937

upon the subject, but tends to the disrepute of vaccination.Dr. Davies and his colleagues record a fatal case of small-pox in a vaccinated child aged thirteen, the only death theyhave met with in a vaccinated person under fifteen yearsof age in the course of two epidemics comprising 687 cases,96 of which were in children under fifteen. There is alsorecorded an interesting instance of a child born in the

small-pox hospital during the early convalescence of themother from a discrete attack ; the child remained in

hospital with the mother for twenty-one days, but was

susceptible neither to small-pox nor to vaccination. Passingto a consideration of the behaviour of the vaccinated andunvaccinated exposed to the infection of small-pox in ’,invaded houses we find some interesting figures. At agesbelow ten, the vaccinated had a twenty-three-fold immunity ’

from attack and a complete security against death as Icompared with a mortality among the unvaccinatedof 11’5 per cent. At ages above ten the vaccinatedhad a three-fold immunity from attack and a ten - fold

immunity against death as compared with the un-

vaccinated. As an instance of the protective value ofvaccination performed after exposure to small-pox, it maybe mentioned that of 59 unvaccinated persons exposed to thedisease, 23 were vaccinated on or before the fifth day ofexposure, 3 seven days after exposure, and 1 not until afterthe eighth day ; in the last 4 cases, as the writersobserve, no protection could probably be claimed fromvaccination. Of the total 27 none contracted small-pox, whereas of the remaining 32 unvaccinated personsmore than half developed the disease. The value of re-vaccination is shown by the figures that follow. Outof 1341 persons remaining in the invaded houses 468were successfully revaccinated, and 8 only-all of whomshowed that they had been infected before revaccination-contracted small-pox. The attack-rate among the 859 oncevaccinated was 5 per cent. In the remaining 14 theattempted revaccination was unsuccessful, and of these, 3developed small-pox and 1 died. Among the hospital staffof 62 persons there were 3 cases of small-pox ; of these onewas that of a person not revaccinated and another a case inwhich revaccination had been performed fourteen yearspreviously; both recovered. The third case was that of awasherwoman at the small-pox hospital, who had been vac-cinated twenty years previously, and who had passed throughseveral epidemics with impunity. She was unfortunately notincluded in the revaccinated list, and she died from hsemor-rhagic small-pox. This sad result illustrates, the writers ofthe report point out, the necessity for the repetition of vac-

cination, especially in persons hourly exposed to contagion.As bearing upon this question may be related the fact thatduring the Bristol epidemic of 1893-94 there were 7 cases ofsmall-pox in those who had been previously attacked by thedisease, the shortest interval between the attacks beingtwenty-five years and the longest sixty-nine years ; none

were fatal. __________

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 5930 births and3949 deaths were registered during the week ending Oct. 5th.The annual rate of mortality in these towns, which hadincreased from 19’3 to 21-0 per 1000 in the three precedingweeks, declined again last week to 19’4. In London therate was 15’9 per 1000, while it averaged 21’9 in the

thirty-two provincial towns. The lowest rates in thesetowns were 13-2 in Croydon, 14’2 in Huddersfield, 14-4 inBrighton, and 14’6 in Derby ; the highest rates were 26’6in Liverpool, 28’8 in Sunderland, 30-3 in Salford, 32-3 inBolton, and 37-2 in Blackburn. The 3949 deaths in-cluded 871 which were referred to the principal zymoticdiseases, against 981 and 923 in the two preceding weeks ;of these, 565 resulted from diarrhoea, 71 from diph-theria, 65 from "fever" " (principally enteric), 64 frommeasles, 56 from whooping-cough, 48 from scarlet fever,and 2 from small-pox. The lowest death-rates from thesediseases were recorded in Norwich, Croydon, Derby, andLondon, and the highest rates in Sunderland, Oldham,Salford, Bolton, and Blackburn. The greatest mortalityfrom measles occurred in Oldham, Salford, and Blackburn;from scarlet fever in Gateshead and Wolverhampton ; fromwhooping-cough in Bradford, Bolton, Wolverhampton, andGateshead ; from "fever" " in Leicester and Sunderland ; and

from in Salford, Oldham, Burnley, Bolton, andBlackburn. The 71 deaths from diphtheria included 44 inLondon, 4 in West Ham, 4 in Salford, and 3 each in

Birmingham, Liverpool, and Manchester. One fatal case

of small-pox was registered in London and 1 in Old-ham, but not one in any other of the thirty-threelarge towns. There were 198 cases of small-poxunder treatment in the Metropolitan Asylum Hospitalsand in the Highgate Small-pox Hospital on Saturdaylast, the 5th inst., against 307, 271, and 234 at theend of the three preceding weeks; 17 new cases wereadmitted during the week, against 42, 23, and 21 in thethree preceding weeks. The number of scarlet fever patientsin the Metropolitan Asylum Hospitals and in the LondonFever Hospital at the end of the week was 2802, against2674, 2732, and 2807 on the three preceding Saturdays ; 252new cases were admitted during the week, against 365, 344,and 339 in the three preceding weeks. The deaths referredto diseases of the respiratory organs in London, which hadincreased in the three preceding weeks from 123 to 173,declined again last week to 158, and were 79 below the cor-rected average. The causes of 30, or 0’8 per cent., of thedeaths in the thirty-three towns were not certified either bya registered medical practitioner or by a coroner. All thecauses of death were duly certified in Bristol, Nottingham,Salford, Sheffield, Newcastle-upon-Tyne, and in fifteen othe?smaller towns ; the largest proportions of uncertified deathswere registered in Birmingham, Leicester, and Liverpool.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight principal Scotchtowns, which had been 18’5 and 17’5 per 1000 in the two pre,-ceding weeks, rose again to 18’3 during the week endingOct. 5th, but was 1’1 per 1000 below the mean rate duringthe same period in the thirty-three large English towns.The rates in the eight Scotch towns ranged from 16’5 inEdinburgh and 17’5 in Dundee to 20-6 in Perth and 21-1 inPaisley. The 527 deaths in these towns included 62 whichwere referred to diarrhoea, 17 to whooping-cough, 8 to-"fever," 4 to scarlet fever, 3 to measles, 2 to diphtheria,and not one to small-pox. In all, 96 deaths resulted fromthese principal zymotic diseases, against 93 and 79 in thatwo preceding weeks. These 96 deaths were equal toan annual rate of 3’3 per 1000, which was 0-9 below themean rate last week from the same diseases in the thirty-three large English towns. The fatal cases of diar-rhaea, which had declined from 78 to 48 in the fivepreceding weeks, rose again to 62 last week, of which27 occurred in Glasgow, 9 in Edinburgh, and 7 in Dundee.The deaths from whooping-cough, which had declined from15 to 9 in the four preceding weeks, rose again to 17 lastweek, and included 10 in Glasgow and 4 in Aberdeen..The deaths referred to different forms of "fever," whichhad been 10 and 6 in the two preceding weeks, increased t<98 last week, of which 3 occurred in Glasgow and 2 in Dundee.The 4 fatal cases of scarlet fever were within one of thenumber in the preceding week, and included 3 in Glasgow.The deaths referred to diseases of the respiratory organs inthese towns, which had been 66 and 82 in the two precedingweeks, further rose to 98 last week, and exceeded by 35the number in the corresponding period of last year. Thecauses of 49, or more than 9 per cent., of the deaths inthese eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 22-1 and 24vper 1000 in the two preceding weeks, declined again to 21-3during the week ending Oct. 5th. During the thirteenweeks of last quarter the death-rate in the city averaged23-4 per 1000, the rate during the same period being18-6 in London and 16-5 in Edinburgh. The 143deaths registered in Dublin during the week undernotice showed a decline of 23 from the number in the

preceding week, and included 12 which were referred to theprincipal zymotic diseases, against 21 and 24 in the two pre-ceding weeks; of these, 8 resulted from diarrhoea, 2 fromscarlet fever, 1 from small-pox, 1 from whooping-cough,and not one either from measles, diphtheria, or "fever."These 12 deaths were equal to an annual rate of 1-8 per1000, the zymotic death-rate during the same period being2-6 in London and 1-9 in Edinburgh. The deaths referred to.diarrhoea, which had been 12 and 13 in the two precedingweeks, declined to 8 last week. The fatal cases of scarlet

938 VITAL STATISTICS OF LONDON DURING SEPTEM1BEH, 1895.

939

fever, which had been 2 in each of the two preceding weeks,were again 2 last week. The mortality from small-poxand from whooping-cough showed a decline from thatrecorded in the previous week. The 143 deaths in Dublinlast week included 28 of infants under one year of age,and 28 of persons aged upwards of sixty years ; the deathsboth of infants and of elderly persons showed a markeddecline from those recorded in the preceding week. Eightinquest cases and 7 deaths from violence were registered ;and 38, or more than a fourth, of the deaths occurredin public institutions. The causes of 6, or more than4 per cent., of the deaths in the city last week were notcertified.

-

VITAL STATISTICS OF LONDON DURING SEPTEMBER, 1895.

In the accompanying table will be found summarised

complete statistics relating to sickness and mortality duringSeptember in each of the forty-three sanitary areas of London.With regard to the notified cases of infectious disease in themetropolis during last month, it appears that the numberof persons reported to be suffering from one or other of thenine diseases specified in the table was equal to 12’4 per1000 of the population, estimated at 4,392,346 persons in themiddle of the current year. In the three preceding monthsthe rates had been 8’4, 11’6, and 9’9 per 1000 respectively.Among the various sanitary areas the rates were considerablybelow the average in Fulham, St. James Westminster, St.Martin-in-the-Fields, St. Olave Southwark, Woolwich, andLee: while they .showed the largest excess in Strand,St. Luke, Bethnal Green, Whitechapel, St. George-in-the-East, Limehouse, Mile End Old Town, and Poplar.The prevalence of small-pox in London showed a markeddecline during September, 117 cases being notified during themonth, including 23 in Bethnal Green, 13 in Camberwell,11 in Whitechapel, 11 in Lambeth, 9 in Islington, and 8in Battersea sanitary areas. The Metropolitan Asylum Hos-pitals contained 227 small-pox patients at the end ofSeptember, against 33, 232, and 331 at the end of the threepreceding months ; the weekly admissions averaged 27,against 10, 49, and 57 in the three preceding months. The

prevalence of scarlet fever in London showed a markedincrease during September ; this disease was proportionallymost prevalent in Strand, Holborn, Clerkenwell, St. Luke,City of London, Bethnal Green, Whitechapel, St. George-in-the-East, Limehouse, and Mile End Old Town sanitaryareas. The Metropolitan Asylum Hospitals contained 2745scarlet fever patients at the end of September, against 1845,2340, and 2435 at the end of the three preceding months ; theweekly admissions averaged 333, against 229, 263, and 292in the three preceding months. The prevalence of diphtheriain London also showed a considerable increase during themonth under notice ; among the various sanitary areas thisdisease showed the highest proportional prevalence in St.Pancras, Bethnal Green, St. George-in-the-East, Limehouse,Mile End Old Town, Poplar, and Camberwell. There were664 cases of diphtheria under treatment in the MetropolitanAsylum Hospitals at the end of September, against 633, 680,and 666 at the end of the three preceding months ; theweekly admissions averaged 101, against 109, 103, and 80 inthe three preceding months. The prevalence of enteric feverin London showed a marked increase during September ; thisdisease was proportionally most prevalent in Marylebone,Stoke Newington, Hackney, Shoreditch, Bethnal Green,Limehouse, Mile End Old Town, Poplar, and Camberwellsanitary areas. Erysipelas was proportionally most prevalentin St. Giles, Strand, St. Luke, and Mile End Old Townsanitary areas. The 14 cases of puerperal fever notified

during September included 3 in Greenwich and 2 in Mary-lebone sanitary areas.The mortality statistics in the accompanying table relate

to the deaths of persons actually belonging to the varioussanitary areas, the deaths occurring in the institutions ofLondon having been distributed among the different sanitaryareas in which the patients had previously resided. Duringthe four weeks ending Saturday, Sept. 28th, the deaths of5393 persons belonging to London were registered, equal toan annual rate of 16-0 per 1000 of the population, against14’9, 21-0, and 16’9 in the three preceding months. Thelowest death-rates during September in the various sanitaryareas were 11’0 in Strand, 11-4 in Lee, 11-5 in Wands-worth, 11’7 in Paddington, 12-2 in Stoke Newingtonand in Lewisham, and 12-3 in St. George Hanover-square andin Hampstead; the highest rates were 20’2 in Mile EndOld Town, 21-0 in St. George Southwark, 21-1 in St. Saviour

Southwark, 21’2 in Whitechapel, 21’4 in Shoreditch, 23-9-in Holborn, 25’4 in St. George-in-the-East, and 25’6 in,St. Luke. During the four weeks of September 983 deathswere referred to the principal zymotic diseases in London; yof these, 449 resulted from diarrhoea, 185 from diphtheria,117 from measles, 77 from whooping-cough, 76 from scarletfever, 67 from enteric fever, 11 from small-pox, and 1 from -an ill-defined form of continued fever. These 983 deaths wereequal to an annual rate of 2-9 per 1000 ; the lowest zymoticdeath-rates were recorded in Hampstead, Stoke Newington,St. Martin-in-the-Fields, Holborn, St. Olave Southwark, and’Lewisham; and the highest rates in St. Luke, Whitechapel,St. George-in-the-East, Mile End Old Town, St. Saviour South--wark, St. George Southwark, and Woolwich sanitary areas.Eleven fatal cases of small-pox were registered in Londonduring the month under notice, the corrected average"in the corresponding periods of the ten preceding yearsbeing only 3 ; of these 11 fatal cases 2 belonged to Lambethand 2 to Camberwell sanitary areas. The 117 deathsreferred to measles were 46 above the corrected average i,among the various sanitary areas this disease showedthe highest proportional fatality in St. Pancras, Clerken-well, St. Luke, Whitechapel, Limehouse, and Mile EndOld Town. The 76 fatal cases of scarlet fever were 21below the corrected average number ; this disease showed’the highest proportional fatality in Shoreditch, Bethnal’

green, and Whitechapel sanitary areas. The 185 deaths.referred to diphtheria were 40 above the corrected average.number; among the various sanitary areas this diseasewas proportionally most fatal in St. Pancras, Clerkenwell,Bethnal Green, St. George-in-the-East, Mile End Old Town,St. George Southwark, Lambeth, and Greenwich. The 77’fatal cases of whooping-cough were 47 below the correctedaverage ; this disease showed the highest proportional fatalityin Fulham, Shoreditch, and Newington sanitary areas. The.67 deaths referred to enteric fever slightly exceeded the cor--rected average number; among the various sanitary areas.the highest proportional fatality of "fever" " was recordedin Hackney, Mild End Old Town, St. George Southwark,Rotherhithe, and Woolwich. The 449 fatal cases ofdiarrhoea were 77 above the corrected average; thisdisease was proportionally most fatal in St. Giles, White-chapel, St. George-in-the-East, Limehouse, St. SaviourSouthwark, Bermondsey, Woolwich, and Plumstead sanitaryareas. In conclusion, it may be stated that the mortalityin London during September from these principal zymoticdiseases was rather more than 12 per cent. above the-average.

Infant mortality in London during September, measured bythe proportion of deaths under one year of age to registeredbirths, was equal to 162 per 1000, and slightly exceeded the.average. Among the various sanitary areas the lowest-rates of infant mortality were recorded in Paddington,Islington, Strand, London City, St. Olave Southwark, and;Rotherhithe ; and the highest rates in Westminster, Holborn,.Whitechapel, St. Saviour Southwark, St. George Southwardand Plumstead.

THE SERVICES.

MOVEMENTS OF THE MEDICAL STAFF.SURGEON-MAJOR-GENERAL LEWER has arrived in England

from Gibraltar on retirement and will be succeeded bySurgeon-Colonel Catherwood. Surgeon-Captain Holt has,been transferred from Aldershot to Sheerness. Surgeon-Major Inman has arrived from Barbados on leave. Surgeon-Captain Fletcher has arrived at Gibraltar. Surgeon-Lieu-tenants Smith, Blackham, and Fairrie have been posted to-Aldershot ; Surgeon-Lieutenants Forrest and Fawsett to-

Portsmouth ; Surgeon-Lieutenants Greech and Grattan toIreland; Surgeon-Lieutenant Profeit to Edinburgh, andSurgeon-Lieutenant Gunter to Shorncliffe.

INDIA AND THE INDIAN MEDICAL SERVICES.

Surgeon-Lieutenant C. B. Prall, 36th Sikhs, is appointedto officiate as Civil Surgeon of Peshawar, in addition to hisother duties, vice Surgeon-Major B. Doyle, on leave..Surgeon-Major J. W. Clarkson is appointed to act as

Sanitary Commissioner for the Government of Bombayduring the absence on leave of Brigade-Surgeon-Lieu-tenant-Colonel C. W. MacRury. Surgeon-Major C. G. W.Lowdell is appointed to act as Deputy Sanitary Com-missioner for the Western Registration District, in