746 is practically useless in India. In England the total solids on-Tees, and 7-2 in Rochdale. The fatal cases of diar- 2 must not be less than 8’5 per cent., while in India a rhcoa and enteritis (among infants under years), which had been and 68 in the three wider limit is as there is no means of ascer- 65, 60, pre- admissible, fell and included 14 in the of buffalo and cow’s milk ceding weeks, to 65, London, taining respective proportion 7 in Birmingham, 5 in Manchester, and 3 in Liver- when mixed. Thus any fair standard for solids would be too hool. The deaths attributed to diphtheria, which had high for cw’s milk alone, and a standard even as high as been 82, 54, and 61 in the three preceding weeks, fell to 8’3 per cent. would still leave it open to the buffalo milk 53, of which 11 occurred in London, 5 in Birmingham, and vendor to add from 10 to 20 per cent. of water without fear 3 in Liverpool. The deaths referred to scarlet fever, which of detection. Dr. Leather describes two other methods for had been 17, 13, and 19 in the three preceding weeks, The 9 the detection of added water-the refractive index of the declined to 12, and included 2 in St. Helens. fatal cases of enteric of which 2 were registered in Sheffield, milk serum and the of the milk. The former fever, freezing-point were equal to the average in the earlier weeks of the would hardly detect 10 per cent. of added water. The quarter. latter method he finds much more dependable, and by it the The number of scarlet fever patients in the Metro. addition of even very small quantities of water are readily politan Asylums Hospitals and the London Fever Hos. detected. pital, which had declined from 2257 to 1839 in the nine Snaall-pox Epidemic in Madras. preceding weeks, further fell to 1783 on Saturday last; 210 new cases were admitted during the week, against The existence of small-pox in an epidemic form in Madras 234, 216, and 193 in the three preceding weeks. These is notified, and the health department of the Madras corpora- hospitals also contained on Saturday last 1443 cases of tion is doing its best to grapple with the disease, which is diphtheria, 237 of whooping-cough, 120 of measles, and 49 of said to have been introduced by the large influx of visitors enteric fever, but not one of small-pox. The 1435 deaths causes in were 166 during the Christmas holidays. Just now there are a large from all London fewer than in the number of from the north Madras previous week, and corresponded to an annual rate of pilgrims passing through 1000. The deaths referred to diseases of the on their to Rameswaram. 16.6 per way respiratory system, which had been 373, 344, and 405 in the Plantain Jiiioe as an Antidote for Snake-bite. three preceding weeks, fell to 337 in the week under notice, were 142 The Times of that at Colombo, in the and below the number registered in the correspond. Ceylon reports week of last year. of a Mr. Donald ing presence large gathering, including doctors, Of the 5722 deaths from all causes in the 96 towns, 171 demonstrated the of as an Obeysekere efficacy plantain juice resulted from violence and 429 were the subject of coroners’ antidote to snake-bite. Mr. Obeysekere liberated a cobra inquests, while 1664 occurred in public institutions. The from a gunny-bag face to face with a valuable bull terrier, causes of 42, or 07 per cent., of the total deaths were upon which the demonstrator’s confidence in his remedy led not certified either by a registered medical practitioner or him to The broke the cobra’s by a coroner after inquest. All the causes of death were experiment. dog, however, certified in London and in its 14 suburban back after a ten minutes’ which he had duly districts, fight, during in Leeds, Bristol, Bradford, Hull, and succeeded in its The bull terrier was then Newcastle-on-Tyne, avoiding fangs. in 58 other smaller towns. Of the 42 uncertified causes, and a was was held off, village pi-dog brought in and 11 were registered in Birmingham, 6 in Liverpool, 3 each severely bitten by the snake. It howled with pain and in Manchester, and Tynemouth, and 2 each in St. Helens, collapsed in a few minutes. The dog was then given Rochdale, Preston, Blackpool, and Darlington. plaintain juice freshly expressed from some young trees of no and when about a had particular variety, breakfast-cup VITAL STATISTICS OF LONDON DURING 1916. been administered it is stated that the dog began to revive. FEBRUARY, In the table will be Within half an hour it was on its feet, and the doctors accompanying found summarised statistics to sickness and in were satisfied that it had over the effects of the complete relating mortality present got the of London and in each of the The adds that the was then City metropolitan boroughs. poison. journal experiment With regard to the notified cases of infectious diseases, it with a which was likewise bitten and repeated cock, badly appears that the number of persons reported to be suffering recovered. Dr. Fabian Hirst, who was present, was asked from one or other of the 10 diseases specified in the table to make further experiments, the result of which will be was equal to an annual rate of 6-0 per 1000 of the population, awaited with interest. estimated at 4,516,612 persons; in the three preceding March 5th. months the rates had been 7’8, 6’3, and 6’5 per 1000 respec- ______tively. The lowest rates in the month were recorded in Kensington, Chelsea, the City of Westminster, St. Maryle- VITAL STATISTICS. bone, and Hampstead; and the highest rates in Stoke Newington, Finsbury, Shoreditch, Bethnal Green, and HEALTH OF ENGLISH TOVPNS.1 Stepney. The prevalence of scarlet fever showed a further decline from that recorded in other recent IN the 96 and Welsh towns with English populations this disease was most last months; proportionally preva- exceeding 50,000 persons at the Census, 7859 births lent during the month in Holborn, Finsbury, Shoreditch, and 5722 deaths were registered during the week ended Bethnal Green, and Greenwich. The Metropolitan Asylums Saturday, March 25th. The annual rate of mortality in Hospitals contained 1956 scarlet fever patients at the these towns, which had been 17’8, 17-2, and 17-9 per 1000 in end of the month, against 2896, 2431, and 2157 at the the three preceding weeks, fell in the week under notice end of the three preceding months; the weekly admis. to 1000 of their aggregate population, estimated at sions and 249 in the the middle of the 1914. averaged 210, against 329, 1248, 18,136,18016-5 per persons at year During three months. was more pre. the first 12 weeks of the current the mean annual preceding Diphtheria slightly quarter valent than it had been in the preceding month; among the death-rate in these towns averaged 15-6, or 0’4 per 1000 several the of than that recorded in London. The annual death-rate boroughs greatest proportional prevalence higher this disease was recorded in Stoke Newington, Stepney, last week ranged from 4-3 in Enfield, 6-3 in Ilford, 6-6 in Battersea, Wandsworth, and Camberwell. The number of Eastbourne, 8-1 in Walthamstow, and 8-8 in Ealing, to under treatment in the in diphtheria patients Metropolitan 22-9 Preston, 23-0 in Liverpool, 23-1 in Dewsbury, 25-5 in Asylums Hospitals, which had been 1551, 1476, and 1491 at Tynemouth, 27’0 in Swansea, and 28’5 in Barrow-in-Furness. the end of the three preceding months, had risen again The 5722 deaths from all causes were 493 fewer than the to 1538 at the end of the month; the weekly admissions number in the and included 391 which were previous week, averaged 198, being 195, 177, and 198 in the three pre- referred to the principal epidemic diseases, against 345 months. The of enteric fever showed and 378 in the two weeks. Of these 391 deaths, ceding prevalence preceding a slight increase ; this disease was proportionally 137 resulted from whooping-cough, 115 from measles, 65 most prevalent in Paddington, Kensington, the City of from infantile diarrhceal diseases, 53 from diphtheria, 12 Westminster, Poplar, Lambeth, and Wandsworth. There from scarlet and 9 from enteric but not one fever, fever, were 50 enteric fever patients under treatment in the from small-pox. The annual death-rate from these diseases Metropolitan Asylums Hospitals at the end of the month, was equal to 1’1 per 1000, and equalled that in the previous 57, and 44 at the end of the three week. The deaths attributed to which against 50, preceding whooping-cough, months; the weekly admissions averaged 7, which was and 93 in the three rose had been 114, 85, preceding weeks, also the average in each of the three months. to and caused the annual death-rates of 1-2 in preceding 137, highest Erysipelas was proportionally most prevalent in Padding- Derby and in Stockport, 1’3 in Gateshead, 1’8 in Cambridge ton, Bethnal and Woolwich. and in and 2’1 in The deaths Shoreditch, Green, Poplar, Stockton-on-Tees, Warrington. The 19 cases of puerperal fever notified during the referred to measles, which had increased from 62 to 127 month included 3 in Bethnal Green and 2 each in St. in the seven fell to the death- preceding weeks, 115 ; highest Pancras, Islington, and Lambeth. The 30 cases of cerebro- rates from this disease were 2’0 in Grimsby, 2-9 in Newport spinal meningitis included 4 in Kensington, 3 in Hackney, Mon.), 3-0 in Swansea, 3-4 in Tynemouth, 3-5 in Stockton- 3 in Shoreditch, 3 in Bermondsey, 2 in St. Pancras, and 2 in 1 The Scottish and Irish figures are not forthcoming owing to the Finsbury; the 2 cases of poliomyelitis belonged to St. Pancras delay in the mails. and Stepney respectively. 747

ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING FEBRUARY, 1916. (Specially oompiled for THE LANCET.)

* Including membranous croup. t The death-rates are corrected for variations in sex and age constitution of the populations of the several boroughs, the population of England and Wales being taken as the standard. The mortality statistics in the table relate to the deaths of Greenwich, and Woolwich. The 3 deaths from enteric fever persons actually belonging to the several boroughs, the deaths were 10 below the corrected average number, and belonged occurring in institutions having been distributed among to St. Fancras, Islington, and Shoreditch respectively. The the boroughs in which the deceased persons had previously mortality from diarrhoea and enteritis among children resided; the death-rates from all causes are further under of age was proportionally greatest in Chelsea, corrected for variations in the sex and age constitution St. Marylebone,2 years Shoreditch, Southwark, and Battersea. In of the populations of the several boroughs. During the conclusion, it may be stated that the aggregate mortality in four weeks ending Feb. 26th the deaths of 5023 London London in February from the principal infectious diseases, residents were registered, equal to an annual death-rate of excluding diarrhoea, was 39’1 per cent. below the average. 14-5 per 1000; in the three preceding months the rates had been 16-2, 17-3, and 13’5 per 1000 respectively. The death- rates for the month ranged from 10’0 in Hampstead, 11-0 in THE SERVICES. Lewisham, 12.3 in Wandsworth, 12’5 in Fulham and in Holborn, and 12’6 in Hammersmith, to 16’6 in St. Pancras, 16’7 in Stepney, 16-9 in Deptford, 18’2 in the City of London, ROYAL NAVY MEDICAL SERVICE. and 18’6 in Finsbury. The 5023 deaths from all causes Surgeon J. H. Wright, Reserve List of Medical Officers, included 303 which were referred to the has been promoted to the rank of Staff Surgeon on the infectious diseases; of these, 30 resulted from principalmeasles, Reserve List of Medical Officers. 21 from scarlet fever, 62 from diphtheria, 123 from whooping- ARMY MEDICAL SERVICE. cough, 3 from enteric fever, and 64 from diarrhoea and enteritis children under 2 of No death Temporary Lieutenant-Colonel W. H. Willcox, R.A.M.C., among years age. to be Colonel. from any of these diseases was recorded in the City of temporary London; among the metropolitan boroughs they caused the ROYAL ARMY MEDICAL CORPS. lowest death-rates in Fulham, Kensington, Hampstead, and Major J. Powell is restored to the establishment. Holborn : and the rates in St. R. R.A.M.C. to be Lieu- highest Chelsea, Marylebone, Major Jones, (T.F.),’ temporary Finsbury, Shoreditch, Stepney, and Greenwich. The 30 tenant-Colonel. cases of measles were equal to only one-seventh of the To be temporary Majors : G. D. Gray and Captain E. W. H. corrected average number in the corresponding period Groves, R.A.M.C. (T.F.). of the five preceding years, and included 5 in Deptford, Captain A. F. C. Martyn is seconded for service with the 4 in Finsbury, 3 in Hammersmith, 3 in Stepney, and Egyptian Army. 3 in Greenwich. The 21 fatal cases of scarlet fever were E. W. Skinner to be temporary Captain. 4 in excess of the average number, and included 4 in The undermentioned temporary Lieutenants relinquish Islington and 2 each in St. Pancras, Finsburv, Shoreditch, their commissions: 0. Barton, N. Keith, J. A. Thoms, Stepney, Battersea, and Greenwich. The 6T deaths from W. K. Hall, and E. N. Drier. diphtheria were 12 more than the corrected average number ; To be temporary Lieutenants: D. P. Thomas, A. G. this disease was proportionally most fatal in Chelsea, Alexander, W. G. Harnett, A. J. Chillingworth, H. M. Stoke Newington, Finsbury. Bethnal Green, Southwark, Harrison, R. A. Quinn, J. 1. Enright, C. E. G. Bateman, Bermondsey, and Wandsworth. The 123 deaths fromJ. G. T. Thomas, B. S. Simmonds, D. S. Graham, A. A. E. whooping-cough were 17 above the corrected average, the Newth, J. R. Wylie, H. W. Harding, J. Young, G. C. B. highest death-rates from this disease being recorded inHawes, A. E. Foerster, C. W. Morrison, W. J. Porteous, Chelsea, Shoreditch, Bethnal Green, Stepney, Southwark,J. S. Annandale, A. J. D. Rowan, A. Morgan, W. G. Weston