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THE BOARD OF EDUCATION AND MEDICAL INSPECTION AND TREATMENT OF LONDON SCHOOL CHILDREN.
1357 in his and in
the prisoner was subject to hysteria, sentence the Lord Chief Justice, after saying to the prisoner, "You made atrocious charges against an honest man and a friend," is reported as having used these words,"You were not, perhaps, in your right mind at the time of the thefts, but undoubtedly you stole the goods." Presumably the attention of the Home Office will be called to his utterance and to the salient features of a crime, the futility of which and the hopelessness of it escaping detection, coupled with the nature of the defence raised, would seem to justify the suggestion that it was committed by a person not in her "right mind." No doubt the defence was insisted upon and excluded any other, but the passing of a sentence of hard la.bour upon a prisoner who, according to the expressed view of the judge sentencing her, may not have been in her right mind, even if it be followed by other measures to meet the case, hardly seems desirable The convict’s line of defence or consistent with justice. makes it impossible for her to expect much public sympathy, but medical men will view the matter otherwise. A Medioal Man and the Justifiable Use of Force.
opinion, passing
According to the evidence given at the Brentford police recently Mr. George Phillips, a medical man practising in West Ealing, had occasion to remonstrate with the court
husband of a female patient in the course of last year on the ground that his conduct had caused injury to her health. This was resented by the husband to such an extent that many months afterwards he summoned the medical man to his house by telephone, and having got him there barred his exit and tried to insist upon retractation of what had been said and an apology. Mr. Phillips refused to tender either, and after being called abusive names by his captor had to seek an exit by throwing the angry husband on to a couch, on account of which forcible proceeding he was summoned for assault. The Bench, however, after hearing the prosecutor’s evidence, at once said that the only question was whether the defendant used such force as was necessary to enable him to leave the house, and being of the opinion that that was all he had done dismissed the case. It is extremely rare, we are glad to say, that we have to record such resentment against a medical man for speaking his mind.
Old
Age Pensions and Starvation. inquest held by Mr. Troutbeck at the Battersea Coroner’s Court recently an account was given of the life of an aged couple which illustrates an undoubted danger which follows in some cases upon the granting of old age pensions, where the recipient is unable to supplement them through The deceased the goodwill of relatives or by other means. was a woman receiving an old age pension and living with her husband, who will not attain the age entitling him to a pension until next June. The two shared a single room, for which they paid 3s. weekly rent, and their income consisted of the 5s. pension of the wife, supplemented by such casual additions as the aged husband could earn by window cleaning, gardening, and other casual employment of a precarious nature. They had, in fact, Is. per week each for food, and the pension which they shared, coupled, no doubt, with the prospect of the husband becoming entitled to one in the near future, kept them both out of the workhouse and the old woman from the infirmary. She had been unable to do anything for herself for 12 months, and her husband, with the aid of their landlady, had attended to her wants as best he might. Dr. L. Freyberger, giving the result of the post-mortem examination which he had made, deposed that death was due to heart failure, accelerated by acute intiammation of the lungs and want of food. He also stated that the husband, who was quite unfit At
to
an
give his wife the attention necessary
suffering from senile decay.
in her
condition,
was
struggle of the poor to keep out of the workhouse must always evoke a measure of sympathy, and the rates are saved through their endurance of semi-starvation. At the same time the 5s. paid by the State can hardly be said to be well expended upon those persons whom it tempts to prolong a miserable existence in squalid and insanitary homes without any possibility of being able to provide for themselves reasonably decent maintenance.
The
THE BOARD OF EDUCATION AND MEDICAL INSPECTION AND TREATMENT OF LONDON SCHOOL CHILDREN. THE receipt of an important letter from the Board of Education declining to sanction proposed extensions of the present scheme for the medical treatment of London school children was reported to the Education Committee of the London County Council on Nov. 8th. In July the Council decided to invite the Board’s approval of agreements with 10 hospitals and 13 committees of local medical practitioners.1 In 10 cases the proposed agreements with committees of medical practitioners were in respect of new centres to be established. The Board of Education in its letter said that the proposed establishment of these centres constituted a very large extension of the Council’s scheme of treatment, and while the Board fully appreciated the desire to make further and continuous progress towards the provision of a complete scheme it appeared doubtful whether the Council would be wise in committing itself at this juncture to such an extensive development of this single type of remedial agency. The reorganisation of the Council’s arrangements for the administration of medical inspection and treatment was a matter of the first importance to the school medical service of London. Though the Board did not suggest that all extension of the London treatment scheme should be postponed pending the reorganisation, it appeared desirable that until the new organisation had been established and the responsible officer (who it was understood would combine the offices of county medical officer of health and school medical officer) had had time to consider and advise the Council on the matter, any extensions of the work should be confined to rather narrow limits, and so far as they were immediately necessary should be undertaken only on a provisional basis. The Board was not satisfied that the establishment of a large number of treatment centres, conducted under conditions similar to those existing at the Norwood and Wandsworth centres, was in all respects desirable. The Board recognised that much valuable work had been done there, but it had regarded the existing organisation of those centres as tentative and experimental, and doubted whether at the present time it was wise to occupy so much ground in all parts of London by this particular form of agency, the establishment of which might prejudice the development of other agencies more appropriate to the circumstances, and better fitted to serve as a basis of a complete and permanent system. Indeed, the Board held that the constitution of these centres must be modified in several important respects if they were to form an integral part of the London system of coordinated inspection and treatment; and it was almost essential that in introducing the modifications required, the Council should have the advice and assistance of the chief medical officer who would be appointed shortly. The Board would be very reluctant to refuse or even to delay provisional sanction to any well-considered extension of the Oouncil’s scheme of treatment whieh would be put into operation at once and be used for the immediate relief of children whose defects had been ascertained but who could not now obtain treatment because the existing means at the disposal of the Council were inadequate. But from the information before it and after considerable inquiry the Board was not satisfied that the existing conditions in respect of medical inspection and medical treatment in London were such as to justify the particular form of develupment on such an extensive scale as the Council proposed for immediate adoption, and therefore some postponement was preferable. it seemed hardly possible for such establishment to be effected within the next three months as the Council suggested. Not one of the new centres, except that at Deptford, was in fact as yet in existence ; nor had any definite arrangements yet been formulated in regard to the acquisition of premises, the appointment of the medical staff, or the precise control and management of the new medical treatment centres. It would appear, therefore, that the postponement of the adoption of these extensions for a few months, pending the intended reorganisation of the Council’s administrative 1
THE
LANCET, July 22nd, 1911, p. 246.
1358 was to take effect in less than three months from the end of October (the date of the Board’s letter), would not involve the loss of any immediate benefits to the children, but would be more likely to result in the ultimate adoption of a scheme more closely coordinated with the Council’s system of medical inspection, more definitely under the supervision of the authority, and more directly fitted to the needs of the area as a whole. The ultimate gain to the children resulting from the establishment of such a scheme would far outweigh any disadvantages which might arise from temporary postponement. In these circumstances, it appeared very desirable that the matter should be further considered by the Council, and the Board had decided therefore that it would not be justified at this stage in sanctioning the proposed large extension of the scheme.
arrangements which
The Board intimated that it would be prepared to sanction proposed arrangements with the committee of the Deptford Children’s Health Centre, and the continuance
the
until Dec. 31st, 1912, of the arrangements for the medical treatment of children at the nine hospitals and three treatment centres (Norwood, Wandsworth, and Woolwich), in respect of which sanction had already been given for the year ending Dec. 31st, 1911. This sanction covered the proposed modifications and extensions of the arrangements with certain of these institutions, and was subject to the Council furnishing the Board before the end of this calendar year with a statement to the effect that the committees of each of the hospitals and treatment centres concerned had consented to the continuance and extension or modification of the existing agreements. The Board would also require to receive from the Council not later than Oct. 31st, 1912, a full report by the Council’s school medical officer on the working of the arrangements sanctioned. The Children’s Care Subcommittee, in reply to this letter, urged that as the scheme under discussion was submitted in response to the expressed wishes of the Board, it could not be intended that the Council should defer the question of any further provision for medical treatment until it had considered the matter in relation to the reorganisation of the general medical work of the Council. The subcommittee read the letter of the Board of Education as implying that, while the Council’s proposals as a whole could not be agreed to, the Board would be willing to consider individual pro posals of an urgent nature on their merits. The Education Committee decided, without discussion, to write to the Board inquiring whether individual proposals for providing treatment might be submitted pending the reorganisation of the Council’s medical service. now
and caused the highest annual death-rates of 1’6 in Birkenhead and in West Hartlepool, 1’7 in Walsall, 2 0 in Stockton-on-Tees, and 29in Warrington. The deaths referred to diphtheria, which had been 44, 60, and 46 in the three preceding weeks, rose to 56 last week; 21 deaths were recorded in London and its suburban districts, 4 in Leeds, and 3 in Preston. The fatal cases of measles, which had increased from 19 to 48 in the five preceding weeks, declined last week to 36, and included 12 in London, 4 in Nottingham, and 3 in Burnley. The deaths attributed to enteric fever, which had been 39, 48, and 28 in the three previous weeks, rose last week to 35, and included 10 in London and its suburban districts, 4 in Hull, and 2 each in Liverpool, Bradford, Leeds, and Newcastle-on-Tyne. The deaths referred to scarlet fever, which had averaged 14 in the four preceding weeks, rose last week to 30, and of these 3 were registered in London, 3 in Stoke-on-Trent, and 2 each in Birmingham, Coventry, Nottingham, Liverpool, Leeds, and Sheffield. The fatal cases of whooping-cough, which had been 35, 25, and 30 in the three preceding weeks, declined last week to 16, and was the lowest number recorded in any week of the current year ; 3 deaths were recorded in London, 2 in Great Yarmouth, and 2 in Liverpool. The number of scarlet fever patients in the Metropolitan Asylums and in the London Fever Hospital, which had steadily increased from 1327 to 2180 in the nine preceding weeks, had further advanced to 2189 on Saturday last; 269 new cases of this disease were admitted to these hospitals during the week, against 355, 344, and 297 in the three previous weeks. These hospitals also contained on Saturday last 1178 cases of diphtheria, 161 of whoopingcough, 146 of enteric fever, and 85 of measles, but not one of small-pox. The 1140 deaths from all causes in London last week were 8 in excess of the number in the previous week, and included 170 which were referred to diseases of the respiratory system, against 210, 218, and 210 in the three preceding weeks. The deaths attributed to different forms of violence in the 77 towns, which had been 150 and 158 in the two preceding weeks, declined to 144 last week, and 355 inquest cases were registered. The causes of 24, or 0-6per cent., of the deaths registered in the 77 towns last week were not certified either by a
medical practitioner or by a coroner after inquest. of death were duly certified in Manchester, Sheffield, Leeds, West Ham, Bradford, Newcastle-on-Tyne,
registered All the
causes
and in 52 other smaller towns. The 24 uncertified causes of death during the week under notice included 5 in Liverpool and 2 each in Birmingham, Bootle, and Gateshead.
Nottingham, Portsmouth,
____
HEALTH OF SCOTCH TOWNS.
VITAL STATISTICS. HEALTH OF ENGLISH TOWNS.
IN 77 of the largest English towns, having an estimated population of 16,157,797 persons in the middle of this year, 8061 births and 4182 deaths were registered during the week ending Nov. 4th. The annual rate of mortality in these towns, which had steadily decreased from 21’2 to 13 3 in the ten preceding weeks, slightly rose to 13.5 Daring the first five per 1000 in the week under notice. weeks of the current quarter the mean annual death-rate in these towns averaged 14 3, or 0’per 1000 above The that recorded in London during the same period. 5 death-rates in the 77 towns last week ranged from 4. in Devonport, 6 4 in King’s Norton, and 6’ 8 in Hornsey and in Dewsbury, to 19 3 in Middlesbrough, 20’5in Great Yarmouth, 20-6in West Bromwich, and 20-8in Bootle. The 4182 deaths from all causes in the 77 towns were 54 in excess of the number returned in the previous week, and included 301 which were referred to the principal epidemic diseases, against numbers decreasing from 2900 to 334 in the ten preceding weeks. Of these 301 deaths, 128 resulted from infantile diarrhoea, 56 from diphtheria, 36 from measles, 35 from enteric fever, 30 from scarlet fever, and 16 from whooping-cough, but not one from small-pox. The mean annual death-rate from these epidemic diseases last week was equal to 1 - 0 per 1000, against 1-3 and 1-1 in the two previous weeks. The deaths of infants under 2 years of age attributed to diarrhoea, which had continuously decreased from 2714 to 164 in the ten preceding weeks, further declined to 128 last week,
eight of the principal Scotch towns, having an estimated population of 1,710,291 persons in the middle of this year, 793 births and 538 deaths were registered during the week ending Nov. 4th. The annual rate of mortality in these towns, which had been 15’77 and 16 -7per 1000 in the two preceding weeks, declined to 16-4 in the week under notice. During the first five weeks of the current quarter the mean annual death-rate in these Scotch towns averaged 16’0 per 1000, and was 1.7 per 1000 above the mean death-rate during the same period in the 77 large English towns. The annual death-rates in the Scotch towns last week ranged from 9 3 and 13 2 in Paisley and to Greenock 18.0 in Dundee and 18-3in Glasgow. The deaths from all causes in the eight towns were 10 fewer than the number in the previous week, and included 47 which were referred to the principal epidemic diseases, against 47 and 52 in the two preceding weeks; of these 47 deaths, 15 resulted from measles, 12 from diarrhoeal diseases, 11 from diphtheria, 5 from whooping-cough, and 4 from scarlet fever, but not one from small-pox or from enteric fever. The mean annual death-rate from these epidemic diseases in the eight towns last week was equal to 1’4 per 1000, and was 0’4 per 1000 above the mean death-rate from the same diseases in the 77 large English towns. The deaths attributed to measles, which had steadily risen from 1 to 12 in the five preceding weeks, further increased to 15 last week, and comprised 8 in Glasgow, 6 in Aberdeen, and 1 in Leith. The deaths referred to diarrhoeal diseases, which had been 41, 20, and 19 in the three previous weeks, further declined last week to 12, all but one of which were of infants under two years of age; 5 In
the prisoner was subject to hysteria, sentence the Lord Chief Justice, after saying to the prisoner, "You made atrocious charges against an honest man and a friend," is reported as having used these words,"You were not, perhaps, in your right mind at the time of the thefts, but undoubtedly you stole the goods." Presumably the attention of the Home Office will be called to his utterance and to the salient features of a crime, the futility of which and the hopelessness of it escaping detection, coupled with the nature of the defence raised, would seem to justify the suggestion that it was committed by a person not in her "right mind." No doubt the defence was insisted upon and excluded any other, but the passing of a sentence of hard la.bour upon a prisoner who, according to the expressed view of the judge sentencing her, may not have been in her right mind, even if it be followed by other measures to meet the case, hardly seems desirable The convict’s line of defence or consistent with justice. makes it impossible for her to expect much public sympathy, but medical men will view the matter otherwise. A Medioal Man and the Justifiable Use of Force.
opinion, passing
According to the evidence given at the Brentford police recently Mr. George Phillips, a medical man practising in West Ealing, had occasion to remonstrate with the court
husband of a female patient in the course of last year on the ground that his conduct had caused injury to her health. This was resented by the husband to such an extent that many months afterwards he summoned the medical man to his house by telephone, and having got him there barred his exit and tried to insist upon retractation of what had been said and an apology. Mr. Phillips refused to tender either, and after being called abusive names by his captor had to seek an exit by throwing the angry husband on to a couch, on account of which forcible proceeding he was summoned for assault. The Bench, however, after hearing the prosecutor’s evidence, at once said that the only question was whether the defendant used such force as was necessary to enable him to leave the house, and being of the opinion that that was all he had done dismissed the case. It is extremely rare, we are glad to say, that we have to record such resentment against a medical man for speaking his mind.
Old
Age Pensions and Starvation. inquest held by Mr. Troutbeck at the Battersea Coroner’s Court recently an account was given of the life of an aged couple which illustrates an undoubted danger which follows in some cases upon the granting of old age pensions, where the recipient is unable to supplement them through The deceased the goodwill of relatives or by other means. was a woman receiving an old age pension and living with her husband, who will not attain the age entitling him to a pension until next June. The two shared a single room, for which they paid 3s. weekly rent, and their income consisted of the 5s. pension of the wife, supplemented by such casual additions as the aged husband could earn by window cleaning, gardening, and other casual employment of a precarious nature. They had, in fact, Is. per week each for food, and the pension which they shared, coupled, no doubt, with the prospect of the husband becoming entitled to one in the near future, kept them both out of the workhouse and the old woman from the infirmary. She had been unable to do anything for herself for 12 months, and her husband, with the aid of their landlady, had attended to her wants as best he might. Dr. L. Freyberger, giving the result of the post-mortem examination which he had made, deposed that death was due to heart failure, accelerated by acute intiammation of the lungs and want of food. He also stated that the husband, who was quite unfit At
to
an
give his wife the attention necessary
suffering from senile decay.
in her
condition,
was
struggle of the poor to keep out of the workhouse must always evoke a measure of sympathy, and the rates are saved through their endurance of semi-starvation. At the same time the 5s. paid by the State can hardly be said to be well expended upon those persons whom it tempts to prolong a miserable existence in squalid and insanitary homes without any possibility of being able to provide for themselves reasonably decent maintenance.
The
THE BOARD OF EDUCATION AND MEDICAL INSPECTION AND TREATMENT OF LONDON SCHOOL CHILDREN. THE receipt of an important letter from the Board of Education declining to sanction proposed extensions of the present scheme for the medical treatment of London school children was reported to the Education Committee of the London County Council on Nov. 8th. In July the Council decided to invite the Board’s approval of agreements with 10 hospitals and 13 committees of local medical practitioners.1 In 10 cases the proposed agreements with committees of medical practitioners were in respect of new centres to be established. The Board of Education in its letter said that the proposed establishment of these centres constituted a very large extension of the Council’s scheme of treatment, and while the Board fully appreciated the desire to make further and continuous progress towards the provision of a complete scheme it appeared doubtful whether the Council would be wise in committing itself at this juncture to such an extensive development of this single type of remedial agency. The reorganisation of the Council’s arrangements for the administration of medical inspection and treatment was a matter of the first importance to the school medical service of London. Though the Board did not suggest that all extension of the London treatment scheme should be postponed pending the reorganisation, it appeared desirable that until the new organisation had been established and the responsible officer (who it was understood would combine the offices of county medical officer of health and school medical officer) had had time to consider and advise the Council on the matter, any extensions of the work should be confined to rather narrow limits, and so far as they were immediately necessary should be undertaken only on a provisional basis. The Board was not satisfied that the establishment of a large number of treatment centres, conducted under conditions similar to those existing at the Norwood and Wandsworth centres, was in all respects desirable. The Board recognised that much valuable work had been done there, but it had regarded the existing organisation of those centres as tentative and experimental, and doubted whether at the present time it was wise to occupy so much ground in all parts of London by this particular form of agency, the establishment of which might prejudice the development of other agencies more appropriate to the circumstances, and better fitted to serve as a basis of a complete and permanent system. Indeed, the Board held that the constitution of these centres must be modified in several important respects if they were to form an integral part of the London system of coordinated inspection and treatment; and it was almost essential that in introducing the modifications required, the Council should have the advice and assistance of the chief medical officer who would be appointed shortly. The Board would be very reluctant to refuse or even to delay provisional sanction to any well-considered extension of the Oouncil’s scheme of treatment whieh would be put into operation at once and be used for the immediate relief of children whose defects had been ascertained but who could not now obtain treatment because the existing means at the disposal of the Council were inadequate. But from the information before it and after considerable inquiry the Board was not satisfied that the existing conditions in respect of medical inspection and medical treatment in London were such as to justify the particular form of develupment on such an extensive scale as the Council proposed for immediate adoption, and therefore some postponement was preferable. it seemed hardly possible for such establishment to be effected within the next three months as the Council suggested. Not one of the new centres, except that at Deptford, was in fact as yet in existence ; nor had any definite arrangements yet been formulated in regard to the acquisition of premises, the appointment of the medical staff, or the precise control and management of the new medical treatment centres. It would appear, therefore, that the postponement of the adoption of these extensions for a few months, pending the intended reorganisation of the Council’s administrative 1
THE
LANCET, July 22nd, 1911, p. 246.
1358 was to take effect in less than three months from the end of October (the date of the Board’s letter), would not involve the loss of any immediate benefits to the children, but would be more likely to result in the ultimate adoption of a scheme more closely coordinated with the Council’s system of medical inspection, more definitely under the supervision of the authority, and more directly fitted to the needs of the area as a whole. The ultimate gain to the children resulting from the establishment of such a scheme would far outweigh any disadvantages which might arise from temporary postponement. In these circumstances, it appeared very desirable that the matter should be further considered by the Council, and the Board had decided therefore that it would not be justified at this stage in sanctioning the proposed large extension of the scheme.
arrangements which
The Board intimated that it would be prepared to sanction proposed arrangements with the committee of the Deptford Children’s Health Centre, and the continuance
the
until Dec. 31st, 1912, of the arrangements for the medical treatment of children at the nine hospitals and three treatment centres (Norwood, Wandsworth, and Woolwich), in respect of which sanction had already been given for the year ending Dec. 31st, 1911. This sanction covered the proposed modifications and extensions of the arrangements with certain of these institutions, and was subject to the Council furnishing the Board before the end of this calendar year with a statement to the effect that the committees of each of the hospitals and treatment centres concerned had consented to the continuance and extension or modification of the existing agreements. The Board would also require to receive from the Council not later than Oct. 31st, 1912, a full report by the Council’s school medical officer on the working of the arrangements sanctioned. The Children’s Care Subcommittee, in reply to this letter, urged that as the scheme under discussion was submitted in response to the expressed wishes of the Board, it could not be intended that the Council should defer the question of any further provision for medical treatment until it had considered the matter in relation to the reorganisation of the general medical work of the Council. The subcommittee read the letter of the Board of Education as implying that, while the Council’s proposals as a whole could not be agreed to, the Board would be willing to consider individual pro posals of an urgent nature on their merits. The Education Committee decided, without discussion, to write to the Board inquiring whether individual proposals for providing treatment might be submitted pending the reorganisation of the Council’s medical service. now
and caused the highest annual death-rates of 1’6 in Birkenhead and in West Hartlepool, 1’7 in Walsall, 2 0 in Stockton-on-Tees, and 29in Warrington. The deaths referred to diphtheria, which had been 44, 60, and 46 in the three preceding weeks, rose to 56 last week; 21 deaths were recorded in London and its suburban districts, 4 in Leeds, and 3 in Preston. The fatal cases of measles, which had increased from 19 to 48 in the five preceding weeks, declined last week to 36, and included 12 in London, 4 in Nottingham, and 3 in Burnley. The deaths attributed to enteric fever, which had been 39, 48, and 28 in the three previous weeks, rose last week to 35, and included 10 in London and its suburban districts, 4 in Hull, and 2 each in Liverpool, Bradford, Leeds, and Newcastle-on-Tyne. The deaths referred to scarlet fever, which had averaged 14 in the four preceding weeks, rose last week to 30, and of these 3 were registered in London, 3 in Stoke-on-Trent, and 2 each in Birmingham, Coventry, Nottingham, Liverpool, Leeds, and Sheffield. The fatal cases of whooping-cough, which had been 35, 25, and 30 in the three preceding weeks, declined last week to 16, and was the lowest number recorded in any week of the current year ; 3 deaths were recorded in London, 2 in Great Yarmouth, and 2 in Liverpool. The number of scarlet fever patients in the Metropolitan Asylums and in the London Fever Hospital, which had steadily increased from 1327 to 2180 in the nine preceding weeks, had further advanced to 2189 on Saturday last; 269 new cases of this disease were admitted to these hospitals during the week, against 355, 344, and 297 in the three previous weeks. These hospitals also contained on Saturday last 1178 cases of diphtheria, 161 of whoopingcough, 146 of enteric fever, and 85 of measles, but not one of small-pox. The 1140 deaths from all causes in London last week were 8 in excess of the number in the previous week, and included 170 which were referred to diseases of the respiratory system, against 210, 218, and 210 in the three preceding weeks. The deaths attributed to different forms of violence in the 77 towns, which had been 150 and 158 in the two preceding weeks, declined to 144 last week, and 355 inquest cases were registered. The causes of 24, or 0-6per cent., of the deaths registered in the 77 towns last week were not certified either by a
medical practitioner or by a coroner after inquest. of death were duly certified in Manchester, Sheffield, Leeds, West Ham, Bradford, Newcastle-on-Tyne,
registered All the
causes
and in 52 other smaller towns. The 24 uncertified causes of death during the week under notice included 5 in Liverpool and 2 each in Birmingham, Bootle, and Gateshead.
Nottingham, Portsmouth,
____
HEALTH OF SCOTCH TOWNS.
VITAL STATISTICS. HEALTH OF ENGLISH TOWNS.
IN 77 of the largest English towns, having an estimated population of 16,157,797 persons in the middle of this year, 8061 births and 4182 deaths were registered during the week ending Nov. 4th. The annual rate of mortality in these towns, which had steadily decreased from 21’2 to 13 3 in the ten preceding weeks, slightly rose to 13.5 Daring the first five per 1000 in the week under notice. weeks of the current quarter the mean annual death-rate in these towns averaged 14 3, or 0’per 1000 above The that recorded in London during the same period. 5 death-rates in the 77 towns last week ranged from 4. in Devonport, 6 4 in King’s Norton, and 6’ 8 in Hornsey and in Dewsbury, to 19 3 in Middlesbrough, 20’5in Great Yarmouth, 20-6in West Bromwich, and 20-8in Bootle. The 4182 deaths from all causes in the 77 towns were 54 in excess of the number returned in the previous week, and included 301 which were referred to the principal epidemic diseases, against numbers decreasing from 2900 to 334 in the ten preceding weeks. Of these 301 deaths, 128 resulted from infantile diarrhoea, 56 from diphtheria, 36 from measles, 35 from enteric fever, 30 from scarlet fever, and 16 from whooping-cough, but not one from small-pox. The mean annual death-rate from these epidemic diseases last week was equal to 1 - 0 per 1000, against 1-3 and 1-1 in the two previous weeks. The deaths of infants under 2 years of age attributed to diarrhoea, which had continuously decreased from 2714 to 164 in the ten preceding weeks, further declined to 128 last week,
eight of the principal Scotch towns, having an estimated population of 1,710,291 persons in the middle of this year, 793 births and 538 deaths were registered during the week ending Nov. 4th. The annual rate of mortality in these towns, which had been 15’77 and 16 -7per 1000 in the two preceding weeks, declined to 16-4 in the week under notice. During the first five weeks of the current quarter the mean annual death-rate in these Scotch towns averaged 16’0 per 1000, and was 1.7 per 1000 above the mean death-rate during the same period in the 77 large English towns. The annual death-rates in the Scotch towns last week ranged from 9 3 and 13 2 in Paisley and to Greenock 18.0 in Dundee and 18-3in Glasgow. The deaths from all causes in the eight towns were 10 fewer than the number in the previous week, and included 47 which were referred to the principal epidemic diseases, against 47 and 52 in the two preceding weeks; of these 47 deaths, 15 resulted from measles, 12 from diarrhoeal diseases, 11 from diphtheria, 5 from whooping-cough, and 4 from scarlet fever, but not one from small-pox or from enteric fever. The mean annual death-rate from these epidemic diseases in the eight towns last week was equal to 1’4 per 1000, and was 0’4 per 1000 above the mean death-rate from the same diseases in the 77 large English towns. The deaths attributed to measles, which had steadily risen from 1 to 12 in the five preceding weeks, further increased to 15 last week, and comprised 8 in Glasgow, 6 in Aberdeen, and 1 in Leith. The deaths referred to diarrhoeal diseases, which had been 41, 20, and 19 in the three previous weeks, further declined last week to 12, all but one of which were of infants under two years of age; 5 In