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538 VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN twenty-eight of the largest English towns 6189 births and 3779 deaths were registered during the week ending the 14th inst. The births were 375, and the deaths 152, above the average weekly numbers during 1884. The annual death-rate in these towns, which had not exceeded 21-4 and 20’6 per 1000 in the preceding two weeks, rose last week to 22’5. During the first ten weeks of the current quarter the death-rate in these towns averaged 22’5 per 1000, against 24’7, the mean rate in the corresponding periods of the nine years 1876-84. The lowest death-rates in these towns last week were 13’5 in Birkenhead, 15’5 in Portsmouth, 16’0 in Hull, and 16’8 in Brighton. The rates in the other towns ranged upwards to 27’6 in New- castle-upon-Tyne, 28’6 in Manchester, 33’9 in Oldham, and 48’3 in Sunderland. The deaths referred to the principal zymotic diseases in the twenty-eight towns, which had been 377 and 395 in the previous two weeks, further rose to 398 last week; they included 129 from measles, 119 from whooping-cough, 41 from diarrhoea, 31 from scarlet fever, 31 from "fever" (principally enteric), 27 from small-pox, and 20 from diphtheria. No death from any of these zymotic diseases was recorded last week in Brighton ; whereas they caused the highest death-rates in Bristol, Cardiff, and Sunderland. The highest death-rates from measles occurred in Huddersfield, Cardiff, and Sunder- land ; from whooping-cough in Preston and Bristol; from scarlet fever in Halifax and Wolverhampton ; and from "fever" in Norwich. The 20 deaths from diphtheria in the twenty-eight towns included 8 in London, 3 in Liver- pool, 2 in Nottingham, and 2 in Oldham. Small-pox caused 45 deaths in London and its outer ring of suburban dis- tricts, 3 in Manchester, 1 in Bradford, and 1 in Cardiff. The number of small-pox patients in the metropolitan asylum hospitals situated in and around London, which had declined in the preceding three weeks from 1223 to 988, further fell last week to 898; the cases admitted were 104 last week, against numbers declining from 255 to 94 in the previous four weeks. The Highgate Small-pox Hospital contained 92 patients on Saturday last, 16 cases having been admitted during the week. The deaths referred to diseases of the respiratory organs in London, which had been 384 and 374 in the preceding two weeks, rose last week to 455, but were 30 below the corrected weekly average. The causes of 96, or 2’6 per cent., of the deaths in the twenty-eight towns last week were not certified either by a registered medical practitioner or by a coroner. All the causes of death were duly certified in Bristol, Leeds, Leicester, and in three other smaller towns. The largest proportions of uncertified deaths were registered in Oldham, Hull, and Wolverhampton. HEALTH OF SCOTCH TOWNS. The annual death-rate in the eight Scotch towns, whicl had been equal to 24-6 and 22-8 per 1000 in the preceding tw( weeks, rose again to 24-4 in the week ending the 14th inst. and exceeded by 2’3 the mean rate during the same weel in the twenty-eight large English towns. The rates in thE Scotch towns last week ranged from 16-6 in Perth and 17.5 in Leith, to 24-3 in Aberdeen and 29-9 in Glasgow. The 69c deaths in the eight towns included 22 which were referred to whooping-cough, 22 to measles, 17 to diarrhoea, 13 tc scarlet fever, 8 to diphtheria, 6 to "fever (typhus, enteric or simple), and not one to small-pox; in all, 88 death resulted from these principal zymotic diseases, against 8 and 71 in the preceding two weeks. These 88 deaths were equal to an annual rate of 3’6 per 1000, which was 1.3 above the mean rate from the same diseases in the twenty-eight English towns. The 22 deaths from whoop- ing-cough showed an increase of 3 upon the number in the previous week, and included 9 in Glasgow, 4 in Edin- burgh, and 4 in Leith. Of the 22 fatal cases of measles, 21 occurred in Glasgow. The 17 deaths attributed to diarrhoea also exceeded the numbers in recent weeks. Ten of the 13 fatal cases of scarlet fever and 5 of the 8 of diph- theria were returned in Glasgow. The 6 deaths referred to "fever" included 2 in Glasgow and 2 in Greenock. The deaths referred to acute diseases of the respiratory organs in the eight towns, which were 122 last week, were 5 above the number returned in the corresponding week of last year. The causes of 93, or nearly 15 per cent., of the deaths registered in the eight Scotch towns last week were not certified. ___ HEALTH OF DUBLIN. The rate of mortality in Dublin, which had been equal to 30’3 and 32-7 per 1000 in the preceding two weeks, further rose to 39’5 in the week ending the 14th inst. During the first ten weeks of the current quarter the death-rate in the city averaged no less than 33’4 per 1000, the mean rate during the same period not exceeding 21’5 in London and 20.2 in Edinburgh. The 267 deaths in Dublin last week showed a further increase of 46 upon the high numbers returned in recent weeks, and included 11 which were referred to measles, 8 to "fever" (typhus, enteric, or simple), 5 to diarrhoea, 4 to whooping-cough, 2 to scarlet fever, and not one either to small-pox or diphtheria. Thus, 30 deaths resulted from these principal zymotic diseases, against 18 and 27 in the preceding two weeks; they were equal to an annual rate of 4’4 per 1000, the rate from the same diseases last week being but 2-1 in London and 1-9 in Edinburgh. The 11 fatal cases of measles in Dublin, which had been 8 and 10 in the previous two weeks, further rose to 11 last week. The 8 deaths from "fever," and the 5 from diarrhœa, also showed a further increase upon recent weekly num- bers. The fatal cases of scarlet fever, on the other hand, were fewer than in any previous week of this year. Three inquest cases and 4 deaths from violence were registered within the city; and 94, or more than a third, of the deaths were recorded in public institutions. The deaths of infants showed an increase, and those of elderly persons. considerably exceeded the numbers in any previous week of this year. The causes of 37, or nearly 14 per cent., of the deaths registered in the city last week were not certified. HEALTH CONDITION OF SOUTHPORT. A voluminous pamphlet has recently been published by Dr. Strethill H. Wright, the main object of which seems to be tm warn the ratepayers of Southport that the vital statistics of that place issued by the sanitary authority are untrustworthy and give a far too favourable impression of its sanitary condi- tion. Dr. Wright asserts confidently that the present popula- tion of Southport is considerably over-estimated, the effect of which would undoubtedly be to under-state the death-rate. It would be out of place to attempt a discussion of the main point in dispute-namely, the present population of South- port ; but some of the issues raised by Dr. Wright are of more than local interest, bearing as they do upon the con- struction of local vital statistics, and upon their value as a test of sanitary condition. We have often found reason to com- plain of defects in the reports of medical officers of health similar to those pointed out by Dr. Wright in the reports issued by Dr. Vernon, the medical officer of health for Southport. It is, in the first place, essential that the method employed for estimating the population of each sanitary district should be clearly described. Now it appears that the enumerated population of the Borough of South- port was 18,086 in 1871, and had increased to 32,206 in 1881, and Dr. Vernon’s estimate for the middle of 1883 is stated to be 35,065. There can be no doubt that Dr. Vernon should describe his method of arriving at this estimate, which is clearly not arrived at by the Registrar-General’s method of assuming that the rate of increase that prevailed between the last two censuses has since been maintained. The rate of increase of population in Southport during the last intercensal period was exceptionally large, and we are not in a position to support or to deny Dr. Wright’s assertion that since 1881 there has practically been no increase, but all who are interested in the vital statistics of Southport are bound to know upon what principle the population of the borough is officially estimated. Dr. Wright next asserts that Dr. Vernon excludes from the mortality statistics of theborough the deaths of borough residents recorded in the Union Workhouse and in the Fever Hospital, both situated outside the borough. There can be no doubt that this is unsound both in theory and practice, and is none the more defensible because other reports than those of Southport err in the same direction. Another objectionable feature of the Southport reports, fairly criticised by Dr. Wright, is what Dr. Vernon calls the "local" rate, obtained by the elimination of a certain number of deaths, of "bad lives imported." For instance, it is stated that of 5G8 deaths in Southport in 1881,106 were of persons said to have resided in Southport under one year;

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538

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 6189 birthsand 3779 deaths were registered during the week endingthe 14th inst. The births were 375, and the deaths 152, abovethe average weekly numbers during 1884. The annualdeath-rate in these towns, which had not exceeded 21-4and 20’6 per 1000 in the preceding two weeks, rose lastweek to 22’5. During the first ten weeks of the currentquarter the death-rate in these towns averaged 22’5 per1000, against 24’7, the mean rate in the correspondingperiods of the nine years 1876-84. The lowest death-ratesin these towns last week were 13’5 in Birkenhead, 15’5in Portsmouth, 16’0 in Hull, and 16’8 in Brighton. Therates in the other towns ranged upwards to 27’6 in New-castle-upon-Tyne, 28’6 in Manchester, 33’9 in Oldham, and48’3 in Sunderland. The deaths referred to the principalzymotic diseases in the twenty-eight towns, which hadbeen 377 and 395 in the previous two weeks, furtherrose to 398 last week; they included 129 from measles,119 from whooping-cough, 41 from diarrhoea, 31 fromscarlet fever, 31 from "fever" (principally enteric),27 from small-pox, and 20 from diphtheria. No death fromany of these zymotic diseases was recorded last week inBrighton ; whereas they caused the highest death-ratesin Bristol, Cardiff, and Sunderland. The highest death-ratesfrom measles occurred in Huddersfield, Cardiff, and Sunder-land ; from whooping-cough in Preston and Bristol; fromscarlet fever in Halifax and Wolverhampton ; and from"fever" in Norwich. The 20 deaths from diphtheria inthe twenty-eight towns included 8 in London, 3 in Liver-pool, 2 in Nottingham, and 2 in Oldham. Small-pox caused45 deaths in London and its outer ring of suburban dis-tricts, 3 in Manchester, 1 in Bradford, and 1 in Cardiff. Thenumber of small-pox patients in the metropolitan asylumhospitals situated in and around London, which haddeclined in the preceding three weeks from 1223 to

988, further fell last week to 898; the cases admittedwere 104 last week, against numbers declining from 255to 94 in the previous four weeks. The HighgateSmall-pox Hospital contained 92 patients on Saturday last,16 cases having been admitted during the week. Thedeaths referred to diseases of the respiratory organs inLondon, which had been 384 and 374 in the precedingtwo weeks, rose last week to 455, but were 30 below thecorrected weekly average. The causes of 96, or 2’6 per cent.,of the deaths in the twenty-eight towns last week were notcertified either by a registered medical practitioner or bya coroner. All the causes of death were duly certified inBristol, Leeds, Leicester, and in three other smaller towns. Thelargest proportions of uncertified deaths were registered inOldham, Hull, and Wolverhampton.

HEALTH OF SCOTCH TOWNS.

The annual death-rate in the eight Scotch towns, whiclhad been equal to 24-6 and 22-8 per 1000 in the preceding tw(weeks, rose again to 24-4 in the week ending the 14th inst.and exceeded by 2’3 the mean rate during the same weelin the twenty-eight large English towns. The rates in thEScotch towns last week ranged from 16-6 in Perth and 17.5in Leith, to 24-3 in Aberdeen and 29-9 in Glasgow. The 69cdeaths in the eight towns included 22 which were referredto whooping-cough, 22 to measles, 17 to diarrhoea, 13 tcscarlet fever, 8 to diphtheria, 6 to "fever (typhus, entericor simple), and not one to small-pox; in all, 88 deathresulted from these principal zymotic diseases, against 8and 71 in the preceding two weeks. These 88 deaths wereequal to an annual rate of 3’6 per 1000, which was 1.3above the mean rate from the same diseases in the

twenty-eight English towns. The 22 deaths from whoop-ing-cough showed an increase of 3 upon the number inthe previous week, and included 9 in Glasgow, 4 in Edin-burgh, and 4 in Leith. Of the 22 fatal cases of measles,21 occurred in Glasgow. The 17 deaths attributed todiarrhoea also exceeded the numbers in recent weeks. Tenof the 13 fatal cases of scarlet fever and 5 of the 8 of diph-theria were returned in Glasgow. The 6 deaths referred to"fever" included 2 in Glasgow and 2 in Greenock. Thedeaths referred to acute diseases of the respiratory organsin the eight towns, which were 122 last week, were5 above the number returned in the corresponding week of

last year. The causes of 93, or nearly 15 per cent., of thedeaths registered in the eight Scotch towns last week werenot certified.

___

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal to30’3 and 32-7 per 1000 in the preceding two weeks, furtherrose to 39’5 in the week ending the 14th inst. During thefirst ten weeks of the current quarter the death-rate in thecity averaged no less than 33’4 per 1000, the mean rate duringthe same period not exceeding 21’5 in London and 20.2 inEdinburgh. The 267 deaths in Dublin last week showeda further increase of 46 upon the high numbers returned inrecent weeks, and included 11 which were referred to measles,8 to "fever" (typhus, enteric, or simple), 5 to diarrhoea,4 to whooping-cough, 2 to scarlet fever, and not one eitherto small-pox or diphtheria. Thus, 30 deaths resultedfrom these principal zymotic diseases, against 18 and 27 inthe preceding two weeks; they were equal to an annualrate of 4’4 per 1000, the rate from the same diseases lastweek being but 2-1 in London and 1-9 in Edinburgh. The11 fatal cases of measles in Dublin, which had been 8 and10 in the previous two weeks, further rose to 11 lastweek. The 8 deaths from "fever," and the 5 from diarrhœa,also showed a further increase upon recent weekly num-bers. The fatal cases of scarlet fever, on the other hand,were fewer than in any previous week of this year. Threeinquest cases and 4 deaths from violence were registeredwithin the city; and 94, or more than a third, of thedeaths were recorded in public institutions. The deaths ofinfants showed an increase, and those of elderly persons.considerably exceeded the numbers in any previous weekof this year. The causes of 37, or nearly 14 per cent., of thedeaths registered in the city last week were not certified.

HEALTH CONDITION OF SOUTHPORT.

A voluminous pamphlet has recently been published by Dr.Strethill H. Wright, the main object of which seems to be tmwarn the ratepayers of Southport that the vital statistics ofthat place issued by the sanitary authority are untrustworthyand give a far too favourable impression of its sanitary condi-tion. Dr. Wright asserts confidently that the present popula-tion of Southport is considerably over-estimated, the effect ofwhich would undoubtedly be to under-state the death-rate.It would be out of place to attempt a discussion of the mainpoint in dispute-namely, the present population of South-port ; but some of the issues raised by Dr. Wright are ofmore than local interest, bearing as they do upon the con-struction of local vital statistics, and upon their value as a testof sanitary condition. We have often found reason to com-plain of defects in the reports of medical officers of healthsimilar to those pointed out by Dr. Wright in the reportsissued by Dr. Vernon, the medical officer of health forSouthport. It is, in the first place, essential that themethod employed for estimating the population of eachsanitary district should be clearly described. Now it appearsthat the enumerated population of the Borough of South-port was 18,086 in 1871, and had increased to 32,206 in 1881,and Dr. Vernon’s estimate for the middle of 1883 is statedto be 35,065. There can be no doubt that Dr. Vernon shoulddescribe his method of arriving at this estimate, which isclearly not arrived at by the Registrar-General’s method ofassuming that the rate of increase that prevailed betweenthe last two censuses has since been maintained. The rateof increase of population in Southport during the lastintercensal period was exceptionally large, and we are notin a position to support or to deny Dr. Wright’s assertion thatsince 1881 there has practically been no increase, but all whoare interested in the vital statistics of Southport are boundto know upon what principle the population of the borough isofficially estimated. Dr. Wright next asserts that Dr. Vernonexcludes from the mortality statistics of theborough the deathsof borough residents recorded in the Union Workhouse andin the Fever Hospital, both situated outside the borough.There can be no doubt that this is unsound both in theoryand practice, and is none the more defensible because otherreports than those of Southport err in the same direction.Another objectionable feature of the Southport reports,fairly criticised by Dr. Wright, is what Dr. Vernon calls the"local" rate, obtained by the elimination of a certainnumber of deaths, of "bad lives imported." For instance, itis stated that of 5G8 deaths in Southport in 1881,106 were ofpersons said to have resided in Southport under one year;

539

Dr. Vernon, by some method of estimate not stated, con-cludes that 90 of these were of "bad lives imported," thusmaking a large reduction in the death-rate, but one whichis open to grave objection. When Dr. Vernon leaves out ofaccount the workhouse deaths belonging to his populationand deducts a large proportion of deaths on very doubtfulauthority, he appears needlessly to invite incredulity as tothe value of his statistics. Dr. Vernon is not alone in hisattempt to improve his death-rate by a liberal correction fordeaths of visitors. This is a tempting but a dangerouspractice, and should at any rate not be attempted unless themethod of correction is most precisely described. The import-ance of health reputation to Southport is so great, and theimpossibility of constructing sound vital statistics without atrustworthy estimate of population is so patent, that theTown Council, as the sanitary authority of the borough,should be induced to undertake a local census, which has inother places been carried out at a very moderate cost.

THE SERVICES.

THE Army medical officers recently inspected, at WoolwichArsenal, one of the two Docker tent hospitals supplied foruse in Suakim. These tents or huts are constructed byMessrs. Christoph and Unmack of Copenhagen, and appearedto meet the approval of the medical staff by their sanitaryarrangements and general suitability for a hot climate. Eachtent or hut is 72 ft. long by 20 ft. wide, its height being 13 ft.Each tent has accommodation for fifty patients, forty-fourin two large wards at each end, and six in a private ward.The Assistant Professorship of Surgery at Netley having

been vacated by Surgeon-Major R. Tobin, who has beenordered on foreign service, the duties will for the present beperformed by Surgeon-Major 0. Codrington, M.D. It isunderstood that the appointment will be conferred uponSurgeon-Major C. H. Y. Godwin, late medical officer ofWoolwich Arsenal, where he was very successful in applyingthe antiseptic system to the numerous severe injuries withwhich he had to deal.

Surgeon-General J. Irvine, Principal Medical Officer tothe Army of Occupation in Egypt, has been selected for asimilar position to her Majesty’s forces stationed in Madras.

ADMIRALTY.—The following appointments have beenmade :-Surgeon Francis G. Wright, to the Bullfrog;Charles G. llaclagan to be Surgeon and Agent at Berwickand Cheswick.ARTILLERY VOLUNTEERS.—1st Norfolk: Acting Surgeon

George Henry Cressey resigns his appointment.RIFLE VOLUNTEERS.—1st Forfar (Dundee): Acting Sur-

geon William Gibb resigns his appointment.

Correspondence.

CHLOROFORM v. ETHER.

"Audi alteram partem."

To the Editor of THE LANCET.SIR,-My attention has only just been called to a letter

from Mr. George E. Walker of Liverpool in your issue oflast week. In this letter Mr. Walker states, as his opinion,that in the production of complete anaesthesia there is littleor no difference between chloroform and ether, whilst in theafter-effects, especially as regards vomiting, nausea, anddepression of spirits, chloroform is much superior to ether.Now, this is exactly contrary to what I have been en-deavouring for years to demonstrate, and I cannot see onwhat grounds Mr. Walker bases his opinion, which I notonly consider erroneous as to fact, but dangerous in theextreme. May I point out to him that the great differencebetween the two is that ether is a cardiac stimulant, whilst,on the other hand, chloroform is a depressor of the heart’saction; that the former never kills by stopping the heart,whilst, on the contrary, the principal cause of death in fatalchloroform cases is the sudden cessation of the heart’saction. I do not deny that dangerous symptoms occasionallyarise during the administration of ether; but when these dooccur the respiratory organs are affected and there is plenty

of time for the proper application of remedies, thesesymptoms being rarely followed by death. In the fatalcases of chloroform administration death begins at theheart, and is instantaneous. If Mr. Walker consults thestatistics of fatal cases, he will find that the proportion ofdeaths in chloroform administration is about 1 in 4500,whilst that of ether is only 1 in 20,000. Granted thatthere is more vomiting, nausea, and depression of spirits,even then I reply that these trifling ailments do notcounterbalance the great advantage of the safety of the oneanaesthetic over the other; moreover, I affirm that, if etherbe rapidly given so that a small quantity suffices to produceanaesthesia, then the insensibility is not followed by thoseafter-effects of which he complains.

I am not fond of rushing into print, but I plead as myexcuse my sincere desire that your columns should not bethe means of propagating the suggestion that chloroform isas safe to administer as ether.

T am Sir

Maddox-st., March, 1885. WOODHOUSE BRAINE, F.R.C.S.

"WHAT WAS THE CAUSE OF DEATH?"To the Editor of THE LANCET.

SIR,—My attention has just been directed to Mr. Knight’scommunication in your issue of the 7th inst. In conse-

quence of the tone of his letter, and of its many inaccu-racies, I desire the privilege of stating my version of thecase, and of placing before the profession some additionalfacts which were not mentioned at the trial.At 10 P.M. on Jan. 5th I had an interview at the Southern

Hospital with the senior house-surgeon and Mr. Knight, andI gave to Mr. Knight a letter which 1 had received from thesolicitor for the defence, in which it was stated that I hadthe coroner’s permission to examine the body of Johnson.Owing to the hesitation exhibited by Mr. Knight to permitthe examination, I suggested that he should think thematter over, and I arranged to meet him at 11 A.Ar. on thefollowing morning. I arrived at the hospital within fiveminutes of the time specified, and was informed by theporter that Mr. Knight had gone out. After some troubleI found Mr. Gordon, the senior house-surgeon, in one of thewards, and he kindly left his work and came to the post-mortem room, and remained with me during my examina-tion of the body.

, The following is a copy of Mr. Knight’s depositions before

the coroner:--" Externally, I find on the top of the head twowounds, one of them an inch in front of the centre, and aninch to the right of the middle; it was pretty clean cut, butwith/slight contusion. It was a small wound half an inchlong and a quarter of an inch deep. An inch behind andtwo inches to the right of this wound I found anotherwound similar in every respect to the first. There was athird cut on the chin over the lower jaw. This wound wasin the shape of the letter Y, about three-quarters of an inchlong by one-third of an inch in depth. I found some bruises;one over-i.e., above the left eye, and another just below orunder the right eye. He had also an abrasion on the middleof the nose. The right eyeball itself was bruised. He hada slight abrasion of the fore or first finger of the righthand, and some blood on the other fingers. He had a smallabrasion two inches below the right elbow. He had a littleblood on the left hand, but no injury. On the right legthere was a small abrasion four inches below the knee. Ihave now described all the injuries to the deceased out-wardly visible. On opening the body I found all the organspretty healthy. There was slight congestion of all theorgans, but their state was consistent with perfect health.There was no injury at all to the bones of the head or body.The cause of death in my opinion, judging from what I haveheard to-day from the witnesses and from my post-mortemexamination, has been concussion of the brain, due to theblows on the head. There was no natural cause presentsufficient to account for death. The condition of the organsgave no indication at all of alcohol."-By Mr. Maddin: "Thedeceased’s lungs were slightly congested. The heart wasquite healthy. It is quite possible that if the deceased hadbeen on a heavy spree of drink, the congestion of his lungsmight be in consequence of that."The following are extracts from my depositions before the

coroner:-" I substantially agree with Mr. Knight’s evidenceas to the external injuries upon the deceased. I differ from