535

THE HONOURS LIST.The Distinguished Service Cross, for services in the

destroyer action in the Adriatic on the night of April 22nd-23rd, 1918, has been conferred upon-Surg. Prob. Charles C. Elliott, R.N.V.R.He carried out his dutios in attending wounded under heavy fire anddifficult conditions. Although he was suffering from a painfulsprained wrist, his skilful work undoubtedly saved several lives.His conduct was an example and encouragement to all on board.

And for services in the Battle of Jutland on May 31st, 1916,upon-Surg. Prob. Alexander Joe, R.N.V.R.Medical Officer of H.M.S. Nestor. He behaved with the greatestcoyness under fire, tending the wounded single-handed both inNestor ant later on board a German destroyer. Hii conduct washighly praiseworthy thrdughout.The following appointments to the Order of the British

Em.pire are announced :-Officers-Dr. Mary Booth (organised Friendly Union of Soldiers’

Wives and Soldiers’ Utub. Svdn1V); L’,.-Col. A. S. Herbert. NewZealand M.C. (for special service*’ in connexion with military hospitalsat Rotorua) Lt-Col. H. H. Y. Hearsey, Principal Medical Officer tothe Civil Government and Assistant Diret1tor of Military MedicalServices, Nyasaland Protectorate.Members.-Dr. 0. Akerman (Natal); Dr. P. P. J. Ganteaume, Mayor

of East London, S.A.; Dr. R. Strachan, Mayor of Germiston. S.A.;Dr. J. B. Addison, Chief Medical Officer. Colony of Seychelles (forservices in connexion with war charities); Dr. R. Howard, of theUniversities Mission to Central Af.lea (for voluntarv service ia attend-ing sick and wounded native soldiers and carriers. Zanzibar) ; S’trgeon-Major Joh» Hutson, Public Health Inspector. Barbados, and PrincipalMedical Officer to the Barbados Defence Force; and Dr. J. Lochhead,Surgeon, Colonial Hospital, Gibraltar (for services to merchant seamen).

MENTIONED IN DESPATCHES.The names of the following medical officers are added to

recent despatches :-Maj.-Gen. W G. A. Bedford, C.B.. O.M.G.. A.M.S.: Temp. Capt.

M. B. Arnold. R.A.M.C. ; Capt. B. A. Odium. R.A.M.O.; Lt. (temp.Capt.) W. H. Ferguson. R.A.M.C. ; Temp. Capt. A. 0. Mann. M.C.,R.A.M.C.; Col. ti. M. Si’np3on, Canadian A.M.C.; Temp. Maj. J J.Abraham, R.A.M.C.; Lt.-Col. (temp Col.) G. A. T. Brav. R A.M.C. ;Maj. (temp. Lt.-Col.) M. Dunning, R.A.M.O ; Col. E. G. R. Evatt,B.A.M.C.; Capt (acting Lt.-Col.) R. C. Lambkin, R.A.M.C. ; Temp. Lt.-Col. H. Warle, R.A.M.C.: Lt.-Col. R. T. Brown, D.S O., R.A.M.C.;Maj. (temp. Lt.-Col.) P. S. Clarke, South African M.C.; Capt. T. S.Dunn, East African Med. Service: Temp. Maj. W J. Gow, R.A.M.C. ;Maj. R. S. Kennedy, M C., I.M.S.; t’apt. (acting Lt.-Col.) J. A.Manifold, R.A.M.C.; Lt..-Col. P. W. O’Gorman, I.M.S.; Surg.-ProbJ. E. Deane, R.N.V.R.

BROUGHT TO NOTICE.The names of Major W. McConaghy, R.A.M.C., and of

Temp. Capt. W. N. Montgomery, R.A.M.C., have beenbrought to the notice of the Secretary of State for War forvaluable services rendered in connexion with militaryoperations in Hedjaz.

FOREIGN DECORATIONS.French.

Croix de Guerre.-Temp. Capt. J. B. McFarland, M.C., R.A.M.C. ;Capt. (acting Maj.) E. R. Lovell, R.A.M.C ; Capt. M. J. H.ImesAustralian A.M.C. ; Maj. (acting Lt.-Col.) H. H. A. Emerdon, D.S 0.,R.A.M.C.; Capt. S. R. Foster, M.C., R.A.M.C.; Maj. (temp. Lt-Col )W. J. S. Harvey, D.S.O., R.A.M.C.; Maj. (temp. Lt.-Col.) F. D G.Howell, D.S.O., MO., R.A.M.C. ; Capt. P. McEw..n. R.A,.5f.C.. Maj.(acting Lt.-Col.) P. J. Marett, R.A.M.C.; Capt. (acting Maj.) J. J. MeI.Shaw, M.C , R A.M.C. ; Capt. (acting Maj.) W. L. Webster, R.A.M.C. ;Temp Capt. A. B. Cluckie, R.A.M.C.Legion d’Honneur: Croix de Cltevalier.-Col. H. R. Casgrain,

Canadian A.M.C. ; Hon. Maj. C. F. Skipper, Canadian A.M.C.Portîlgue8e.

Dlilitary Order of A vis. 2nd Class.- dajor W. H. G. H. Best, R.A.M.C.Hellenic.

Order of the Redeemer. Clast. Urand Commander :Surg.-Gen.Sir H. R. Whiteh-ad, K.C.B. 3rd Class, Commander Lieut.-Col.A. R. Aldridge, O.B, C.S.I., C.M.G., R A M.C. 5th Class, Cavalier :Capt. J. P. Litt, R.A.M.C. Japanese.

Ordet. of the Sacred Treas2cre, 3rd Class.-Col. T. J. R. Lucas, C.B.(retired pay).

-

INFLUENZA ON AMERICAN TRANSPORTS.Alarming accounts have been current regarding the

prevalence and fatality of influenza among the U.S A.troops on their way across the Atlantic, especially on the ill-fated s.s. Otranto. There has evidently been some con-fusion between the number of cases and the number ofdeaths. Regarding the Otranto, we are in a position to statethat up to the time of arrival in English waters there hadbeen about 50 cases of influenza and pneumonia. Four ofthese cases of pneumonia proved fatal. Among the survivors,a considerable number of whom were injured in the accident,deaths have occurred from pneumonia due to exposure duringrescue. But this mortality should, of course, not be creditedto the prevailing epidemic.

MAJOR-GENERAL M. W. IRELAND, THE NEWSURGEON- GENERAL, U.S.A.

As we announced last week, Major-General Merritte W.Ireland has been appointed Surgeon-General to the UnitedStates Forces. General Ireland entered the Medical Corpsof the American Army in 1891 as a first lieutenant.He was promoted to the grade of captain in 1896.During the Spanish-American War he was with theFifth Army Corps expedition, which fought the battle ofSantiago and received the surrender of the city. Shortlyafter the conclusion of the Cuban campaign General Irelandwas sent to the Philippine Islands as major and surgeon ofthe 35th Infantry, U.S. Volunteers. Soon after arrival therehe was detached from regimental service and placed incharge of the Medical Supply Depot in the city of Manila,which he adminis-ered with great success. Returning tothe United States at the end of two years, he was called tothe Surgeon-General’s office in Washington, D.C., in 1902,under Surgeon-General O’Reilly, and placed in charge ofthe personnel division of that office, which he administeredmost successfully until 1912, when he was again sent to thePhilippines and put in charge of a large hospital in the

vicinity of the city of Manila, located at Fort William

McKinley.General Ireland returned to the United States in 1915,and at the time that America entered the present war was

the commanding officer of the large base hospital at FortSam Houston, Texas. Detached from this duty, he accom-panied General Pershing to Europe as a member of his staffand filled the position of assistant to the chief surgeon ofthe American Expeditionary Forces from July, 1917, untilMarch, 1918, when he was promoted to chief surgeon of thecommand while yet a colonel. His promotion to the gradeof brigadier-general followed in May of the present year,and he attained the grade of major-general in the MedicalCorps last August. General Ireland returns to the UnitedStates very shortly to take up the duties of his new positionat U S. Army Headquarters at Washington. He has alwaysbeen a man of untiring energy and acute judgment in theconduct of affairs, and the Medical Corps under his strongguidance will acquit itself well in the great endeavour whichit has now before it.

____

THE INCOME-TAX OF MEDICAL WOMEN ATTACHEDTO THE R.A.M.C.

Dr. Louisa Garrett Anderson has written calling attentionto the fact that medical women attached to the R.A.M.C. dothe work of commissioned officers when enforcing di-ciplinein such a hospital as the General Military Hospital, Endell-street, perform the surgical duties of officers in the R. A.M. C.,and receive the same rate of pay, but because they do thiswithout having commissions or honorary commissions theyare not entitled to the Service rate of income-tax. Whereabatement is made in the case of men on the ground thatthey are doing work of a military character, it is not easy tosee why work of the same kind performed by women shouldnot entitle them to the same privilege.

URBAN VITAL STATISTICS.

VITAL STATISTICS OF LONDON DURING SEPTEMBER, 1918. ’

IN the accompanying table will be found summarised completestatistics relating to sickness and mortality in the City of Londonand in each of the metropolitan boroughs. With regard to thenotified cases of infectious disease it appears that the number ofpersons reported to he suffering from one or other of the tendiseases specified in the table was equal to an annual rate of4-7 per 1000 of the population, estimated at 4,026,901 persons ; inthe three preceding months the rates had been 4’5. 3’5. and 3’2 per1000. No case of any of these diseases was notified during the monthof September in the City of London. Among the metropolitanboroughs the lowest rates were recorded in Chelsea, the City ofWestminster, St. Marylebone. Hampstead, and Hulborn; and thehighest rates in Finsbury, Bethnal Gfen, S’epney. Southwark,Bermondsey. and Greenwich. The prevalence of scarlet fever was60 per cent. higher than in the preceding month ; this diseasewas proportionally most prevalent in Finsbury. Bethnal Green,Stepney, Southwark. Bermondsey, and Lambeth. The MetropolitanAsylums Hospitals contained 931 scarlet fever patients at the endof the month, against 846, 753, and 690 at the end of the threepreceding months; the weekly admissions averaged 164, against127, 105, and 101 in the three preceding mon ha. The pre-valence of diphtheria was about 50 per cent. higher than in August;the greatest proportional prevalence of this disease ws recorded inSt. Pancras, Hackney, Bethnal Green, Stepney, Southwark, Bermondsey,

536

ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING SEPTEMBER, 1918.

(Specially compiled for THE LANCET.)

Including membranous crodp.

and Greenwich. The number of diphtheria patients under treatment tin the Metropolitan Asylums Hospitals, which had been 1179, 918, and886 at the end of the three preceding months, numbered 1051 at the end B’Iof September; the weekly admissions averaged 166, against 165, 122, aand 107 in the three preceding months. The prevalence of enteric fever twas about equal to that in the two preceding months; of the 28 cases }-notified in oeptember, 5 belonged to Islington, 5 to Wandsworth, and 2 teach to Paddington, Fulham, Hackney, Greenwich, I ewisham, and rWoolwich. There were 43 cases of enteric fever under treatment in the

aMetropolitan Asylums Hospitals at the end of the month, against 40,23, 1and 32 at the end of the three preceding months; the weekly admissions (averaged 6, against 6, 4, and 6 in the three preceding months. Erysipelas rwas proportionally most prevalent in St. Pancras, Islington, Finsbury,Bethnal Green, and Southwark. The 10 cases of puerperal fever notified fduring the month included 3 in Hackney and 2 in Woolwich. Of the 8 i

cases of cerebro-spinal meningitis 2 belonged to Wandsworth. ;The mortality statistics in the table relate to the deaths of persons 1

actually belonging to the several boroughs, the deaths occurring in Iinstitutions having been distributed among the boroughs in which ithe deceased persons had previously resided. During the four weeksended Sept. 28th the deaths of 3537 London residents were registered, equal to an annual rate of ] 1’4 per 1000; in the three precedingmonths the rates had been 11’8, 14°8, and 10’1 per 1000. The death-rates ranged in September from 6"5 in the City of London, 8’8 inHampstead, 9-2 in the City of Westminster, 9-3 in Woolwich, and 9-9in Stoke Newington, to 12’7 in St. Pancras. 12’8 in St. Marylebone,13’7 in Bermondsey, 13.8 in Bethnal Green, 14’2 in Poplar, and 16’2 inHolborn. The 3537 deaths from all causes included 394 whichwere referred to the principal infectious diseases ; of these, 18resulted from measles, 9 from scarlet fever, 29 from diphtheria,28 from whooping-cough, 7 from enteric fever, and 303 fromdiarrhoea and enteritis among children under 2 years of age.Among the metropolitan boroughs the lowest death-rates from thesediseases were recorded in Paddington, Chelsea, the City of West-minster, St. Marylebone, Hampstead, and -Stoke Newington; and thehighest in Shoreditch. Bethnal Green, Stepney, Poplar, Bermondsey,and Woolwich. The 18 deaths from measles were 19 below the averagenumber in the corresponding period of the five preceding years, andincluded 6 in St. Pancras and 3 in Bermondsey. The 9 fatal cases ofscarlet fever showed a decline of 2 from the average ; of these, 3 deaths

belonged to Lambeth. The 29 deaths from diphtheria were 10 less thanthe average, and included 4 in Stepney, 4 in Woolwich, 3 in Islington,and 3 in Poplar. The deaths from whooping-cough numbered 28, andshowed a decline of 13 from the average; of these, 4 belonged toIslington, 3 to Bermondsey, and 3 to Battersea. The 7 fatal cases ofenteric fever were one less than the average number; 2 deaths belongedto St. Panoras. The 303 deaths from diarrhoea and enteritis amongchildren under 2 years of age were less than a half of the average;this disease was proportionally most fatal in Fulham, Hackney,Shoreditch, Bethnal Green, Stepney, and Poplar. In conclusion, it maybe stated that the aggregate mortality in London in September fromthese principal infectious diseases was 51 per cent. below the average.

(Week ended Oct. 12th, 1918.)English and 1Velsh Towns.-In the 98 English and Welsh towns,

with an aggregate civil population estimated at 16,500,000 persons, theannual rate of mortality was 15’1, against 11’4 and 12.6 per 1000 in thetwo preceding weeks. In London, with a population slightly exceed-ing 4,000,000 persons, the death-rate was 14’0, or 1’3 per 1000 abovethat recorded in the previous week; among the remaining towns therates ranged from 4’7 in Gillingham, 5’4 in Barnsley and in Rhondda,and 6’2 in Ilford, to 33’5 in Birkenhead, 41’6 in Southampton, 43’4 inExeter, and 44’1 in Portsmouth. The principal epidemic diseasescaused 207 deaths, which corresponded to an annual rate of 0’7 per 1000,and included 96 from infantile diarrhoea. 49 from diphtheria, 22 fromwhooping-cough, 21 from measles, 15 from scarlet fever, and 4 fromenteric fever. The deaths from diarrhoea, which had declined from 435 to186 in the six preceding weeks, further fell to 96, and were 147 below thenumber registered in the corresponding week of last year; 30 deathsbelonged to London, 7 to Liverpool, and 6 each to Birmingham andSheffield. The 1148 cases of scarlet fever and 1182 of diphtheriaunder treatment in the Metropolitan Asylums Hospitals and theLondon Fever Hospital were 129 and 57 above the respective numbersremaining at the end of the previous week. The deaths frominfluenza in London numbered 80. against 17 in each of the two pre-ceding weeks. The causes of 47 deaths in the 96 towns were un-certified, of which 12 were registered in Birmingham, 10 in Liverpool,5 in Walthamstow. and 3 in Leicester.

Scotch Towns.-In the 16 largest Scotch towns, with an aggregatepopulation estimated at nearly 2.&00.000 persons, the annual rate ofmortality which had increased from 10’6 to 19’0 in the four precedingweeks, further rose to 24 per 1000. Of the 1141 deaths from all causes.45 were classified to influenza, which was also stated as a contributorycause in 339 deaths classified to other diseases; in the previous weekthese numbers were 35 and 159 respectively. The 767 deaths in Glasgowcorresponded to an annual rate of 35’9 per 1000, and included 11 fromwhooping-cough, 5 from infantile diarrhoea, 4 from diphtheria, and1 from measles. The 74 deaths in Edinburgh were equal to a rateof 11’6 per 1000, and included 3 each from scarlet fever and diphtheria,2 from infantile diarrhoea, and 1 from measles.

Irish Towns.-The 188 deaths in Dublin corresponded to an annualrate of 24’6, or 3’3 per 1000 above that recorded in the previous week,and included 7 from infantile diarrhoea, and 1 each from entericfever, scarlet fever, and diphtheria. The 106 deaths in Belfast wereequal to a rate of 14’1 per 1000. and included 4 from infantile diarrhoeaand 1 each from enteric fever and measles.

BRITISH HOSPITALS ASSOCIATION.-A conferencewill be held at St. Thomas’s Hospital, London, to-day (Friday,Oct. 18th) at 3 P.M. to consider the proposal to create a

Ministry of Health, in its relation to the voluntary hospitals.Lord Sandhurst will preside.