1174 VITAL STATISTICS.

an average attendance of 28,741 who are inspected bytwo school doctors assisted by school nurses. Treatmentis considered in detail and attention drawn to the increasein the efficiency of preventive treatment by thecoordination of school and public health functions. The

sanitary authority has further established a tuberculosis dis-pensary, i,o which school children are admitted free of

charge, and a cleansing station is in course of erection. Sir

’George Newman’s report is extensively quoted in regard tothe school clinic. Arrangements are in force with three

ophthalmic surgeons for treatment at 7s. a head for exami-nation and prescription, and opticians supply sphericallenses at 2s. 6d. and cylindrical at 4s. 6d. Seven dentistshave also agreed to attend school children at a reduced scaleof fees. The provision of X ray treatment for ringworm isunder consideration, and an open-air school is urged, anestimate of the cost being given at 448 17s. lld. net perannum for 82 children in average attendance. With regardto nutrition, it is stated that No exact meaning can beattached to figures under this heading." A precisely measur-able criterion of nutrition still appears to elude the effortsof many of us. Dr. Edward Walford’s whole report is

broadly conceived and puts the problems in true perspective,and is consequently not only more interesting reading butmore definitely useful than a bald recital of percentages.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 95 largest English towns, with an aggregate popula-tion estimated at 17,639,881 persons at the middle of thisyear, 8304 births and 4800 deaths were registered during theweek ending Oct. 19th. The annual rate of mortality inthese towns, which had steadily increased from 11’0 to13’7 per 1000 in the five preceding weeks, further rose to14’2 per 1000 in the week under notice. During the firstthree weeks of the current quarter the mean annual death-rate in these towns averaged 13-4 per 1000, against 15-2per 1000 in London during the same period. No death wasrecorded last week in the borough of Northampton, while inthe other towns the death-rates ranged from 4’9 9 in Oxford,5’8 8 in Gillingham, ;6’3 3 in Ilford, and 6’8 8 in Grimsby, to

17.9 9 in Sunderland, 18.2 2 in Liverpool, 19’1 in Bootle, 20’1 1in Middlesborough, and 20’ 3 in Dudley.The 4800 deaths from all causes were 171 in excess of

the number in the previous week, and included 426 whichwere referred to the principal epidemic diseases, againstnumbers rising from 310 to 394 in the three preceding weeks.Of these 426 deaths, 169 resulted from measles, 121 frominfantile diarrhoeal diseases, 49 from diphtheria, 36 fromwhooping-cough, 29 from scarlet fever, and 22 from entericfever, but not one from small-pox. The mean annual death-rate from these epidemic diseases last week was equalto 1-3 3 per 1000, against 1-0 0 and 1-2 2 in the two

preceding weeks. The deaths attributed to measles, whichhad been 67, 90, and 139 in the three preceding weeks,further rose to 169 last week, and caused the highest annualdeath-rates of 1’2 2 in Birmingham, 1’3 3 in Liverpool and inSwansea, 1-5 in Middlesbrough, 1-6 in Birkenhead and inWest Hartlepool, 1-7 in Wigan and in Rhondda, 2’1 inWest Ham, 2-6 in Tynemouth, and 2-7 in Lincoln. Thedeaths of infants under 2 years of age referred to diarrhoeaand enteritis, which had been 134, 153, and 129 in thethree preceding weeks, further declined to 121 last week,and included 46 in London and its suburban districts, 15 inLiverpool, 5 in Stoke-on-Trent, 5 in Birmingham, 4 in Man-chester, and 4 in Leeds. The fatal cases of diphtheria, whichhad been 41, 43; and 56 in the three preceding weeks, fellto 49 last week; 12 deaths occurred in London, 6 in Ports-mouth, 4 in Birmingham, 3 in Stoke-on-Trent, and 3 inManchester. The deaths attributed to whooping-cough,which had been 44, 29, and 33 in the three preceding weeks,were 36 last week; of this number, 14 were registered inLondon, 5 in Liverpool, and 2 each in West Ham, East Ham,Salford, and Burnley. The deaths referred to scarlet fever,which had been 17, 17, and 26 in the three preceding weeks,further rose to 29 last week, and included 8 in London, 5 inBirmingham, 2 in Portsmouth, and 2 in Liverpool. The fatalcases of enteric fever, which had been 7, 20, and 11 in the

three preceding weeks, rose to 22 last week ; 2 deaths were

recorded in London, in West Ham, in Manchester, and inBradford.The number of scarlet fever patients under treatment

in the Metropolitan Asylums and in the London Fever

Hospital, which had steadily risen from 1512 to 2095 inthe eight preceding weeks, had further increased to 2217 onSaturday last; 345 new cases of this disease were

admitted to these institutions during the week, against305, 317, and 322 in the three preceding weeks. These

hospitals also contained on Saturday last 940 cases of

diphtheria, 486 of measles, 267 of whooping-cough, and 53 ofenteric fever, but not one of small-pox. The 1454 deaths fromall causes in London were 111 in excess of the number inthe previous week, and were equal to an annual rateof 16-8 per 1000. The deaths referred to diseases of the

respiratory system, which had steadily risen from 103 to 282in the five preceding weeks, further rose to 327 in the weekunder notice, and were 99 in excess of the number recordedin the corresponding week of last year.Of the 4800 deaths from all causes in the 95 towns last

week, 197 resulted from different forms of violence, and433 were the subject of coroners’ inquests. The causes of 47,or 1’ 0 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 Manchester, Leeds, Bristol, West Ham, Bradford, Hull,Nottingham, Portsmouth, and in 66 other smaller towns.The 47 uncertified causes of death last week included 11 in

Birmingham, 5 in Liverpool, 5 in South Shields, and 3 inGateshead.

____

HEALTH OF SCOTCH TOWNS.

In the 18 largest Scotch towns, with an aggregate popula-tion estimated at 2,182,400 persons at the middle of this year,1110 births and 568 deaths were registered during the weekending Saturday, Oct. 19th. The annual rate of mortality inthese towns, which had been 13’0, 12-2, and 14’1 per1000 in the three preceding weeks, declined to 13-6 per1000 in the week under notice. During the first three weeksof the current quarter the mean annual rate of mortality inthese Scotch towns averaged 13’3 per 1000, against 13’4per 1000 in the 95 large English towns. Among theseveral Scotch towns the annual death-rates last week

ranged from 6’5 5 in Kirkcaldy, 6’9 9 in Govan, and 8’4 in

Partick, to 16 8 in Leith, 17’2 in Hamilton, and 18’9 9 inDundee.The 568 deaths from all causes were 23 fewer than the

number in the previous week, and included 32 which werereferred to the principal epidemic diseases, against numbersrising from 29 to 59 in the three preceding weeks. Ofthese 32 deaths, 11 resulted from diphtheria, 10 frominfantile diarrhoeal diseases, 6 from whooping-cough, 2 fromscarlet fever, 2 from enteric fever, and 1 from measles,but not one from small-pox. These 32 deaths from the

principal epidemic diseases were equal to an annual death-rate of 0-8 8 per 1000, against 1-3 3 in the 95 large Englishtowns. The deaths attributed to diphtheria, which hadincreased from 5 to 10 in the four preceding weeks, were11 last week, and included 6 in Glasgow, 2 in Dundee, and2 in Paisley. The deaths of infants under 2 years of agereferred to diarrhoea and enteritis, which had been 12, 15, and28 in the three preceding weeks, declined to 10 last week ; ofthis number, 4 were registered in Glasgow and 4 in Dundee.The fatal cases of whooping-cough, which had been 3, 4, and11 in the three preceding weeks, fell to 6 last week, andincluded 2 in Partick. The 2 deaths from scarlet feverwere registered in Greenock and Falkirk respectively ; the2 deaths referred to enteric fever in Aberdeen, and the fatalcase of measles in Glasgow.The deaths referred to diseases of the respiratory organs

in the 18 Scotch towns, which had been 68, 62, and 80 inthe three preceding weeks, further rose to 102 last week ;23 deaths were attributed to different forms of violence, againstnumbers rising from 16 to 34 in the three previous weeks.

HEALTH OF IRISH TOWNS.

In the 22 town districts of Ireland, having an aggregatepopulation estimated at 1,154,150 persons at the middleof this year, 600 births and 365 deaths were registeredduring the week ending Oct. 19th. The annual rate ofmortality in these towns, which had been 14’5, 15’5, and

1175THE SERVICES.

17,6 per 1000 in the three preceding weeks, declined to16’5 per 1000 in the week under notice. During the firstthree weeks of the current quarter the mean annual death-rate in these Irish towns averaged 16’5 5 per 1000 ; in the95 large English towns the corresponding death-rate wasequal to 13’4, while in the 18 Scotch towns it did notexceed 13-3 per 1000. The annual death-rate in theseveral Irish towns last week was equal to 19.8 8 in Dublin(against 16-8 in London), 14-2 in Belfast, 16-3 in Cork,6 - 4 in Londonderry, 35 - 2 in Limerick, and 17-1 1 in Water-ford, while in the remaining 16 smaller towns the meandeath-rate did not exceed 12, 3 per 1000.The 365 deaths from all causes in the 22 Irish towns

were 24 fewer than the number in the previous week, andincluded 43 which were referred to the principal epidemicdiseases, against numbers rising from 26 to 45 in the threepreceding weeks; of these 43 deaths, 20 resulted from

measles, 14 from diarrhceal diseases, 3 from enteric fever,3 from whooping-cough, 2 from diphtheria, and 1 fromscarlet fever, but not one from small-pox. These 43 deathsfrom the principal epidemic diseases were equal to anannual death-rate of 1- 9 per 1000 ; the death-rate from thesediseases last week in the 95 large English towns was equalto 1-3, while in the 18 Scotch towns it did not exceed 0-8per 1000. The deaths attributed to measles, which had risenfrom 1 to 20 in the six preceding weeks, were again 20 lastweek, and comprised 10 in Limerick, 8 in Belfast,and 2 inDublin. The deaths referred to diarrhoeal diseases, whichhad been 11, 13, and 13 in the three preceding weeks,were 14 last week, all of which related to infants under 2years of age; 6 deaths were registered in Dublin, 3 inBelfast, and 2 in Waterford. Of the 3 fatal cases of entericfever last week, which were slightly in excess of recent

weekly numbers, 2 occurred in Dublin and 1 in Newry. The3 deaths attributed to whooping cough last week wererecorded in Dublin, Limerick, and Newry respectively. The2 fatal cases of diphtheria were registered in Dublin, andthat of scarlet fever in Belfast.The deaths referred to diseases of the respiratory system

in the 22 Irish towns, which had been 53, 49, and 70 in thethree preceding weeks, rose to 76 in the week under notice.Of the 365 deaths from all causes, 105, or 29 per cent.,occurred in public institutions, and 7 resulted from differentforms of violence. The causes of 10, or 2-7 per cent., ofthe total deaths were not certified either by a registeredmedical practitioner or by a coroner after inquest ; in the95 large English towns the proportion of uncertified causesof death last week did not exceed 1 - 0 per cent.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE undermentioned Fleet-Surgeons have been promoted

to the rank of Deputy Surgeon-General in His Majesty’sFleet:-James Lawrence Smith, M.V.O. (dated July 22nd,1912), and Alexander Gascoigne Wildey (dated Oct. 6th,1912).

ROYAL ARMY MEDICAL CORPS.

Colonel H. 0. Trevor has taken up duty as AssistantDirector of Medical Services in the Cork District, in succes-sion to Colonel J. R. Dodd. Colonel H. S. McGill has been

granted leave of absence from India on medical certificate.Lieutenant-Colonel B. J. Inniss has embarked for a tour

of service at Mauritius. Lieutenant-Colonel R. J. Copelandhas been appointed for duty in the Northern Command.Lieutenant-Colonel T. Daly has been selected for theincreased rate of pay under Article 317 of the RoyalWarrant. Lieutenant-Colonel H. M. Sloggett has arrivedhome on leave of absence from Malta. Lieutenant-ColonelW. A. Morris has been selected to hold Medical Charge atScarborough, in succession to Major H. V. Dillon. Lieutenant-Colonel J. Donaldson has been transferred from the com-mand of the Station Hospital at Rawal Pindi Cantonmentto Murree Cantonment as Senior Medical Officer. Lieu-tenant-Colonel J. W. Bullen has taken up duty at theStation Hospital, Agra Cantonment. Lieutenant-Colonel A. J.Luther has embarked for a tour of service in South Africa.Lieutenant-Colonel R. J. Windle, late physician and surgeonat the Royal Hospital, Kilmainham, Dublin, has been placedunder orders for a tour of service in India, and will be postedto the Sixth (Poona) Division of the Southern Army.

Major T. B. Jones has been appointed to hold charge ofthe Military Hospital at Pembroke Dock and Senior MedicalOfficer of the Western Coast Defences. An exchange on theroster has been approved between Major L. F. F. Winslow,in charge of the Military Hospital at Sheffield, and MajorA. M. MacLaughlin, sanitary officer to the Scottish Com-mand ; the latter officer will embark for a tour of servicewith the Southern Army in India. Major W. E. Hudlestonhas been transferred from Tidworth, Salisbury Plain, toPortsmouth District for employment in connexion with

recruiting duties. Major W. J. Taylor has been appointed tothe Military Hospital at Colchester, pending embarkation forservice abroad. Major A. 0. B. Wroughton has beenappointed to hold charge of the Military Hospital atMaidstone. Major C. H. Furnivall has taken up the

appointment of Civil Surgeon at Ziarat. Major H. H.Norman has arrived home on leave of absence from Shwebo.

Major A. D. Jameson has been appointed Specialist inDermatology and Venereal Diseases to the First (Peshawar)Division of the Northern Army in India. Major J. C. B.Statham has embarked for a tour of service on the West.Coast of Africa.

Captain P. Dwyer has been selected for appointment asSpecialist in Otology at the Royal Infirmary, Phoenix Park,Dublin. Captain A. E. S. Irvine has arrived home on leaveof absence from Simonstown, South Africa. Captain P. C. T.Davy has been appointed Senior Medical Officer on boardthe transport s.s. lJongola, which left Karachi for

Southampton on Oct. 18th, and Captain P. Sampson andCaptain H. H. Blake have been appointed for generalduty on the same transport. Captain W. J. E.Bell has been transferred from the Military Hospitalat Gosport to Cosham for duty. Captain E. J. Kavanaghhas joined the Station Hospital, Multan, for duty.Captain C. W. Holden has arrived home for duty fromNorth China, tour expired. Captain R. S. Smyth hasarrived home on leave of absence from Ambala Cantonment.Captain C. Scaife has been appointed a Specialist in thePrevention of Disease and placed in charge of the Head-quarters Brigade Laboratory at Belgaum. Captain A. Hendryhas been transferred from the Fifth (Mhow) Division to theBombay Brigade and posted for duty to the Station Hospitalat Colaba. Captain J. F. Grant has taken up duty at theMilitary Hospital, Maymyo, Burma, on transfer from BhamoCantonment. Captain F. Casement has arrived home onleave of absence from the Eighth (Lucknow) Division.

Captain G. E. Cathcart has been selected for appointment asSpecialist in Physical Training to the Aldershot Command.Captain H. V. Bagshawe has embarked for a tour of servicein Egypt. Captain A. L. Foster has been transferredfrom the Military Hospital at Rawal Pindi to Kalabagh,Murree Hill District. Captain J. S. McCombe has taken

up duty at the Military Hospital, Secunderabad, on

transfer from Malapuram. Captain R. G. S. Gregghas arrived home on leave of absence from LucknowCantonment. Captain P. A. Lloyd-Jones has been selectedfor appointment as Specialist in Ophthalmology to the Cam-bridge Hospital at Aldershot. in succession to Major F. M.Mangin, who has been placed under orders for a tour ofservice in India with the Northern Army.

Lieutenant C. M. Nichol, lately holding charge of theMilitary Hospital and medical officer of D Squadron, 16th(Queen’s) Lancers, at Weedon, has joined for duty at Cairo.Lieutenant W. A. Frost has been appointed to Tregantle.Lieutenant H. J. G. Wells has been transferred from the

Military Hospital at Kinsale to Cork for general duty.INDIAN MEDICAL SERVICE.

The King has approved of the retirement of the under-mentioned officers :-Colonel William Alfred Corkery (datedAugust 25th, 1912) and Lieutenant-Colonel William AinleySykes, D.S.O. (dated July 18th, 1912).

Colonel R. W. S. Lyons has been selected for appointmentas Assistant Director of Medical Services to the Third(Lahore) Division of the Northern Army in India, insuccession to Colonel W. A. Corkery, retired.

Lieutenant-Colonel W. E. Jennings has arrived home onleave of absence from India. Lieutenant-Colonel J. R.Roberts, C.I.E., has been appointed Surgeon on the PersonalStaff of the Viceroy of the East Indies, in succession toLieutenant-Colonel F. O’Kinealy, who has resigned. Lieu-tenant-Colonel J. J. Pratt, civil surgeon in the United