269 seems a very simple case, and Lord Robertson said in Brintons, Lim., v. Turvey (1905, A.C. 230) that he thought that a case of rupture was also a very simple case of accident in the sense of the statute. The present case is not the case of an industrial disease. It is the giving way of an artery causing effusion of blood on the brain, and I am unable to see any distinc- tion between this kind of physiological injury resulting in disablement and the kind of injury we had to consider in the cases of Stewart. The real difficulty in the case is not to connect the attack of partial paralysis which the claimant sustained in immediate sequence to heavy exertion with that exertion ; it is rather whether we are to connect that with the subsequent and more serious paralysis which occurred four days later and which seems to have resulted in per- manent disablement. It is said that the sheriff has refused to make a finding that the second attack was consequent upon the first. That may have been because it was one of the matters which he desired to leave to the decision of the court. At all events, before we can affirm the sheriff’s decision I think it will be necessary that we should hold that these two attacks were connected. The first attack was a slight one, and the man was in course of recovering from it when the second attack supervened. But unless we had evidence which would enable us to assign a different origin to the second attack, I think the logical deduction from the evidence is that the man’s improvement was only a partial recovery from the first attack, which was caused by the arteries of the brain being in a strained condition in con- sequence of over-exertion, and that this second attack was a further development of the injury he suffered from the over- exertion. Looking Back. FROM THE LANCET, SATURDAY, Jan. 22nd, 1831. REMITTENT FEVER-TRIAL OF SALICINE. Of the two other cases admitted, one appeared to be remittent fever. It was very difficult to get an account of the man. I could not learn that he had been in an aguish district, but only that he had been ill seven days. He, however, resided in Thames Street, and had been some way along the banks of the river, though hardly into the country. He was seized on the Thursday before with violent shiverings, violent heat, and afterwards sweating, and he had also pain of the head. When I saw him he was shivering ; his account, however, was imperfect as to the period of the day at which the attacks came on, but it appeared that he was affected with rigours at different parts of the day. Under these circumstances, I considered the disease to be remittent fever. Remittent fever will frequently occur insidiously, and unless you are quite up to it, you may as easily pass it over as some forms of epilepsy. I have had many cases of remittent fever which, in addition to the symptoms of continued fever, were merely character- ised by excessive sweating; and other cases, in addition to the symptoms of continued fever, characterised by shivering at different times of the day. But there are other cases, again, in which the disease is perfectly clear from the train of shivering, heat, and sweating, taking place violently at certain periods in the twenty-four hours, or at certain more distant periods, besides the continued fever. In other cases there is no shivering nor sweating at intervals, but occasional, and, perhaps, periodical exacerbations of the heat, quickness of pulse, &c. That these diseases have been remittent fever has appeared from the rapid way in which they have yielded to the free exhibition of bark, after the failure of the ordinary remedies of continued fever. In the case of this man the remittent fever was becoming con- tinued fever ; his tongue was brown ; he was constantly more or less delirious ; his mind wandered, and was more or less in stupor ; he was very deaf, and it was necessary to combine the treatment demanded by the two species of fever. It was requisite to apply blisters at the back of the neck, and to give him mercury. He took five grains of hydrarg. cum creta, ;and he also took the new French remedy, salicine. A remedy has been discovered by the French, procured from the willow, which is said to be as effectual in the cure of ague as quinine. This man took the remedy in the same doses ; that is to say, he took five grains every six hours, and he is now doing remarkably well. I have, in fact, in typhus fever, given the sulphate of quinine with considerable benefit, several grains every few hours. The debility of this man would have induced me to give him this remedy, even had he not had the remittent form of the disease. When I found him shivering in bed, and ascertained that he had lived at the water-side, and had been near the tower-moat, which, for some time past, was a disgraceful focus of malaria and ague, I had no hesitation in giving him a remedy of this descrip- tion. I am anxious to ascertain the powers of salicine, because, when they are once established, so that there will be a demand for it, it will be sold at a cheaper rate than the sulphate of quinine, although, compared with the original price of three guineas per ounce, that is now exceeding cheap. This is what I am told, although, of course, I am not very conversant with these matters. This man took the same dose as is given of sulphate of quinine in severe cases, and it appeared to have the same effect as quinine; that is, it neither sickened him nor heated him ; it was as innocuous as the sulphate of quinine 168t{,ally is ; he still takes it, and is mending rapidly.l VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN 76 of the largest English towns 8495 births and 5237 deaths were registered during the week ending Jan. 16th. The annual rate of mortality in these towns, which had been equal to 18 - 2 and 17’ 5 per 1000 in the two pre- ceding weeks, further declined to 16’ 6 in the week under notice. During the 14 weeks of last quarter the annual death-rate in these towns averaged only 14’ 9 per 1000, and in London the mean rate during the same period did not exceed 14’ 3. The lowest recorded annual death-rates in these towns during last week were 4 - 9 in Hornsey, 8.5 in Uoventry, 8.9 in lyings Norton, and 9*9 in Walthamstow ; the rates in the other towns ranged upwards, however, to 24.6 in Merthvr Tydfil, 24-7 in Oldham, 26-2 in Sunderland, and 27.3 in Bury. In London the recorded death-rate during the week was equal to 16-9 per 1000. The 5237 deaths from all causes in the 76 towns showed a further decline of 298 from the higher numbers returned in the two preceding weeks, and included 491 which were referred to the principal epidemic diseases, against 497 and 450 in the two previous weeks; of these 491 deaths, 221 resulted from measles, 72 from diph- theria, 56 from diarrhoea, 54 from whooping-cough, 50 from scarlet fever, and 38 from "fever" (principally enteric), but not one from small-pox. The deaths referred to these epidemic diseases in the week under notice were equal to an annual rate of 1.6per 1000, against 1’3, 1 6, and 1’4 in the three preceding weeks ;in London the recorded rate trom tnese cliseases was equal to t b per luuu. N O death from any of these epidemic diseases was registered during last week in Cardiff, Gateshead, Southampton, Hornsey, or in nine other smaller towns ; the annual death-rate therefrom, however, ranged upwards in the other towns to 3-0 in Manchester, 3-3 in Merthyr Tydfil, 3-6 in Sunderland, and 4.8 in Rotherham. The fatal cases of measles in the 76 towns, which had been 168, 231, and 229 in the three preceding weeks, declined again to 221 in the week under notice, but caused annual death- rates equal to 2-2 in Warrington, 2 - 6 in Leicester and in Sunderland, and 4’ 0 in Rotherham. The deaths from diphtheria, which had been 82 and 62 in the two previous weeks, rose again last week to 72, of which 24 occurred in London and its suburban districts, three in Bristol, four in Birmingham and its surrounding districts, three in Liverpool, seven in Manchester and Salford, five in Leeds, and three in Hull. The 56 deaths attributed to diarrhoea showed a slight increase. The 50 fatal cases of scarlet fever exceeded the number in any recent week, including 18 in London and its suburban districts, seven in Liverpool, and 1 Excerpt from a Clinical Lecture delivered at St. Thomas’s Hospital, London, by Dr. Elliotson, Jan. 3rd, 1831.
Transcript
269
seems a very simple case, and Lord Robertson said in
Brintons, Lim., v. Turvey (1905, A.C. 230) that he thoughtthat a case of rupture was also a very simple case
of accident in the sense of the statute. The
present case is not the case of an industrial disease.It is the giving way of an artery causing effusion ofblood on the brain, and I am unable to see any distinc-tion between this kind of physiological injury resultingin disablement and the kind of injury we had to consider inthe cases of Stewart. The real difficulty in the case is not toconnect the attack of partial paralysis which the claimantsustained in immediate sequence to heavy exertion with thatexertion ; it is rather whether we are to connect that withthe subsequent and more serious paralysis which occurredfour days later and which seems to have resulted in per-manent disablement. It is said that the sheriff has refusedto make a finding that the second attack was consequentupon the first. That may have been because it was one ofthe matters which he desired to leave to the decision of thecourt. At all events, before we can affirm the sheriff’sdecision I think it will be necessary that we should hold thatthese two attacks were connected. The first attack was a
slight one, and the man was in course of recovering from itwhen the second attack supervened. But unless we hadevidence which would enable us to assign a different originto the second attack, I think the logical deduction from theevidence is that the man’s improvement was only a partialrecovery from the first attack, which was caused by thearteries of the brain being in a strained condition in con-sequence of over-exertion, and that this second attack was afurther development of the injury he suffered from the over-exertion.
_______________
Looking Back.FROM
THE LANCET, SATURDAY, Jan. 22nd, 1831.
REMITTENT FEVER-TRIAL OF SALICINE.
Of the two other cases admitted, one appeared to beremittent fever. It was very difficult to get an account ofthe man. I could not learn that he had been in an aguishdistrict, but only that he had been ill seven days. He,however, resided in Thames Street, and had been some wayalong the banks of the river, though hardly into the country.He was seized on the Thursday before with violent shiverings,violent heat, and afterwards sweating, and he had also
pain of the head. When I saw him he was shivering ;his account, however, was imperfect as to the period ofthe day at which the attacks came on, but it appearedthat he was affected with rigours at different partsof the day. Under these circumstances, I consideredthe disease to be remittent fever. Remittent fever will
frequently occur insidiously, and unless you are quite up toit, you may as easily pass it over as some forms of epilepsy.I have had many cases of remittent fever which, in additionto the symptoms of continued fever, were merely character-ised by excessive sweating; and other cases, in addition tothe symptoms of continued fever, characterised by shiveringat different times of the day. But there are other cases,again, in which the disease is perfectly clear from the trainof shivering, heat, and sweating, taking place violently atcertain periods in the twenty-four hours, or at certain moredistant periods, besides the continued fever. In othercases there is no shivering nor sweating at intervals,but occasional, and, perhaps, periodical exacerbations ofthe heat, quickness of pulse, &c. That these diseases havebeen remittent fever has appeared from the rapid way inwhich they have yielded to the free exhibition of bark, afterthe failure of the ordinary remedies of continued fever. Inthe case of this man the remittent fever was becoming con-tinued fever ; his tongue was brown ; he was constantly moreor less delirious ; his mind wandered, and was more or lessin stupor ; he was very deaf, and it was necessary to combinethe treatment demanded by the two species of fever. It was
requisite to apply blisters at the back of the neck, and to givehim mercury. He took five grains of hydrarg. cum creta,;and he also took the new French remedy, salicine. A remedy
has been discovered by the French, procured from thewillow, which is said to be as effectual in the cure of ague asquinine. This man took the remedy in the same doses ; thatis to say, he took five grains every six hours, and he is nowdoing remarkably well. I have, in fact, in typhus fever,given the sulphate of quinine with considerable benefit,several grains every few hours. The debility of this manwould have induced me to give him this remedy, even had henot had the remittent form of the disease. When I found himshivering in bed, and ascertained that he had lived at thewater-side, and had been near the tower-moat, which, forsome time past, was a disgraceful focus of malaria and ague,I had no hesitation in giving him a remedy of this descrip-tion. I am anxious to ascertain the powers of salicine,because, when they are once established, so that there willbe a demand for it, it will be sold at a cheaper rate than thesulphate of quinine, although, compared with the originalprice of three guineas per ounce, that is now exceeding cheap.This is what I am told, although, of course, I am not veryconversant with these matters. This man took the same doseas is given of sulphate of quinine in severe cases, and itappeared to have the same effect as quinine; that is, itneither sickened him nor heated him ; it was as innocuous asthe sulphate of quinine 168t{,ally is ; he still takes it, and ismending rapidly.l
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN 76 of the largest English towns 8495 births and 5237deaths were registered during the week ending Jan. 16th.The annual rate of mortality in these towns, which hadbeen equal to 18 - 2 and 17’ 5 per 1000 in the two pre-ceding weeks, further declined to 16’ 6 in the week undernotice. During the 14 weeks of last quarter the annualdeath-rate in these towns averaged only 14’ 9 per 1000, andin London the mean rate during the same period did notexceed 14’ 3. The lowest recorded annual death-rates inthese towns during last week were 4 - 9 in Hornsey,8.5 in Uoventry, 8.9 in lyings Norton, and 9*9 inWalthamstow ; the rates in the other towns ranged upwards,however, to 24.6 in Merthvr Tydfil, 24-7 in Oldham,26-2 in Sunderland, and 27.3 in Bury. In Londonthe recorded death-rate during the week was equal to16-9 per 1000. The 5237 deaths from all causes in the76 towns showed a further decline of 298 from the highernumbers returned in the two preceding weeks, and included491 which were referred to the principal epidemic diseases,against 497 and 450 in the two previous weeks; of these491 deaths, 221 resulted from measles, 72 from diph-theria, 56 from diarrhoea, 54 from whooping-cough, 50 fromscarlet fever, and 38 from "fever" (principally enteric),but not one from small-pox. The deaths referred to these
epidemic diseases in the week under notice were equal toan annual rate of 1.6per 1000, against 1’3, 1 6, and 1’4in the three preceding weeks ;in London the recorded ratetrom tnese cliseases was equal to t b per luuu. N O death
from any of these epidemic diseases was registered duringlast week in Cardiff, Gateshead, Southampton, Hornsey, or
in nine other smaller towns ; the annual death-ratetherefrom, however, ranged upwards in the other townsto 3-0 in Manchester, 3-3 in Merthyr Tydfil, 3-6in Sunderland, and 4.8 in Rotherham. The fatalcases of measles in the 76 towns, which had been 168,231, and 229 in the three preceding weeks, declined againto 221 in the week under notice, but caused annual death-rates equal to 2-2 in Warrington, 2 - 6 in Leicester and inSunderland, and 4’ 0 in Rotherham. The deaths fromdiphtheria, which had been 82 and 62 in the two previousweeks, rose again last week to 72, of which 24 occurred inLondon and its suburban districts, three in Bristol, four inBirmingham and its surrounding districts, three in Liverpool,seven in Manchester and Salford, five in Leeds, and three inHull. The 56 deaths attributed to diarrhoea showed a slightincrease. The 50 fatal cases of scarlet fever exceeded thenumber in any recent week, including 18 in Londonand its suburban districts, seven in Liverpool, and
1 Excerpt from a Clinical Lecture delivered at St. Thomas’s Hospital,London, by Dr. Elliotson, Jan. 3rd, 1831.
270
nine in Manchester and Salford. The 54 deaths from
whooping-cough also exceeded recent weekly numbersand showed the highest rate of mortality, 1. 5 per 1000, inWest Bromwich. Of the 38 deaths referred to " fever," nineoccurred in Manchester and Salford and three in Oldham.The number of scarlet fever patients under treatment in theMetropolitan Asylums and the London Fever Hospitals, whichhad been 3557 and 3347 on the two preceding Saturdays,had further declined to 3261 at the end of the week undernotice ; the new cases of this disease admitted to these
hospitals during the week under notice were 358, against379 and 323 in the two preceding weeks. The registereddeaths in London referred to pneumonia and otherdiseases of the respiratory organs, which had been 422in the previous week, declined to 379 in the weekunder notice, and were 63 below the corrected
average number in the corresponding week of thefive years 1904-08. The causes of 46, or 0-9 percent., of the deaths registered in the 76 towns duringthe week were not certified, either by a registeredmedical practitioner or by a coroner. All the causes ofdeaths registered during the week under notice were againduly certified in Leeds, West Ham, Bradford, Newcastle-on-Tyne, Salford, Nottingham, and in 46 other smallertowns; the 46 uncertified causes of death in the 76 townslast week included 11 in Liverpool, three each in Birming-ham, St. Helen’s, and Gateshead, and two each in
Northampton, Preston, and Blackburn.
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in eight of the principalScotch towns, which had been equal to 16 1, 17’ 4, and19 - 5 per 1000 in the three preceding weeks, declined to18’1 in the week ending Jan. 16th. During the 14weeks of last quarter the annual death-rate in these
eight towns averaged 15’ 5 per 1000, and exceeded by0 - 6 the mean rate during the same period in the 76
English towns. Among the eight Scotch towns thedeath-rate during the week under notice ranged from12-2 and 15-2 in Leith and Greenock to 25-9 inDundee and 26-4 in Perth. The 648 deaths from allcauses registered in the eight towns last week showed adecline of 50 from the number returned in the previousweek, and included 73 which were referred to the
principal epidemic diseases, against 51, 60, and 70 in thethree preceding weeks ; of these 73 deaths, 39 resulted fromwhooping-cough, 13 from diarrhoea, seven from diphtheria,six from "fever," five from scarlet fever, and three frommeasles, but not one from small-pox. These 73 deathswere equal to an annual rate of 2 - 0 per 1000, exceeding by0’ 4 the mean rate during the week from the same diseasesin the 76 largest English towns. The 39 fatal cases ofwhooping-cough in the eight Scotch towns showed a furtherincrease upon recent weekly numbers, and included 27 inGlasgow, four in Aberdeen, three in Paisley, and two eachin Dundee and Greenock. The 13 deaths attributed todiarrhoea showed, however, a further decline from thosereturned in recent weeks ; six occurred in Glasgow andthree both in Edinburgh and Dundee. Six of the sevendeaths from diphtheria (corresponding with the number inthe previous week) were returned in Glasgow. The sixdeaths referred to ’’ fever," of which four were certified as
enteric and two as cerebro-spinal meningits, included three inGlasgow. Scarlet fever caused two deaths both in Glasgowand in Aberdeen ; and the three fatal cases of measles werealso returned in Aberdeen, where the annual death-rate fromthe principal epidemic diseases during the week was equalto 3’ 2 per 1000. The deaths referred to diseases of the
respiratory organs in the eight towns, which had increasedin the four preceding weeks from 101 to 129, further rose to151 in the week under notice, but were 48 below the numberreturned in these towns in the corresponding week of lastyear. The causes of 16, or 2’ 5 per cent., of the deaths
registered during the week in the eight towns were notcertified ; in the 76 large English towns during the sameweek the proportion of uncertified causes of death did not exceed 0 - 9 per cent. -
’
HEALTH OF DUBLIN.
The annual rate of mortality in Dublin, which hadbeen equal to 17-2, 28-3, and 23 - 6 in the three preceding
weeks, was 23 ’7 in the week ending Jan. 16th. Duringthe 14 weeks of last quarter the death-rate in the cityaveraged 20’ 5 per 1000, whereas the mean rate duringthe same period did not exceed 14 3 in London and 14’ 4 4in Edinburgh. The 181 deaths of Dublin residents duringthe week under notice were within one of the numberreturned in the previous week, and included 15 whichwere referred to the principal epidemic diseases, against12 and 16 in the two preceding weeks. These 15 deathswere equal to an annual rate of 2 - 0 per 1000 ; the rate fromthese epidemic diseases in the same week did not exceed 1 - 5 5in London and 0’9 in Edinburgh. Of the 15 deathsfrom these epidemic diseases in Dublin last week eightresulted from measles, three from 11 fever," two from
whooping-cough, and one each from diphtheria anddiarrhoea, but not one either from scarlet feveror small-pox. The fatal cases both of measles and of" fever" showed a slight decline from the numbers returnedin the previous week. The 181 deaths from all causes
during the week included 29 of infants under one year of ageand 49 of persons aged upwards of 60 years. Two inquestcases and one death from violence were registered duringthe week ; and 54, or 30’ 0 per cent., of the deaths occurredin public institutions. The causes of six, or 3’3 per cent.,of the deaths registered in Dublin last week were not
certified ; the proportion of uncertified causes of death inLondon last week did not exceed 0’ 1 per cent., and in
Edinburgh it was 1 - 9 per cent.
ADMINISTRATIVE COUNTY OF DURHAM.
Dr. T. Eustace Hill, the county medical officer of health ofDurham, sends us the following :-
Chief Tital Statistics for 1908 and their Comparison with1907 and the Average of the Ten 1ears 1898-1907.
VITAL STATISTICS OF LONDON DURING DECEMBER, 1908.IN the accompanying table will be found summarised com-
plete statistics relating to sickness and mortality in the Cityof London and in each of the metropolitan boroughs. Withregard to the notified cases of infectious diseases, it appearsthat the number of persons reported to be suffering fromone or other of the nine diseases specified in the table wasequal to an annual rate of 7 6 per 1000 of the population,estimated at 4,795,757 persons in the middle of last year ;in each of the two preceding months the rate was 9 2 2per 1000. The lowest rates last month were recordedin Paddington, Westminster, St. Marylebone, Hampstead,Holborn, and the City of London ; and the highest ratesin Shoreditch, Bethnal Green, Poplar, Greenwich,Lewisham, and Woolwich. Scarlet fever was muchless prevalent than in other recent months ; amongthe several metropolitan boroughs the greatest pro-portional prevalence of this disease was recordedlast month in Hackney, Poplar, Bermondsey, Battersea,
271
272
Greenwich, and Woolwich. The number of scarlet fever
patients under treatment in the Metropolitan Asylums Hos-pitals at the end of last month was 3498, against 3431,3776, and 3787 at the end of the three preceding months ;the weekly admissions averaged 371, against 506, 493, and477 in the three preceding months. The prevalence of
diphtheria showed a slight decline from that recorded in thetwo preceding months ; this disease was proportionally mostprevalent in Hammersmith, Fulham, Chelsea, Bethnal Green,Deptford, Greenwich, Lewisham, and Woolwich. There were1241 diphtheria patients under treatment in the Metro-
politan Asylums Hospitals at the end of last month, against953, 1118, and 1228 at the end of the three precedingmonths; the weekly admissions averaged 143, against158 in each of the two preceding months. Entericfever also was less prevalent in December than ineither of the two preceding months; the greatest propor-tional prevalence of this disease last month was recorded in
Hampstead, Holborn, Finsbury, Shoreditch, Bethnal Green,Poplar, Bermondsey, and Greenwich. The MetropolitanAsylums Hospitals contained 147 enteric fever patients at theend of last month, against 95, 145, and 184 at the end ofthe three preceding months ; the weekly admissions averaged16, against 18, 24, and 29 in the three preceding months.The 20 cases of puerperal fever notified during the monthincluded three which belonged to Islington, and two eachto Paddington, Hampstead, Stepney, Southwark, Camberwell,and Lewisham. Of the three cases notified as cerebro-spinalmeningitis one belonged to Fulham, one to Islington, andone to Battersea.The mortality statistics in the table relate to the deaths of
persons actually belonging to the various boroughs, the deathsoccurring in institutions having been distributed among theseveral boroughs in which the deceased persons had pre-viously resided. During the five weeks ending Jan. 2nd thedeaths of 6591 persons belonging to London were registered,equal to an annual rate of 14 . 3 per 1000 ; in the three pre-ceding months the rates had been 12 - 8, 12 3, and 14 6 6 per1000. Among the several boroughs the death-rates lastmonth ranged from 9’ 9 in Hampstead, 10 3 in Lewisham,11-3 in Greenwich, 11.8 8 in Paddington and in Woolwich,12 . 1 in Battersea, and 12 - 3 in Wandsworth and Deptford,to 17’2 in Shoreditch, 18.1 1 in Finsbury and in Bermondsey,18 2 in Stepney, 18’ 5 in Bethnal Green, and 19 - 1 inHolborn. The 6591 deaths from all causes included 566which were referred to the principal infectious diseases ; ofthese, 267 resulted from measles, 52 from scarlet fever,90 from diphtheria, 29 from whooping-cough, 39 fromenteric fever, and 89 from diarrhoea, but not any from
small-pox, from typhus fever, or from ill-defined pyrexia.No death from any of these diseases was recordedlast month in the City of London ; while among the
metropolitan boroughs they caused the lowest death-ratesin Paddington, Kensington, Hampstead, St. Pancras, StokeNewington, Holborn, Lambeth, and Deptford; and the
highest rates in St. Marylebone, Bethnal Green, Stepney,Islington, Poplar, Southwark, and Bermondsey. The 267 fatalcases of measles were 76 in excess of the corrected averagenumber for the corresponding period of the five precedingyears ; the greatest proportional mortality from this diseaselast month was recorded in St. Marylebone, Islington,Finsbury, Bethnal Green, Stepney, Southwark, and Bermond-sey. The 52 deaths from scarlet fever were slightly fewer Ithan the corrected average number ; this disease was pro-portionally most fatal in Hackney, Shoreditch, Stepney,Poplar, and Bermondsey. The 90 fatal cases of diphtheriawere equal to the average ; among the various metropolitanboroughs the highest death-rates from this disease were
recorded in Hammersmith, Chelsea, Shoreditch, BethnalGreen, Stepney, Camberwell, and Lewisham. The 29 deathsfrom whooping-cough were equal to less than one-fourthof the corrected average number for the correspondingperiod of the five preceding years ; the greatest propor-tional mortality from this disease last month was re-
corded in Chelsea, Shoreditch, Bethnal Green, Ber-
mondsey, and Battersea. The 39 fatal cases of enteric feverslightly exceeded the corrected average number; this diseasewas proportionally most fatal in St. Marylebone, Stoke
Newington, Finsbury, Shoreditch, Poplar, Bermondsey, andGreenwich. The 89 deaths from diarrhoea also showed a
slight excess over the corrected average ; the greatest pro-portional mortality from this cause was recorded in Hammer- ismith, Fulham, St. Marylebone, Islington, Finsbury, Stepney, i’
Southwark, Camberwell, and Lewisham. In conclusion, tmay be stated that the aggregate mortality in London lastmonth from these principal infectious diseases was 2’3 percent. below the average.
Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 117 per 1000. The lowest rates of infantmortality were recorded in St. Marylebone, Hampstead,Stoke Newington, Hackney, Lambeth, Camberwell, and
Lewisham ; and the highest rates in Kensington, Hammer-smith, Westminster, Bethnal Green, Stepney, and South-wark.
THE SERVICES.
ROYAL NAVY MEDICAL SERVICE.
THE following appointments are notified :—Fleet-Surgeon E. C. Lomas, D. S. 0., to the President, additional, for threemonths’ course at West London Hospital. Stafr-Surgeon :W. K. Hopkins, to the Royal Arthur, lent, for voyage.
ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel R. Jennings has been noted for the
appointment of Administrative Medical Officer at Devonport.Colonel H. R. Whitehead, Principal Medical Officer, 1st(Peshawur) Division at Cherat, has been selected for the
appointment of Principal Medical Officer, Southern Command.Colonel 0. E. P. Lloyd, V.C., from Ranikhet, has beenappointed Principal Medical Officer, Peshawur Division.Major R. J. Blackham, D.P.H., has been appointedDivisional Sanitary Officer, 1st (Peshawur) Division, India.
TERRITORIAL FORCE.
Royal Army Medical Corps.For attmalament to Units other than Medicai Units :-Sm-
geon-Lieutenant-Colonel Frederick William Gibbon, from TteTyne Division (Electrical Engineers) Royal Engineers (Volua-teers), to be Lieutenant-Colonel, with precedence as in theVolunteer Force (dated April lst, 1908). Edgar Reid (lateSurgeon-Captain, 3rd Glamorgan Volunteer Rifle Corps)to-be Captain (dated April 1st, 1908). The undermentionedSurgeon-Lieutenant-Colonels and Honorary Surgeon-Colonds,from the 6th Volunteer Battalion, The Manchester Regim61t,to be Lieutenant-Colonels with the honorary rank of SurgEon-Colonels, with precedence as in the Volunteer Force (dstedApril lst, 1908): Thomas Fort and Robert Lancelot Sparjow.Lieutenant Henry Arthur Clifton Harris, from the Sussexand Kent Bearer Company, Royal Army Medical Corps(Volunteers), to be Lieutenant, with precedence as it the
Volunteer Force (dated April lst, 1908). Surgeon-LieutEnant-Colonel and Honorary Surgeon-Colonel William MtehellRoocroft, from the 5th Battalion, The Manchester Reginent,to be Lieutenant-Colonel with the honorary rank of Sirgeon-Colonel, with precedence from August 20th, 1904 (datedApril 2nd, 1908). Lieutenant Alfred Harold Godwin,from the 2nd West Lancashire Field Ambulalce, tobe Lieutenant (dated August 13th, 1908). JohnWilfred Bird to be Captain (dated Sept. 14th 1908).Lieutenant Charles H. Sedgwick to be Captaii (datedSept. 25th, 1908). Surgeon-Captain John Robert A7illiams,from the 6th Battalion, The Royal Welsh Fusililrs, to beCaptain (dated Nov. 18th, 1908). Surgeon-Mjor HarryLegh de Legh, from the 4th Battalion, Alexanda, Princessof Wales’s Own (Yorkshire Regiment), to be Mfjor (datedNov. llth, 1908). Captain William R. Willis resigns hiscommission (dated Dec. 4th, 1908).
lst London Territorial Division: Surgeor-Lieutenant-Colonel and Honorary Surgeon-Colonel James Jantlie, fromthe Honorary Colonelcy of the Eastern Commaid, MaidstoneCompanies, and the London District, London CompaniesRoyal Army Medical Corps (Volunteers), is alpointed to theHonorary Colonelcy of the division, with prcedence as inthe Volunteer Force (dated April lst, 1908).The announcements in the London Gazde of Nov. 6th,
1908, regarding the transfer of Surgeon-Majr Hugh RansonBramwell and Surgeon-Captain John Comie from theTynemouth Royal Garrison Artillery Volunteers) are
cancelled.lst East Anglian Field Ambulance : Gptain Francis A.
Brooks to be Major (dated Nov. 30th, 190f).2nd Lowland Field Ambulance : Captah Peter F. Shaw to
