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URBAN VITAL STATISTICS.

VITAL STATISTICS OF LONDON DURINGNOVEMBER, 1920.

IN the accompanying table will be found summarised.statistics relating to sickness and mortality in the City ofLondon 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 from oneor other of the ten diseases notified in the table was equal toan annual rate of 15-8 per 1000 of the population, estimatedat 4,358,309 persons; in the three preceding monthsthe rates had been 6’6, 11’3, and 16’3 per 1000. Amongthe metropolitan boroughs the lowest rates from thesediseases were recorded in Chelsea, the City of West-minster, St. Marylebone, Hampstead, Holborn, and theCity of London ; and the highest in Hammersmith,Fulham, Finsbury, Bethnal Green, Stepney, Poplar, andBermondsey. The prevalence of scarlet fever was slightlyless than in the preceding month ; this disease was propor-tionally most prevalent in Hammersmith, Bethnal Green,Stepney, Poplar, and Bermondsey. The MetropolitanAsylums Hospitals contained 5508 scarlet fever patientsat the end of the month, against 2251, 3683, and 5117at the end of the three preceding months; theweekly admissions averaged 780, against 335, 603, and873 in the three preceding months. Diphtheria was slightlymore prevalent than in the preceding month ; the greatestproportional prevalence of this disease was recorded inFulham, Islington, Finsbury, Shoreditch, Bethnal Green,and Poplar. The number of diphtheria patients undertreatment in the Metropolitan Asylums Hospitals, whichhad been 1388, 1773, and 2284 at the end of the three pre-ceding months, further rose to 2604 at the end of November;the weekly admissions averaged 360, against 173, 266, and364 in the three preceding months. The prevalence ofenteric fever was about equal to that in the three preced-ing months ; of the 23 cases notified during the four weeksended Nov. 27th, 4 belonged to Hackney, 3 to Paddington,3 to Islington, and 3 to Camberwell. There were 16 casesof enteric fever under treatment in the Metropolitan AsylumsHospitals at the end of the month, against 17, 14, and19 at the end of the three preceding months; the weeklyadmissions averaged 3. against 3, 3, and 4 in the three

preceding months. Erysipelas was proportionally mostprevalent in Paddington, St. Marylebone, Bethnal Green,Stepney, Southwark, Battersea, and Deptford. The 32 casesof puerperal fever included 16 in Lambeth, 4 in Fulham,4 in Poplar, 3 in Hammersmith, and 3 in Wandsworth. The6 cases of cerebro-spinal meningitis belonged respectivelvto Finsbury, Stepney, Lambeth, Wandsworth, Camberweli,and Lewisham ; and the 2 cases of poliomyelitis to Hammer-smith and Finsbury.The mortality statistics in the table relate to the deaths

of civilians actually belonging to the several boroughs, thedeaths occurring in institutions having been distributedamong the boroughs in which the deceased persons hadpreviously resided. During the four weeks ended Nov. 27ththe deaths of 4542 London residents were registered, equalto an annual rate of 13-6 per 1000; in the three precedingmonths the rates had been 9’3, 9-9, and 10-5 per 1000.The death-rates ranged from 10’1 in Hampstead, 10’7in Lewisham, 10-9 in Paddington, 11’3 in the Cityof London, and 11’4 in Woolwich, to 15-9 in Chelseaand in Finsbury, 16’7 in Southwark, 17’1 in Shoreditch,17-3 in Poplar, and 18-1 in Holborn. The 4542 deathsfrom all causes included 233 which were referred to theprincipal infectious diseases; of these, 10 resulted frommeasles, 24 from scarlet fever, 92 from diphtheria, 9 fromwhooping-cough, 3 from enteric fever, and 95 from diarrhoeaand enteritis among children under 2 years of age. Amongthe metropolitan boroughs the lowest death-rates from thesediseases were recorded in Hammersmith, the City of West-minster, Hampstead, St. Pancras, Stoke Newington, Holborn,and Greenwich ; and the highest in Islington, Finsbury,Shoreditch, Bethnal Green, Southwark, and Bermondsey.The 10 deaths from measles were only one-fifth of theaverage number in the corresponding period of the fivepreceding years ; of these, 2 belonged to Shoreditch, 2 to

Bethnal Green, and 2 to Poplar. The 24 fatal cases of scarletfever exceeded the average by 10; of these, 2 belonged to eachof the boroughs of Hammersmith, Islington, Shoreditch,Stepney, Southwark, Wandsworth, and Camberwell. The 92deaths from diphtheria exceeded the average number by25; the greatest proportional mortality from this diseaseoccurred in Islington, Finsbury, Bethnal Green, Poplar,Bermondsey, and Lewisham. The 9 fatal cases of whooping-cough were one-third of the average; of these, 2 belongedto Finsbury. Three deaths from enteric fever were regis-

ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING NOVEMBER, 1920.

(Specially compiledfor THE LANCET.)

* Including membxanous croup.

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tered during the month, against an average of 7. The95 fatal cases of infantile diarrhoea showed a decline of 16from the average ; the greatest proportional mortality fromthis disease occurred in Kensington, Haokney, the City ofLondon, Shoreditch, Bethnal Green, and Southwark. Inconclusion, it may be stated that the aggregate mortalityin London during November from these principal infectiousdiseases was 15’6 per cent. below the average in the corre-sponding period of the five preceding years.

(Week ended Dec. 4th, 1920.)English and Welsh Towns.-In the 96 English and Welsh

towns, with an aggregate civil population estimated at nearly18 million persons, the annual rate of mortality, which hadbeen 13’4, 12’8, and 13’5 in the three preceding weeks, fellto 13’2 per 1000. In London, with a population of nearly4 million persons, the death-rate was 13-1, or 1-0 per1000 below that recorded in the previous week, whileamong the remaining towns the rates ranged from 7-4 inEdmonton and in Southend-on-Sea, 7’8 in Norwich, and 7’9in Ilford, to 19.4in Gateshead, 20’7 in Tynemouth, and 22-1 inMiddlesbrough. The principal epidemic diseases caused 204deaths, which corresponded to an annual rate of 0’6 per 1000,and comprised 94 from intantile diarrhœa, 59 from diphtheria,18 from measles, 16 from whooping-cough, 15 from scarletfever, and 2 from enteric fever. The mortality from thesediseases slrowed no marked excess in any of the large towns.There were 5438 cases of scarlet fever and 2655 of diphtheriaunder treatment in the Metropolitan Asylums Hospitalsand the London Fever Hospital, against 5575 and 2626 respec-tively at the end of the previous week. The causes of 27 ofthe 4494 deaths in the 96 towns were uncertified, of which4 were registered in Birmingham, and 2 each in London,Hull, Darlington, South Sh’lelds, and Tynemouth.

Scottish Towns.-In the 16 largest Scottish towns, with anaggregate population estimated at nearly 2 million persons,the annual rate of mortality, which had been 14-3, 13’6,and 14’3 in the three preceding weeks, fell to 13’5 per1000. The 298 deaths in Glasgow corresponded to an annualrate of 14-0 per 1000, and included 6 from diphtheria, 3 frominfantile diarrhoea, and 1 each from enteric fever and scarletfever. The 73 deaths in Edinburgh were equal to a rateof 11’2 per 1000; no fatal case of any of the principalinfectious diseases was registered during the week.Irish Towns.-The 116 deaths in Dublin ’corresponded

to an annual rate of 14-6, or 1’1 per 1000 below thatrecorded in the previous week, and included 4 from infantilediarrhoea, 3 from diphtheria, and 1 from whooping-cough.The 105 deaths in Belfast were equal to a rate of 13’3per 1000, and included 6 from infantile diarrhoea, 3 fromwhooping-cough, 2 from diphtheria, and 1 from measles.

The Services.ARMY MEDICAL SERVICE. II

Temp. Major-Gen. Sir R. James (Major, R.A.M.C., T.F.) relin- quishes his temporary commission. !

Col. F. Kiddle retires on retired pay. ’,

ROYAL ARMY MEDICAL CORPS.Lieut.-Col. P. J. Probyn retires on retired pay. ’

Major A. C. Duffey is placed on the half-pay list on account ofill-health.Major H. E. J. A. Howley retires on retired pay and is granted

the rank of Lieutenant-Colonel. -

Captains to be acting Majors: C. R. Dudgeon and H. G. Winter.Capt. B. H. C. Lea-Wilson is restored to the establishment.Capt. J. D. Duncan (5th R. Highrs., T.F.) to be temporary Captain.The undermentioned Lieutenants (temporary Captains) to be

Captains : J. M. Morrison and J. S. B. Forbes.Officers relinquishing their commissions:-Capt. C. W. Wise ;

Temp. Capt. W. F. Abbott (granted the rank of Major). Temp.Captains retaining the rank of Captain: T. H. R. Crowle, J.McCulloch, and J. G. Garson.

SPECIAL RESERVE OF OFFICERS.

Captains relinquishing their commissions and retaining the rankof Captain : A. B. MeA. Lang, C. K. Mowll, D. G. Duff, D. Finlayson,T. Fleming, F. W. A. Watt, J. H. Brown. C. S. Baxter, D. C. Lamont,D. Fergusson, W. Scotland, A. M. Davidson, A. S. Goudie, A. G. F.McArthur, W. Napier, A. K. I. Jones, J. W. H. Grice, F. L. Whincup,R. Andrew, and G. Winter. -

INDIAN MEDICAL SERVICE.The King has approved the retirement of Lieut.-Cols. R. H. Castor

and J. Davidson, and Major V. B. Nesfield.

UNIVERSITY OF EDINBURGH : CAMERON PRIZE INTHERAPEUTICS.—Sir Robert Jones, who last July wasawarded the Cameron prize in therapeutics, will give anaddress in Edinburgh University early in January. He hasplaced the amount of the emolument constituting the prizeat the disposal of the University authorities for the purposeof founding an annual prize in therapeutics.

Correspondence.

THE POLICY OF THE LONDON PANELCOMMITTEE.

"

Audi alteram partem."

To the Editor of THE LANCET.

SIR,-The .criticisms that have appeared in themedical press of the action of the London Panel Com-mittee in refusing to take part in the election of theInsurance Acts Committee of the British MedicalAssociation, indicate that the Committee’s motive forthis course has been misunderstood. In view of the

approaching elections of Panel Committees in mostdistricts (although not in London, since an election tookplace there last summer) it appears desirable that theposition of the London Panel Committee should bemade clear, so’ that individual practitioners who sharethe views of the majority of London men may supportcandidates of like opinions to represent them on theirPanel Committees.

’

The London policy is quite simple. It being agreedthat the conditions of service and terms of remunera-tion under the Insurance Acts can only be satis-factorily arranged by the method of collectivebargaining, it is contended that it is right that thebody to, whom is entrusted the duty of conductingsuch bargaining should consist entirely of personsdirectly elected by, and solely responsible to, thoseon whose behalf they are negotiating. The actiontaken by the London Panel Committee in determiningnot to be represented on the Insurance Acts Committeewas not decided upon without due consideration. Thejustification for the action is not that any exception istaken to the personnel of the Insurance Acts Committeebut to its constitution. The London Panel Committeeare of opinion that the body negotiating with theGovernment on behalf of the panel practitioners shouldbe elected by the panel profession, and exception istaken to the fact that six members of the InsuranceActs Committee are elected by the representativemeeting, and these six, together with the four ex-officiomembers of the British Medical Association Committees,in reality constitute the Insurance Acts Committee.These ten may coopt the representatives of localmedical and panel committees, and whilst in actualpractice they have always done so, yet the fact remainsthat the cooptjion is permissive. But even if we admitthat a compulsory cooption might be better, there stillremains the fact that ten members do not directlyrepresent, nor are they directly elected by, panel prac-titioners through their panel committees. The view ofthe London Panel Committee is that the negotiatingbody should be the executive of, and elected by, theConference of Local Medical and Panel Committees;that each member of the negotiating body should derivehis authority from that Conference. The inclusion ona negotiating body of persons, however competent inthemselves, who are not directly elected is liable tolessen the cofidence of those who are to be bound bythe conclusions arrived at, and thereby to lead to therisk of a repudiation of the terms agreed upon. TheLondon Panel Committee are also of opinion that thecost of such conference and of its executive should beborne by practitioners through their panel committees.It is felt that the expense should in no part be borneby any outside association or union, and that under nocircumstances should money, so allocated, be used forany other purpose than that of safeguarding theinterests of the panel profession.

It has been represented that this policy might beconstrued as3ungrateful or hostile to the British MedicalAssociation. The London Panel Committee believe thata majority of their members are loyal members of theAssociation, who regard it as in the best interests ofthe Association that it should be free to voice the viewsof all classes of the profession, and should not be opento the criticism that it is unevenly dominated by theinterests of Insurance practitioners or of any othersection of its members. The London Panel Committee