185VITAL STATISTICS.

therefore be some increased risk of pollution on the growthof the town in that direction." Although the sewers anddrains within a radius of a quarter of a mile of thesewells have been, it is said, carefully constructed and arereported to be under careful supervision we can quiteunderstand the misgivings of Dr. Richards upon the wholequestion, more particularly as it is upon these wells thatCroydon is dependent for the bulk of its water-supply.Filtration of this supply would certainly seem to beindicated. Dr. Richards suggests consideration by the LocalGovernment Board of the whole question but possibly thatBoard might take the view that the Royal Commission onSewage Disposal has indicated a way out of the difficulty bythe appointment of Rivers Boards, which boards should havecontrol of sewage disposal and water-supply in their districts.During 1905 a nurse was admitted into the isolation hospitalunder the following circumstances. Her mistress who wassuffering from Malta fever left Malta with the nurse onJuly 2nd, reaching London on July 10th. Shortly afterarrival the mistress suffered from a relapse and on August lstthe nurse who had remained with her mistress was attackedwith an illness resembling enteric fever. But as the

symptoms were somewhat anomalous a specimen of herblood was examined to ascertain whether it would agglu-tinate a culture of micrococcus Melitensis and a positiveresult was obtained, the subsequent course of the case con-firming the diagnosis of Malta fever. The case, as Dr.Richards observes, raises some interesting speculations.Reporting to the education authority on March 23rd, 1906,Dr. Richards states that at that time there were no less than180 children excluded from school on account of ringwormand he sets forth various reasons as to why the councilshould undertake the treatment of this condition. Hehas also, in his capacity as medical officer to the educationauthority, obtained data as regards the physical conditionof school children and for purposes of comparison he hasexamined the boys in the Grammar School and the girls inthe High School. The whole report as regards schoolsshows what a large tax the work must make upon the timeof a medical officer of health and it accentuates the im-

portance of assistance being provided for that officer.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8322 births and 3556deaths were registered during the week ending July 14th.The annual rate of mortality in these towns, which hadbeen 12’ 4 and 12’ 3 in the two preceding weeks, furtherdeclined last week to 11 - per 1000, and was the lowestrate recorded in any week of the present year. Duringthe past four weeks the death-rate in these townshas averaged 12’4 per 1000, while in London the averagerate during the same period has been as low as 12’ 3per 1000. The lowest death-rates last week in the 76towns were 4’9 9 in Newport (Mon.), 56 6 in East Ham,6’ 2 in Hastings, 68 8 in Grimsby, and 6’ 9 in Bourne-mouth ; the highest rates were 17 - in St. Helens andin Burnley, 19’ 8 in Huddersfield, and 20’ 3 in Rochdale.The 3556 deaths in the 76 towns last week were 165 belowthe numbers in the previous week, and included 361 that wereattributed to the principal epidemic diseases, against 372 and406 in the two preceding weeks ; of these, 113 resulted fromdiarrhoea, 97 from measles, 59 from whooping-cough, 39from diphtheria, 27 from " fever " (principally enteric), 25from scarlet fever, and one from small-pox. The deaths fromthese principal epidemic diseases were equal to an annualrate of 1 - 2 per 1000 in the 76 towns and to 1 - 0 per 1000 inLondon. No death from any of these diseases was recordedlast week in Rhondda, Southampton, Stockport, Walsall, orin 12 other smaller towns, while they caused death-ratesexceeding 2’5 per 1000 in West Ham, Manchester, Burnley,Preston, Rotherham, and Middlesbrough. The highest death-rates from measles occurred in Manchester, Burnley, Hud-dersfield, and Halifax; from whooping-cough in Rotherham,Middlesbrough, and Sunderland ; and from diarrhoea in WestHam, Norwich, Bootle, and Preston. The 39 fatal casesof diphtheria included nine in London, four in Liverpool,and three in Bristol ; scarlet fever caused six deaths inLondon, four in Sheffield, and two each in Birminghamand Rotherham ; while of the 27 deaths from "fever" "

four belonged to London, four to West Ham, and two to

Oldham. The fatal case of small-pox was registered in Hull.The four cases of small-pox under treatment in theMetropolitan Asylums hospitals at the end of last weekshowed a further decline from recent weekly numbers,and no new case was admitted during the week. Thenumber of scarlet fever patients under treatment in thesehospitals and in the London Fever Hospital on Saturday,July 14th, was 2840, or 73 more than the number on theprevious Saturday ; 406 new cases were admitted duringthe week, against 366 and 377 in the two preceding weeks.The deaths in London referred to pneumonia and otherdiseases of the respiratory organs, which had continuouslydeclined in the 12 preceding weeks from 399 to 118, were119 last week, but were 17 below the corrected average forthe corresponding week of the four years 1902-05. Thecauses of 33, or 0 9 per cent., of the deaths registered inthe 76 towns were not certified either by a registeredmedical practitioner or by a coroner. In West Ham,Portsmouth, Bristol, Manchester, Salford, Bradford, Leeds,Sheffield, and in 42 other smaller towns the causes of all thedeaths were duly certified; only one uncertified death wasregistered in London and in each of 21 other smaller towns ;while there were two such cases in Sunderland and threeeach in Leicester, Liverpool, and Gateshead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 16’0, 14’5, and 15 ’ 3per 1000 in the three preceding weeks, declined againto 14’ 3 per 1000 in the week ending July 14th, but was 2’ 6per 1000 in excess of the rate in the 76 large Englishtowns. The rates in the eight Scotch towns last weekranged from 10’ 2 in Paisley and 10’ 7 in Leith to 15’ 5in Glasgow and in Dundee and 17 ’ 0 in Greenock. The 491deaths in the eight towns showed a decrease of 33 fromthe number registered in the preceding week, and included22 which were referred to diarrhoea, 17 to whooping-cough,12 to measles, seven to "fever," three to diphtheria, twoto scarlet fever, and not one to small-pox. In all, 63

deaths resulted from these principal epidemic diseases lastweek, against 59 and 50 in the two preceding weeks; theywere equal to an annual rate of 1 8 per 1000, which was0 6 above the average rate during the week from the samediseases in the 76 English towns. The 22 deaths attributedto diarrhoea in the Scotch towns showed a slight increaseupon the numbers in the two preceding weeks andincluded 14 in Glasgow, four in Dundee, and threein Aberdeen. The fatal cases of whooping-cough, whichhad been nine and eight in the two previous weeks,rose last wek to 17, of which nine occurred in

Glasgow, five in Aberdeen, and two in Leith. The 12 deathsfrom measles were slightly in excess of the numbers in thetwo preceding weeks, and included seven in Edinburgh andfive in Glasgow. All the seven deaths from "fever," ofwhich four were returned as cerebro-spinal fever, were

I recorded in Glasgow, as were also two of the three fatalcases of diphtheria. The deaths in the eight townsreferred to diseases of the respiratory organs, includingpneumonia, which had declined in the five preceding weeksfrom 95 to 52, rose again last week to 59, but were six

. below the number returned in the corresponding week ofi last year. The causes of 28, or 5’ 7 per cent., of the deaths, registered in the eight towns last week were not certified,l the proportion of uncertified deaths in the 76 large EnglishI towns during the same week being only 0’ 9 per cent..

___

HEALTH OF DUBLIN.’ The death-rate in Dublin, which had been 16’ 4 and 16 ’ 9per 1000 in the two preceding weeks, further rose to18’7 7 per 1000 during the week ending July 14th.During the past four weeks the death-rate has averaged18 1 per 1000, the rates during the same period being 12 ’ 3 inLondon and 14’ 1 in Edinburgh. The 136 deaths of Dublinresidents registered during the week under notice were 13 inexcess of the number in the preceding week, and included 12which were referred to the principal epidemic diseases,against three, five, and four in the three preceding weeks ;of these, six resulted from whooping-cough, three from

diarrhoea, two from "fever," and one from measles.These 12 deaths were equal to an annual rate of1’7 7 per 1000, the death-rates last week from the

principal epidemic diseases being 1’ in London and

186 VITAL STATISTICS OF LONDON DURING JUNE, 1906.

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187VITAL STATISTICS OF LONDON DURING JUNE, 1906.-THE SERVICES.

1’4 in Edinburgh. The six fatal cases of whooping- 1cough exceeded the number recorded in any previous weekof the year, the deaths from this cause in the three pre-ceding weeks being two, one, and four. The 136 deathsfrom all causes in Dublin last week included 25 of infantsunder one year of age and 32 of persons aged upwards of60 years. Four inquest cases and two deaths from violencewere registered. The deaths occurring in public institutionsnumbered 61, or nearly 45 per cent., of the total deaths ; inLondon the proportion was 42 per cent. The causes of two,or nearly 1’5 5 per cent., of the deaths registered in Dublinlast week were not certified either by a registered medicalpractitioner or by a coroner ; in London only one of the1072 deaths was uncertified, while in Edinburgh the pro-portion was 11 6 per cent.

VITAL STATISTICS OF LONDON DURING JUNE, 1906.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 it

appears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in the tablewas equal to an annual rate of 7 ’ 6 per 1000 of the population,estimated at 4,721,217 persons in the middle of the year.In the three preceding months the rates had been 5’ 7,5’9, and 6 - 4 per 1000 respectively. The lowest rates lastmonth were recorded in Kensington, Hampstead, StokeNewington, Holborn, Poplar, and Lewisham ; and thehighest rates in Finsbury, the City of London, Shore-ditch, Stepney, Bermondsey, and Greenwich. Ten casesof small-pox were notified last month, against seven,one, and six in the three preceding months ; of theseten cases, six belonged to Camberwell, two to Hackney,and one each to Paddington and Bethnal Green. The

Metropolitan Asylums hospitals contained 11 small-poxpatients at the end of last month, against ten, six, and fiveat the end of the three preceding months. The prevalenceof scarlet fever showed a slight excess in June as comparedwith the previous months of this year; this disease was

proportionally most prevalent in the City of London andin the boroughs of Hammersmith, Shoreditch, Stepney,Bermondsey, Battersea, and Greenwich. The MetropolitanAsylums hospitals contained 2705 scarlet fever patients atthe end of last month, against 2353, 2192, and 2462 at theend of the three preceding months ; the weekly admissionsaveraged 354, against 238, 282, and 321 in the three

preceding months. Diphtheria was considerably more

prevalent than in the preceding month ; the greatestproportional prevalence of this disease was recordedin Fulham, Finsbury, Stepney, Bermondsey, and Green-wich. The number of diphtheria patients in the Metro-politan Asylums hospitals, which had been 924, 860,and 760 at the end of the three preceding months,had risen again to 782 at the end of last month ; theweekly admissions averaged 114, against 111, 103, and 98in the three preceding months. The prevalence of entericfever was greater last month than in any other recentmonth; amongst the various metropolitan boroughs thisdisease was proportionally most prevalent in Chelsea,Islington, Finsbury, Bethnal Green, Southwark, andLambeth. There were 93 enteric fever patients undertreatment in the Metropolitan Asylums hospitals at the endof last month, against 65, 56, and 41 at the end of thethree preceding months ; the weekly admissions averaged20, against 11, 11, and 12 in the three preceding months.Erysipelas was proportionally most prevalent in Hammer-smith, Chelsea, St. Pancras, Stepney, Bermondsey, andWandsworth. The 17 cases of puerperal fever includedfive belonging to Islington and three each to Finsbury andLambeth.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various boroughs, thedeaths occurring in public institutions having been distri-buted among the boroughs in which the deceased personshad previously resided. During the four weeks endingJune 30th 4305 deaths of persons belonging to Londonwere registered, equal to an annual rate of 11’ 9 per1000 of the population ; in the three preceding months therates had been 16 ’ 2, 17 - 0, and 13 - 8 per 1000. The death-rates last month ranged from 8 - 0 in Hampstead, 8’ 2 inWoolwich, 8 ’4 in Lewisham, 9’1 in Stoke Newington,and 9’ 4 in Hackney and Battersea, to 14’ 7 in Shoreditch

and in Bethnal Green, 15’5 5 in Bermondsey, 15 9 in Holbornand in the City of London, 16’4 in Chelsea, and 17’4 inFinsbury. The 4305 deaths from all causes in London lastmonth included 436 which were referred to the principal infec-tious diseases ; of these, 198 resulted from measles, 39 fromscarlet fever, 34 from diphtheria, 77 from whooping-cough,20 from enteric fever, and 68 from diarrhoea. No deathfrom any of these diseases was recorded in the City ofLondon ; among the metropolitan boroughs they caused thek)we"t rates in the City of Westminster, Hampstead, StokeNewington, Lewisham, and Woolwich; and the highestrates in St. Pancras, Holborn, Finsbury, Shoreditch, BethnalGreen, Poplar, and Bermondsey. The 198 deaths frommeasles were slightly above the corrected average numberin the corresponding periods of the four preceding years;this disease was proportionally most fatal in St. Pancras,Holborn, Fins bury, Shoreditch, Poplar, and Bermondsey.The 39 fatal cases of scarlet fever were seven in excess ofthe corrected average number; the greatest proportionalmortality from this disease occurred in Paddington,Hammersmith, Chelsea, St. Pancras, Bethnal Green, Stepney,Bermondsey, and Lambeth. The 34 deaths from diphtheriawere 11 fewer than the average for the correspondingperiods of the four preceding years ; among the variousmetropolitan boroughs diphtheria was proportionally mostfatal in the City of Westminster, St. Marylebone,Finsbury, Stepney, and Lambeth. The 77 fatal cases

of whooping-cough showed a decline of 44 from thecorrected average number; the highest death-ratesfrom this disease were recorded in Holborn, Finsbury,Shoreditch, Bethnal Green, Bermondsey, Battersea, andWandsworth. The 20 deaths from "fever" were slightlyin excess of the average for the corresponding periods of thefour preceding years ; of these 20 deaths three belonged toIslington, two each to St. Pancras and Southwark, and oneeach to 13 other boroughs. The 68 fatal cases of diarrhoeawere considerably below the corrected average number ;among the various metropolitan boroughs this disease wasproportionally most fatal in Paddington, Fulham, Shore-ditch, Southwark, Bermondsey, Camberwell, and Deptford.In conclusion, it may be stated that the aggregate mortalityin London last month from the principal infectious diseaseswas nearly 16 per cent. below the average.

Infant mortality, measured by the proportion of deathsamong children under one year of age to registered births,was equal to 85 per 1000. The lowest rates of infantmortality were recorded in Paddington, St. Marylebone, theCity of London, Wandsworth, Lewisham, and Woolwich;and the highest rates in Kensington, Chelsea, the City ofWestminster, St. Pancras, Holborn, and Shoreditch.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet Sur-

geons : J. Ll. Thomas to the Pembroke W. Hackett to thePresident, for three months’ course at West London Hos-pital. Staff Surgeons : E. G. E. O’Leary to the Thetis, onrecommissioning; M. J. Smith and H. W. B. Shewell to thePresident, for three months’ course at West London Hos-pital. Surgeons : A. 1. Sheldon to the Astr&aelig;a, and onrecommissioning ; P. G. Williams to the Alacrity, and onrecommissioning ; W. G. M. Anderson to the Impregnable,for the Inconstant; ; T. B. Shaw to the Royal NavalRendezvous, lent ; R. R Horley to the President, forthree months’ course at West London Hospital ; B. Pick,lent to Portland Hospital; J. J. H. Rooney to the Blake;W. Bastian to the President, for three months’ course atWest London Hospital; J. G. Watt to the Sirius; and P. L.Crosbie and J. H. le B. Page to the Vivid.

In accordance with the provisions of Her late Majesty’sOrder in Council of April lst, 1881, Surgeon George EdwardGlynn has been placed on the Retired List (dated July 5th,1906) ; Surgeon Frederick Francis Mahon has been promotedto the rank of Staff Surgeon in His Majesty’s Fleet (datedJuly llth, 1906).

I ROYAL ARMY MEDICAL CORPS.

Lieutenant-Colonel John M. Nicolls retires on retired I ay(dated July 14th, 1906). Captain Arthur E. Milner to beMajor (dated April 28th, 1906).