1163 of infants under one year of age and 35 of persons The lowest death-rates during April in the various sanitary aged upwards of sixty years ; the deaths of infants showed districts were 13’3 in Wands worth, 13’4 in Lewisham (ex- a slight increase, while those of elderly persons showed a cluding Penge), 15’3 in Kensington, 15’6 in Plumstead, 16-(}’ further decline from recent weekly numbers. Five inquest in Hampstead, and 16’2 in Hammersmith ; in the other cases and 5 deaths from violence were registered; and 62, sanitary districts the rates ranged upwards to 25’4 in or more than a third, of the deaths occurred in public St. George Southwark, 27-5 in Holborn, 27’7 in Limehouse, institutions. The causes of 6, or 4 per cent., of the deaths 28-6 in Whitechapel, 29-7 in St. George-in-the-East, 29-8 i]2, in the city last week were not certified. City of London, and 34-0 in St. Luke. During the four weeks of April 696 deaths were referred to the principal zymotic diseases in London; of these, 210 resulted from. VITAL STATISTICS OF LONDON DURING APRIL, 1893. whooping-cough, 172 from diphtheria, 125 from measles, 89 IN the table will be found summarised from scarlet fever, 51 from diarrhoea, 30 from different forms. accompanying I " complete statistics relating to sickness and mortality during of fever (including 28 from enteric fever and 2 from ill- April in each of the forty-one sanitary districts of London. defined forms of continued fever), and 19 from small-pox. These 696 deaths were to an annual rate of 2’1 With regard to the notified cases of infectious disease in the equal per 1000, and in the three months. metropolis during last month, it appears that the number of against 2-1, 19, 2 -0 preceding the various districts the lowest persons reported to be suffering from one or other of the Amongst sanitary zymotic. death-rates were recorded in St. Hanover- nine diseases in the accompanying table was equal to 10 ’5 per Kensington, George of Wands- 1000 of the population, estimated at 4,305,551 persons in the square, Westminster, City London, Bermondsey, and and the rates in middle of this year. During the preceding six months the worth, Camber well ; highest Fulham, St. St. Olave- rate had steadily declined from 17-9 to 8-6 per 1000. Shoreditch, George-in-the-East, Limehouse, Amongst the various sanitary districts the rates last month Southwark, Battersea, Greenwich, and Plumstead. Nineteen. fatal cases of were in London were considerably below the average in Kensington, Hammer- small-pox registered during, smith, Westminster, St. Saviour Southwark, Wands worth, the month under notice, the corrected average number in Camberwell, and Woolwich; whilst they showed the largest the corresponding periods of the preceding ten years being of these to to Green- excess in St. Giles, Strand, Holborn, Clerkenwell, Limehouse, 22 ; 19 deaths, 3 belonged Whitechapel, 3 Mile End Old Town, Poplar, and St. Olave Southwark. The wich, 2 to St. George Hanover-square, and 2 to St. Martin in-the-Fields districts. The 125 deaths referred prevalence of small-pox in London showed a further marked sanitary to measles were less than half the increase during April, an average of 118 cases weekly being average number ; amongst notified, against 20, 40, and 61 in the preceding three months ; the various sanitary districts this disease showed the highest in St. of the 470 cases notified during last month, 67 belonged to proportional fatality St. Pancras, Luke, Shoreditch, and Greenwich, 37 to Marylebone, 31 to Mile End Old Town, 27 to Limehouse. The 89 fatal cases of scarlet fever exceeded by 40 the Islington, 24 to Camberwell, 23 to Poplar, 20 to St. Giles, corrected number ; this disease was proportionally most fatal in 19 to St. Pancras, 16 to Strand, 16 to Whitechapel, 16 to St. Giles, Strand, and Limehouse sanitary districts. The 172- Limehouse, 14 to Rotherhithe, 13 to Lambeth, 12 to Kensington, deaths referred to diphtheria were more than double the cor- and 12 to Plumstead sanitary areas. The Metropolitan rected average number ; amongst the various sanitary districts Asylum Hospitals contained 448 small-pox patients at the this disease showed the highest proportional fatality in end of April, against 39, 80, 152, and 248 at the end of the Paddington, Marylebone, St. Pancras, Strand, Clerkenwell, preceding four months ; the weekly admissions averaged 106, Shoreditch, St. George-in-the-East, and Plumstead. The 210 against 10, 20, 38, and 55 in the preceding four months. fatal cases of whooping-cough were 88 below the corrected this disease was most in The prevalence of scarlet fever in London showed an increase average; proportionally fatal Fulham, Mile End and Battersea. upon that recorded in recent months ; this disease was pro- Chelsea, Limehouse, Old Town, portionally most prevalent in Fulham, Hampstead, St. Martin- sanitary districts. The 30 deaths referred to different forms in-the-Fields, Clerkenwell, Whiteohapel, Limehouse, Mile End of "fever" were 15 below the corrected average; there was Old Town, Poplar, St. Olave Southwark, and Battersea sanitary no marked excess of "fever " mortality during last month districts. The Metropolitan Asylum Hospitals contained in any of the metropolitan sanitary districts. The 51 fatal 2024 scarlet fever patients at the end of April, against cases of diarrhoea were slightly below the average. In con- numbers declining from 3843 to 1938 at the end of the clusion, it may be stated that the mortality in London during preceding six months ; the weekly admissions averaged 219, April from these principal zymotic diseases was more than against 254, 223, 214, and 196 in the preceding four months. 15 per cent. below the average. Diphtheria also showed slightly increased prevalence during Infant mortality in London during the month under the month under notice ; amongst the various sanitary districts notice, measured by the proportion of deaths under one yea this disease showed the highest proportional prevalence in of age to registered births, was equal to 127 per 1000, Paddington, St. James Westminster, Strand, Clerkenwell, and was below the average; the lowest rates of infant Bethnal Green, St. George-in-the-East, Poplar, and Plumstead. mortality were recorded in St. George Hanover-square, There were 302 cases of diphtheria under treatment in the St. James Westminster, St. Giles, Mile End Old Town, Metropolitan Asylum Hospitals at the end of April, against St. Olave Southwark, and Lewisham ; the highest rates in 283 at the end of each of the preceding two months ; the St. Martin-in-the-Fields, Strand, St. Luke, Shoreditch, Bethna] weekly admissions averaged 61, against 49, 58, and 50 in the Green, Limehouse, St. George Southwark and Greenwich preceding three months. The prevalence of enteric fever also sanitary dstricts showed a slight increase during April ; this disease was pro- portionally most prevalent in Clerkenwell, St. Luke, Lime- house, and Poplar sanitary districts. The Metropolitan!Asylum THE SERVICES. Hospitals contained 50 enteric fever patients at the end of April, against numbers declining from 124 to 37 at the end of MOVEMENTS OF THE MEDICAL STAFF. the six the admissions preceding months ; weekly averaged 9, THE officers have arrived in on sick 12, 10, and 7 in the three months. following England against preceding Erysipelas leave from India per lJfalabar: Surgeon-Major Haselden, showed the highest proportional prevalence during the month and and The under notice in St. St. St. Surgeon-Captains Way Thompson. following Pancras, Giles, Luke, Whitechapel, have arrived on of a tour of service : St. completion Brigade- George-in-the-East, and Poplar sanitary districts. Three to Aldershot, cases of Surgeon-Lieutenant-Colonel Major, posted puerperal fever were notified during April in and Dowman and St. and in Surgeon-Colonel Inkson, Surgeon-Captains Pancras, 3 Islington sanitary districts. Le V. C. Max- The statistics in the table relate Quesne, Brigade-Surgeon-Lieutenant-Colonel mortality accompanying ham has left Barbadoes on relief. to the deaths of Surgeon-Lieutenant- persons actually belonging to the various Colonel Retired has been to the the deaths in the Anderson, List, appointed metropolitan sanitary districts, occurring Charge at Bury St. Edmunds in succession to Brigade- institutions of London having been distributed amongst the various districts in which the had Surgeon Boulton, resigned. Brigade - Surgeon - Lieutenant- sanitary patients previously Colonel Muir has been to the Medical of resided. The distribution of appointed Charge these deaths, and especially of the Aldershot. Wilson those from Cambridge Hospital, Surgeon-Captain resulting zymotic diseases, affords the most trust- has joined the North-Western District for duty. worthy data that can be secured upon which to calculate reliable rates of mortality. During the four weeks ending ARMY MEDICAL STAFF. Saturday, April 29th, the deaths of 6539 persons belonging to Surgeon-Lieutenant-Colonel James Francis Supple to be London were registered, equal to an annual rate of 19 ’8 per Brigade-Surgeon-Lieutenant-Colonel, vice R. N. Macpherson, 1000, against 19-2 and 19-8 in the preceding two months. retired (dated April 9th, 1893). 1164 INDIA AND THE INDIAN MEDICAL SERVICES. Surgeon-Lieutenant-Colonel J. B. Maurice, M.D., resigns his commission (dated 6th, 1893). The following appointments are announced Surgeon- May -Captain J. C. S. Vaughan to act as Civil Surgeon of Monghyr VOLUNTEER CORPS. until further orders. Surgeon-Captain F. O’Kinealy to act as T,iigigzeer: Ist Middlesex : William Henry Bourke, M.D., ’Civil Surgeon of Nadia until further orders. Surgeon-Major to be Surgeon-Lieutenant (dated May 6th, 1893).-Rifle: R. Macrae, Civil Surgeon of Shahabad, to be Civil Surgeon of 2nd Volunteer Battalion, the Queen’s (Royal West Surrey Puri.