor the second quarter of the year a table concerning mor-tality from infectious diseases in watering-places and summerresorts. This table showed the deaths registered in the -second quarter of the year from each of the common epi-demic diseases in those urban districts which are most

nearly coterminous with our chief watering-places. We have--always regarded this table as particularly valuable to those-of the public who are in quest of holiday quarters, as well asto the members of our profession whose advice is constantlysought at that season by those patients who contemplate -visitieg the seaside or other health resorts.

Like several of its predecessors the present return contains-a series of tables showing the number of cases of notiflable7infectious diseases occurring in the larger towns of "

England and Wales during the preceding quarter. Their

proportion to population is - also given in a concludingtable.

1 Article on the Incidence of Notifiable Infectious Disease in SanitaryDistricts of England and Wales, THE LANCET, May 4th, 1912, p. 1209.

1712

HEALTH OF ENGLISH TOWNS.

In the 95 largest English towns, having -an estimatedpopulation of 17,639,816 persons in the middle of this year,8817 births and 4022 deaths were registered during the weekending June 15th. The annual rate of mortality in thesetowns, which had decreased from 13’0 to 12- 4 in the threepreceding weeks, further fell to 11’9 9 per 1000 in the weekunder notice. During the first 11 weeks of the current

quarter the mean annual death-rate in these 95 towns

averaged 13. 4 per 1000, and was 0. 6 per 1000 in excess ofthe average rate recorded in London during the same period.The annual death-rates in the several towns last week

ranged from 2-8 in Wimbledon, 4-5 in Enfield, 4’9 inEastbourne, 5’1 in Bournemouth, and 57 in Leyton,to;17-3 in Salford, 17-7 in Liverpool, 19-1 in Middles-brough, 19’4 in Barrow-in-Furness, and 21’5 in Merthyr-Tydfil.The 4022 deaths from all causes in the 95 towns were 161

fewer than the number in the preceding week, and included423 which were referred to the principal epidemic diseases,against 397 and 418 in the two preceding weeks. Of these423 deaths 201 resulted from measles, 86 from whooping-cough, 61 from infantile diarrhceal diseases, 32 from diph-theria, 26 from scarlet fever, and 17 from enteric fever, butnot one from small-pox. The mean annual death-rate fromthese diseases was equal to 1’3 per 1000, against 1’2in each of the two preceding weeks. The deathsattributed to measles, which had been 204, 166, and 174in the three preceding weeks, rose to 201 last week,and caused the highest annual death-rates of 1’4 in

Nottingham, in Manchester, and in Leeds, 2 5 in Liverpooland in Cardiff, 3’1 1 in Gateshead, 3-5 in Ipswich, 4-9 9 inRotherham, and 8’ 8 in Merthyr Tydfil. The deaths referredto whooping-cougb, which had steadily decreased from 152to 98 in the four preceding weeks, further declined to 86last week; the highest annual death-rates recorded fromthis disease were 1’3 3 in Salford, I - 5 in Bootle, 1 - 7 in

Acton, and I - 9 in Burnley. The fatal cases of diarrhoea andenteritis among infants under two years of age, which hadbeen 69, 56, and 68 in the three preceding weeks, declinedto 61 last week, and included 23 in London and its suburbandistricts, 9 in Liverpool, and 3 in Stoke-on-Trent. The deathsattributed to diphtheria, which had declined from 47 to33 in the three preceding weeks, were 32 last week; 6deaths were recorded in London, and 2 each in Edmonton,Portsmouth, Southend-on.Sea, Bristol, Manchester, and

Newport (Mon.). The deaths referred to scarlet fever,which had been 20, 18, and 23 in the three preceding weeks,rose to 26 last week, and included 3 in London, 2 in

Birmingham, 2 in Liverpool, and 2 in Preston. The fatal casesof enteric fever numbered 17 last week, against numbersrising from 14 to 22 in the three preceding weeks ; 2 deathswere registered in London and 2 in Bradford.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and in the London Fever Hospital,which had steadily increased from 1213 to 1291 in the fourpreceding weeks, had further risen to 1328 on Saturdaylast ; 178 new cases of this disease were admitted to theseinstitutions during the week, against 182, 155, and 185 in thethree preceding weeks. These hospitals also contained onSaturday last 938 cases of diphtheria, 515 of measles,487 of whooping-cough, and 38 of enteric fever, but not oneof small-pox. The 1013 deaths from all causes in Londonwere 53 in excess of the number in the previous week, andwere equal to an annual death-rate of 11’7 per 1000. Thedeaths referred to diseases of the respiratory organs, whichhad steadily declined from 225 to 140 in the six precedingweeks, rose to 153 last week, and were 14 in excess of thenumber registered in the corresponding week of last

year.Of the 4022 deaths from all causes in the 95 towns last

week, 168 resulted from different forms of violence, and 365were the subject of coroners’ inquests. The causes of 30, or0’7 per cent., of the deaths registered were not certifiedeither by a registered medical practitioner or by a coronerafter inquest. All the causes of death were duly certifiedin London and in 13 of its 14 suburban districts, in Man-chester, Leeds, Bristol, Bradford, Hull, Newcastle-on-Tyne,Stoke-on-Trent, and in 55 other smaller towns. The 30 un- 1certified causes of death last week included 6 in Birming- J

ham, 4 in Liverpool, 2 in West Bromwich, 2 in Darlington,and 2 in Gateshead. 1

HEALTH OF SCOTCH TOWNS.

In the 18 largest Scotch towns, with an aggregate popula-tion of 2,182,400 persons in the middle of this year,1125 births and 620 deaths were registered during theweek ending June 15th. The annual rate of mortality inthese towns, which had been 15 4, 15’ 0, and 15’ 5 per 1000 inthe three preceding weeks, fell to 14’8 per 1000 in the weekunder notice. During the first 11 weeks of the currentquarter the mean annual rate of mortality in these Scotchtowns averaged 15-7 per 1000, and was 2’3 per 1000 inexcess of that recorded in the 95 large English towns duringthe same period. Among the several Scotch towns thedeath-rates last week ranged from 5’2 in Kirkcaldy, 7’6 inFalkirk, and 9’0 0 in Clydebank, to 19’0 0 in Partick, 20’8 inDundee, and 21’ 2 in Hamilton.The 620 deaths from all causes were 28 fewer than the

number in the previous week, and included 59 which werereferred to the principal epidemic diseases, against 57 and70 in the two preceding weeks. Of these 59 deaths, 27resulted from measles, 14 from whooping-cough, 13 frominfantile diarrhceal diseases, 4 from diphtheria, and 1 fromscarlet fever, but not one from enteric fever or from

small-pox. These 59 deaths from the principal epidemicdiseases were equal to an annual rate of 1 - 4 per 1000,against 1’3 per 1000 in the 95 large English towns.The deaths attributed to measles, which had been 29,25, and 33 in the three preceding weeks, declined to27 last week, and included 8 in Dundee, 5 in Hamilton,4 in Partick, and 3 in Coatbridge. The deaths referredto whooping-cough, which had decreased from 17 to9 in the four preceding weeks, rose to 14 last week; 4deaths were registered in Glasgow, 3 in Paisley, and 2 inEdinburgh. The fatal cases of diarrhoea and enteritis amonginfants under two years of age, which had been 10, 7, and15 in the three preceding weeks, were 13 last week, of whichnumber 6 were recorded in Glasgow and 5 in Dundee. Thedeaths attributed to diphtheria, which had averaged 7 inthe three preceding weeks, declined to 4 last week, andcomprised 2 in Glasgow and 2 in Dundee. The fatal caseof scarlet fever occurred in Partick.The deaths referred to diseases of the respiratory system

in the 18 Scotch towns, which had increased from 89 to107 in the three preceding weeks, declined to 97 in the weekunder notice, and 19 deaths were attributed to differentforms of violence, against numbers decreasing from 31 to 21in the five preceding weeks.

HEALTH OF IRISH TOWNS.

In the 22 town districts of Ireland, having an estimatedpopulation of 1,157,014 persons in the middle of this year,545 births and 382 deaths were registered during the weekending June 15th. The annual rate of mortality in thesetowns, which had increased from 16 to 18’8 8 per 1000 inthe three preceding weeks, declined to 17- 2 per 1000 in theweek under notice. During the first 11 weeks of thecurrent quarter the mean annual death-rate in these Irishtowns averaged 19’ 6 per 1000 ; in the 95 large Englishtowns the corresponding death-rate did not exceed 13’4 4per 1000, while in the 18 Scotch towns it was equal to15’7 per 1000. The annual death-rates in the severalIrish towns last week were equal to 22’ 7 in Dublin(against 11-7 in London), 14-4 in Belfast, 13-6in Cork,14 - 0 in Londonderry, 12-2 in Limerick, and 19’0 0 in Water-ford ; while in the remaining 16 towns the mean death-rate did not exceed 13’ 9 per 1000.The 382 deaths from all causes were 35 fewer than the

number in the previous week, and included 37 which werereferred to the principal epidemic diseases, against 31 and 32in the two preceding weeks ; of these 37 deaths, 17 resultedfrom measles, 5 from whooping.cough, 5 from diphtheria,4 from enteric fever, 4 from diarrhceal diseases, and 2 fromscarlet fever, but not one from small-pox. These 37 deathsfrom the principal epidemic diseases were equal to anannual death-rate of 1’ 7 per 1000; the death-rate fromthese diseases during the same period was equal to 1’3 per1000 in the 95 large English towns, and to 1-4 per 1000in the 18 Scotch towns. The deaths attributed to

measles, which had steadily increased from 8 to 15 in thefour preceding weeks, further rose to 17 last week, andwere all recorded in Dublin. The deaths referred to

whooping-cough, which had been 14, 6, and 9 in the three

1713VITAL S CATISTICS OF LONDON DURING MAY, 1912.

1714

preceding weeks, fell to 5 last week. The, 5 fatal cases

of diphtheria were slightly in excess of the average in theearlier weeks of the quarter, and included 3 in Dublin.The deaths attributed to diarrhceal diseases numbered 4,against 8, 6, and 3 in the three preceding weeks ; of these 4deaths, all of which related to infants under two years ofage, 3 occurred in Dablin and 1 in Belfast. Of the 4 deathsreferred to enteric fever, 2 were registered in Dublin and 2 inBelfast, while the 2 fatal cases of scarlet fever were recordedin Galway and Kilkenny respectively.The deaths referred to diseases of the respiratory system,

which had been 72 and 84 in the two preceding weeks,declined to 75 in the week under notice. Of the 382deaths from all causes in the 22 Irish towns, 141,. or, 37per cent., occurred in public institutions, and 7 resultedfrom different forms of violence. The causes of .16, or 4’2per cent., of the total deaths were not certified either by aregistered medical practitioner or by a coroner after inquest;in the 95 English towns the proportion of uncertified causesof, death last week did not exceed O’ 7 per cent.

VITAL STATISTICS OF LONDON DURING MAY, 1912.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 suffer-

ing from one or other of the ten diseases specified in thetable was equal to an annual rate of 4-8 per 1000 of thepopulation, estimated at 4,519,754 persons in the middle ofthe year. In the three preceding months the rates were

5 - 4, 5 2, and 4 3 per 1000 respectively. The lowest rates lastmonth were recorded in the Cities of London and West-minster, Hampstead, Hackney, and Camberwell ;. and the

’ highest rates in’ Paddingtion, Hammersmith, Holborn, Dept-ford, Greenwich, and Woolwich. The prevalence of

scarlet fever was greater than in either of the two

preceding months; this disease was proportionallymost prevalent in Hammersmith, Holborn, Deptford,Greenwich, and Woolwich. The number of scarlet feverpatients under treatment in the Metropolitan Asylums

Hospitals, which had been .1375, 1296, and 1201 atthe end of the three preceding months, had risen againto 1222 at the end of last month; the weekly admissions

averaged 158, against 166, 141, and 129 at the end of thethree preceding months. Diphtheria was rather more

prevalent than it had been in the previous month; thegreatest proportional prevalence of this disease was recordedin Paddington, Hammersmith, Chelsea, St. Pancras, Stoke

... Newington, and Woolwich. The Metropolitan Asylums" Hospitals contained 952 diphtheria patients at the end

.-of last month, against 1129, 1045, and 982 at the- end of the three preceding months; the weekly ad-missions averaged 117, against 137, 122, and 103 in the

w-three preceding months. The prevalence of enteric fever- showed a considerable increase last month ; this diseasewas proportionally most prevalent in Chelsea, Holborn,

"Shoreditch, Bethnal Green, and Wandsworth. There were32 enteric fever patients under treatment in the MetropolitanAsylums Hospitals at the end of May, against 64, 52, and43 at the end of the three preceding months ; the weeklyadmissions averaged 8, against 7 in each of the two pre-ceding months. Erysipelas was proportionally most pre-valent in Kensington, Bethnal Green, - Southwark, Ber-

mondsey, Deptford, and Greenwich. The 40 cases of puer-peral fever notified during the month included 4 in Fulhamand 3 each in Islington, Hackney, Bethnal Green, Stepney,

"Poplar, and Wandsworth. The 11 cases notified as cerebro-

spinal meningitis included 3 in Islington and 2 in Sbore-ditch ; and the 9 cases of poliomyelitis included 2 in

Paddington and 2 in Islington.The mortality statistics in the table relate to the deaths of

persons actually belonging to the several boroughs, the deathsoccurring in institutions having been distributed amongthe boroughs in which the deceased persons had pre-viously resided; the death-rates from all causes are furthercorrected for variations in the sex- and age-constitutionof the population of the several boroughs. During the

’five weeks ending’ Jane lst the deaths of 5497 Londonresidents were registered, equal to an annual rate of 13’3

, per 1000 of the population ; in the three preceding months

the rates were 17’ 9, 14.0 0, and, 14 3 per 1000 respectively.The death-rates last month ranged from 9. 5 in Hamp-stead, 9.6 6 in Wandsworth, 9 7 in Lewisham, 11.]4 in StokeNewington, 11.7 in Hammersmith, and 11-8 in Fulham, to15’4 in Shoreditch, 15.8 8 in. St. Pancras, 16.9 in Chelsea,17’ 1 in Holborn and in Southwark, and 19. 1 in Finsbury. The5497 deaths from all causes included 476 which were referredto the principal infectious diseases of these. 150 resultedfrom measles, 18 from scarlet fever, 40 from diphtheria,152 from whooping-cough, 16 from enteric fever, and 100from diarrhœa and enteritis among children under 2 years ofage. The lowest death-rates from these diseases last monthwere recorded in the City of London, Kensington, Chelsea,St. Marylebone, , Hampstead, and Stoke Newington; andthe highest rates in Fulham, Shoreditch, Southwark,Bermondsey, and Woolwich. The 150 deaths from measlesshowed a decline of 80 from the corrected average numberin the corresponding period of the five preceding years;this disease was proportionally most fatal last month inFulham, St. Pancras, Holborn, Southwark, Bermondsey, andWoolwich. The 18 fatal cases of scarlet fever were 18below the corrected average number, and included 3in Stepney, and 2 each in Paddington, the City ofWestminster, Bermondsey, Deptford, and Lewisham. The40 deaths from diphtheria were 8 fewer than the correctedaverage number ; the greatest proportional mortality fromthis disease last month was recorded in Fulham, St. Maryle-bone; Hampstead, Finsbury, Bethnal Green, and Bermondsey.The 152 fatal cases of whooping-cough showed a slightdecline from the corrected average number ; the highestdeath-rates from this disease were recorded in Fulham,Finsbury, - Shoreditch,- Stepney, Poplar, Southwark, andWoolwich. The 16 deaths from enteric fever were 7 in excessof the corrected average, and included 2 in the City ofWestminster, 2 in Shoreditch, and 2 in Camberwell. The

mortality from diarrhoea and enteritis among children undertwo years of age was proportionally greatest in Hammer-smith, Fulham, Shoreditch, and Stepney. ’ In conclusion, itmay be stated that the aggregate mortality in London lastmonth from the principal infectious diseases (excludingdiarrhoea) was 2iJ.’ 5 per cent, below the average.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments have been notified: Sbaff-

Surgeons : J. Verdon to the Ganges, additional, forGanges II.; and T. D. Liddle to the Challenger. Sar-geon : T. C. Patterson to the Torck.

ROYAL ARMY MEDICAL CORPS.Lieutenant Robert’ W. Vint, from the seconded list, is

restored to the establishment (dated June 1st, 1912).Colonel S. Westcott, C M G., has been selected for

appointment as Assistant Director of Medical Services in thePortsmouth District, in succession to Colonel H. G. Hathaway.Lieutenant-Colonel W. C. Beevor, C M.G., has taken overcharge of the Royal Infirmary, Phosnix Park, Dublin. Lieu-tenant-Colonel L. T. M. Nash has been selected for theincreased rate of pay under Article 317 of the Royal Warrant.Lieutenant-Colonel C. C. Reilly has been appointed to

command the Military Hospital at Colaba, Bombay.Major A. W. Bewley has been transferred from the Station

Hospital, ’Meerut Cantonment, to the Bareilly Brigade, forduty at Ranikhet. Major C. H. Straton has taken up dutyas Specialist Sanitary Officer to the South African Commandat Pretoria. Major B. F. Wingate has been transferred fromSecunderabad to the Military Hospital at Wellington, MadrasPresidency. Major H: N. Duon, on arrival from India, hasbeen posted to the Southern Command Major F. M. Manginhas been placed under orders for service abroad during thecoming trooping season.

Captain D. L Harding has been transferred from Ennis-dllen to the Military Hospital at Belfast. Captain G. F.Rugg has been selected for appointment as Specialist in .

Dperative Surgery to the ’First (Peshawar) Division of thesorthern Army in India. Captain W. C. Smales has arrivedhome on leave of absence from Poona. Captain W. J.Veston, on return from Gibraltar, has been appointed forluty to the! Irish Command.’ Captain’H. C.° Sidgwlck has