186 LOOKING BACK.-VITAL STATISTICS.

however, showed a fall in the probability in the seventhmonth of life which is not noticeable in the table for 1905.The influence of social condition on mortality at different

periods of the first year of life is well shown in a table inwhich are compared the rates of infant mortality obtainingin groups of metropolitan districts arranged according to

degrees of overcrowding as revealed by the recent census.Allowing for some irregularities in the rates due to the factpreviously noted that the births in lying-in institutions havenot been distributed to the di-tricts in which the mothersreside, it appears that the mortality of infants in their firstyear increases with the proportion of the population at allages living in overcrowded tenements. When the figures foreach’ , trimester" are considered the same phenomenon isobservable but the fact particularly deserves notice that thedifference in mortality between the least and the mostovercrowded groups is the least marked in the firstthree months of life, more marked in the second,still more marked in the third, and most marked of all in thefourth three-month period of life. This important questionof the influence of social condition on infantile mortality isbrought into prominence for the first time in the presentreport. Unfortunately a similar method has not as yetbeen attempted for other parts of the United Kingdom, butuntil this has been done no trustworthy data will be avail-able whereby the relation of social circumstances to infantvitality can he looked for. Sir Shirley Murphy has dividedthe districts of London into five groups in the increasingorder of overcrowding, the first group showing a pro-portion of 8 per cent. of the population living inone room and the fifth group a proportion of 28 percent. Owing probably to the more complete registrationof births and deaths in the better circumstanced districtsthe mortality in the most overcrowded group in the firstmonth of life scarcely exceeds that of the group that is leastovercrowded. As age progresses, however, the differencencreases and this may be due either to decrease of the’ifference of death registration in the several districts or to"the effect of environment becoming more marked as it isafforded a longer time in which to operate." AlthoughSir Shirley Murphy very properly hesitates to straininferences from the experience of a single year, neverthelesshe thinks that the figures which he has published tend toinvalidate the conclusion expressed by some persons thatante-natal conditions constitute a predominant factor indetermining infant mortality.

Looking Back.FROM

THE LANCET, SATURDAY, Jan. 17th, 1829.

REMARKABLE CASE OF COMPLETE ABSTINENCE.

ANNA GARBERO, of Racconis in Piemont, died on the 19thof May, 1828, after having been for two years, eight months,and elevtn days, without any solid or liquid nourishment.Sixteen hours after death she was examined by MM. Rolandoand Gallo, of Turin. The serous and synovial membraneswere dry, and resembled parchment ; the diameter of theprincipal veins and arteries was much less than usual, butthe most remarkable morbid alteration was that of the

digestive organs ; the transverse colon had descended to thehypogastric region, its two extremities remaining fixed intheir natural situation ; the stomach had descended in asimilar manner ; and being much contracted, had the

appearance of part of the larger intestine. The duodenumwas in a natural condition, but the other small intestineswere considerably contracted ; the lower part of the

coeoum, and the middle portion of the transverse colon,contained small hardened scybala ; at the lower part of thecolon descendens, the membranes of the intestinal canalwere thickened and callous, so as to hinder the further

progress of the excrement; and in the sigmoid flexure, itwas completely obliterated. The mucous membrane of thestomach was softened and friable ; that of the intestinalcanal had undergone the same alteration, and was of a browncolour, such as is observed in incipient gangrene; thevalvulm conniventes were hardened, and the whole tract ofthe small intestines was empty. The mucous membrane of

the rectum was of a violet colour, thickened, beset with hardscirrhous excrescences, and covered with very foetid pus.The mesenteric glands were in a natural condition ; the

epiploon and mesentery exhibited no traces of fat, and werenearly in the same state as the pleura and peritoneum.-Annali di 0/KC<M.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 9413 births and 6348deaths were registered during the week ending Jan. 12th.The annual rate of mortality, which had been equal to 19’7 7and 22 4 per 1000 in the two preceding weeks, declinedagain to 20’ 7 in the week under notice. During the 13weeks of last quarter the death-rate in these towns

averaged only 16’2 per 1000, the rate during the same

period in London being 16’0. The lowest death-rates in the76 towns during last week were 8’ 7 in Hornsey, 10’ 3 inKing’s Norton, 14’ 3 in Willesden, and 14’ 4 in Aston Manor,in Rhondda, and in Barrow in-Furnes ; the rates in theother towns ranged upwards to 30 2 in West Bromwich,31 5 in Brighton, 31 8 in Hanley, and 32 8 in Middles-brough. The 6348 deaths in the 76 towns showed a

decline of 531 from the high number in the previousweeks, which was partly due to the delay of registrationduring the Christmas holidays. They included 423 whichwere referred to the principal epidemic diseases, against430 and 478 in the two preceding weeks ; of these,140 resulted from measles, 91 from whooping-cough, 70from diphtheria, 47 from diarrhoea, 41 from scarlet fever,34 from "fever" (principally enteric), and not one fromsmall-pox. The deaths from these epidemic diseases wereequal to an annual rate of 1 - 4 per 1000 in the 76 towns ;the rate in London from the same diseases did not exceed1’ 2. No death from any of these epidemic diseases wasregistered last week in Halifax, Northampton, York, Coventry,or in eight other of the 76 towns ; the annual death ratetherefrcm, however, ranged upwards to 4’7 in Smethwick,Bootle, and Hull, and 8’ 2 in Warrington. The fatal cases ofmeasles showed the largest proportional excess in West Ham,Leicester, Bootle, Rotherham, Hull, and Warrington ; andwhovping-cough in Huddersfield, Leyton, Rotherham, andWalthamstow. The 70 deaths from diphtheria showed adecline of 29 from the number in the previous week, but thisdisease caused a high death-rate in Reading, Smethwick, andLeyton ; the deaths from scarlet fever also showed an excess inSmethwick and Hanlev. The deaths referred to "fever"included 11 in London, two in Birmingham, two in Salford,two in Blackburn, and two in Swansea. The fatal cases ofdiarrhoea were fewer than in recent weeks. No case of small-

pox has been under treatment in the Metropolitan AsylumsHospitals since the end of June last. The number of scarletfever patients under treatment in the Metropolitan AsylumsHospitals and in the London Fever Hospital, which hadbeen 3846 and 3707 in the two preceding weeks, had furtherdeclined to 3521 at the end of the week under notice; 285new cases were admitted to these hospitals during the week,against 237 and 309 in the two previous weeks. The deathsin London referred to pneumonia and other diseases ofthe respiratory organs, which had steadily increased inthe six preceding weeks from 312 to 718, declined again to620 in the week under notice, but exceeded the correctedaverage in the corresponding week of the last five years by261 ; 83 deaths were also referred to influenza. The causesof 62, or 1’ 0 per cent , of the deaths registered during theweek were not certified either by a registered medical prac-titioner or by a coroner. All the causes of death were dulycertified in Leeds, Bristol, West Ham, Salford, Newcastle-on-Tyne, and in 38 other of the 76 towns ; the proportionof uncertified deaths, however, again showed a considerableexcess in Liverpool, Birmingham, St. Helens, Sunderland,and Gateshead.

____

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 19’ 0 and 22 9 in thetwo preceding weeks, declined again to 20’8 in theweek ending Jan. 12th, and was almost identical with therate recorded during the same week in the 76 English towns.

187VITAL STATISTICS.-THE SERVICES.

The rates in the eight Scotch towns ranged from 18’ 2 and I19’ 2 in Paisley and Edinburgh, to 24-0 0 in Perth and 25 - 6in Greenock. The 721 deaths in the eight towns showed adecline of 75 from the number returned in the previousweek, and included 67 which were referred to the

principal epidemic diseases, against 55 and 71 in thetwo preceding weeks. These 76 deaths were equal to anannual rate of 1’ 9 per 1000, which exceeded by 0’ 5 therate from the same diseases in the 76 English towns ;they included 19 which were referred to whooping-cough,18 to "fever," 12 to diarrhoea, nine to measles, six to

diphtheria, three to scarlet fever, and not one to small-

pox. The 19 fatal cases of whooping-cough showed a slightincrease, and included 13 in Glasgow and four in Greenock.The 18 deaths from "fever" exceeded the number in anyrecent week, 14 occurring in Glasgow and four in Edin-

burgh ; 11 of these I I fever " deaths in Glasgow and three inEdinburgh were certified as cerebro-spinal meningitis. Fourdeaths were attributed to diarrhoea both in Glasgow and inEdinburgh. Five fatal cases of measles were returned in Aber-deen and two in Edinburgh; three deaths from diphtheriaand the two from scarlet fever were recorded in Glasgow. Thedeaths in the eight towns referred to diseases of the respira-tory organs, including pneumonia, which had been 119, 167,and 182 in the three preceding weeks, further rose to 185in the week under notice, and exceeded the numberreturned in the corresponding week of last year by 59.The causes of 22, or 3’ 0 per cent., of the deaths registeredduring the week in the eight towns were not certified or werenot stated ; the mean proportion of uncertified deaths in the76 English towns during the week did not exceed 1’ 0 percent.

____

HEALTH OF DUBLIN.

The annual death-rate in Dublin, which had been equalto 28’ 8, 18’ 4, and 31-9 in the three preceding weeks,declined again to 29’ 0 in the week ending Jan. 12th. Duringthe 13 weeks of last quarter the death-rate in the cityaveraged 23 - 9 per 1000, the mean rate during the sameperiod being only 16’0 in London and 16’2 in Edinburgh.The 219 deaths of Dublin residents during the week undernotice showed a decline of 22 from the high numberin the previous week, which excess was mainly due tothe delay of registration during the Christmas week; theyincluded eight which were referred to the principal epidemicdiseases, against five and 19 in the two preceding weeks.These eight deaths were equal to an annual rate of 1 - 1 per1000, against 1’2 in London and 1-8 in Edinburgh. These

eight deaths from these epidemic diseases in Dublin last weekincluded three from measles, two from whooping-cough, two Ifrom diarrhoea, one from " fever," and not one either fromscarlet fever, diphtheria or small-pox. The fatal cases ofmeasles corresponded with the number in the previous week,while those both of whooping-cough and diarrhoea showed amarked decline. Four inquest cases and one death fromviolence were registered during the week; and 87, or

40’1 1 per cent., of the deaths occurred in public institutions.The causes of seven, or 3’ 2 per cent., of the deaths

registered in the city during the week were not certified ;the percentage of uncertified deaths in the week undernotice did not exceed 0 - 2 in London, while it was 3 - 1 inEdinburgh.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

THE following appointments are notified :-Fleet Surgeons :P. V. Jackson to the Sapphire on recommissioning, andP. E. Maitland to the Majestic. Staff Surgeon : J. Martin tothe President, for three months’ course at West London Hos-pital. Surgeon: F. C. Robinson to the Sapphire on recom-missioning, to be lent to the Tyne. i

In accordance with the provisions of Her late Majesty’sOrder in Council of April lst, ] 881, Staff Surgeon AlbertBobart has been allowed to withdraw from His Majesty’sNaval Service with a gratuity.

ROYAL ARMY MEDICAL CORPS.

Major R. W. H. Jackson, specialist sanitary officer at

Dublin, is appointed to the Belfast District. Captain E.Brodribb, from Gibraltar, is appointed for duty at Kilkenny,and Captain S. de C. O’Grady from Limerick to Dublin.Captain F. S. Penny joins the London District for duty.

ROYAL ARMY MEDICAL CORPS IN INDIA.

Lieutenant-Colonel J. J. C. Bennett has assumed commandof the Station Hospital, Saugor, on return from leave. MajorF. W. Begbie has been posted for duty in the 5th Division.Captain L. L. G. Thorpe has returned from leave and hasarrived at Jubbulpore. Captain A. W. Gibson has left Dthalafor Aden. Captain T. F. Ritchie is granted 60 days generalleave from Dec. 7th, 1906. Lieutenant J. Campbell is

appointed specialist in the prevention of disease.

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Major-General Lord Cheylesmore, C.V.O.,will distribute

the prizps of the London Companies Royal Army MedicalCorps (Volunteers), on Saturday, Feb. 9bh, at their head-quarters, 51, Calthorpe-street, Gray’s Inn-road, London,W.C.

MR. HALDANE’S NEW ARMY SCHEME.

The Army Order recently issued puts us in possession ofsome very important information regarding the greatchanges, which are still, however, quite incomplete, proposedto be carried out in Mr. Haldane’s new army scheme. Thereis little or nothing in the Army Order or in the explanatorymemorandum accompanying it which calls in any special wayfor medical comment. Nevertheless, as no great and funda-mental changes can take place in the army as a whole withoutmore or less affecting every branch and department of it,and as the present War Minister’s declared aim and object areto develop, if not to create, a national army and to organise anew and comprehensive system of national defence we mayventure to express some of the impressions that haveoccurred to us. Seeing, moreover, that any movement inthis direction is necessarily intimately associated with thatof the maintenance of our national stamina and vigour itbecomes a question of public health. On this relation,however, there is no need to enter here beyond callingattention to the important bearing which it has uponthis army problem. As regards the titular changesintroduced, for British military purposes a division isa handier tactical unit and one more in accordancewith the army traditions of this country and with thepresent organisation of our Indian army than an armycorps. Divisions and brigades lend themselves well to

army medical organisation purposes. We can only sup-pose, however, that before Mr. Haldane for economicalreasons made the reductions that he did in the regular armyof trained soldiers he had taken some steps to ascertain howhis new proposals for recruiting and reorganising the regulararmy from the non-regular-as to foreign service, for

example-were likely to be received and to work, for onthis success mainly depends. It is as impossible to havea river without water as an army without recruits, andthe quality, in training and efficiency, of any forceto take the field against that of a ContinentalPower has in the present day to be of the best,As we have already said, no one can doubt Mr. Haldane’ssincerity of purpose and breadth of view. The object whichhe seeks has, and should have, no element of political partyspirit about it. The appearance of his complete schemewill naturally be awaited with great interest and curiosity,and should it prove reasonably adequate to the needs of theoccasion and likely to lead to some settlement of this

question on a satisfactory basis he will have well deservedall the praise which he will surely obtain from men of allparties.

NAVAL MEDICAL SUPPLEMENTAL FUND.

At the quarterly meeting of the directors of the NavalMedical Supplemental Fund held on Jan. 15th, when Sir J.Dick, K.C.B., presided, the sum of f.62 was distributedamong the several applicants.THE NEW ARMY MEDICAL SERVICE ADVISORY BOARD.

The personnel of the reconstructed Advisory Board formedby the amalgamation of the Army Medical Advisory Boardand the Army Hospital Sanitary Committee has now beenannounced. We publish the names in another column (seep. 178) and believe that our readers will agree with us that

i the selection of members has been made judiciously.