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The incidence of enteric fever was lower in 1908 than in anyprevious year, but the disease amongst the cases which werenotified was of a distinctly severe type with a fatality-rate of25 - 4 per cent. The death-rate from this disease was 0’ 09 per1000 as compared with a death-rate from "fever " in Englandand Wales of 0 07 per 1000. Norwich yielded a death-rate of0 - 29 and Wigan of 0 30 per 1000. The greater part of entericfever in Birmingham is attributed by the medical officer ofhealth to filth nuisances in connexion with the pan-closets,which were at one time found in every back-yard and whichwere for the first time vigorously attacked in 1903, an attackwhich has been carried on incessantly ever since. Eachyear has shown a marked diminution in the number of thesereceptacles, and a coincident decrease in the amount ofenteric fever in the city, in the same fashion as has been thecase in certain other towns where a similar substitution ofthe water-carriage for the conservancy system of sewagedisposal has taken place. In so far as Birmingham is con-cerned, it is an interesting fact that it was not until theconversion was seriously commenced that a substantial fallin enteric fever took place. There are still 8000 pan-closetsleft in Birmingham. It has also been found in this city thata considerable proportion of those who suffer from entericfever at certain times of the year have eaten uncooked shell-fish shortly before attack, but, of course, the etiologicalimportance of this fact cannot be gauged until we knowwhat proportion of the poor population in any given townare in the habit of consuming these shell-fish. In the caseof Birmingham it is thought that uncooked mussels haveprobably been an important factor in producing enteric fever,since in the last quarter of 1908 19 cases out of 74 had con-sumed mussels shortly before attack. The new Birminghamsanatorium for pulmonary tuberculosis was opened in

October, 1908, and an examining physician has been

appointed in order to ensure that only favourable cases

will be selected, and the medical officer of health entertainshopes that the after-results will compare favourably withthose secured elsewhere.

Connty Boron[Jh of Nort3eampton.-Dr. J. Doig McCrindlereports that 32 cases of pulmonary tuberculosis applied forsanatorium treatment during the year, and 11 were rejectedas unsuitable. As regards the remainder, one went to aprivate sanatorium, one or two others refused to accept abed, and 11 others were rejected by the medical referee.Thus only nine survived the tests of one or another kind,and of these one obtained a letter of admission throughanother source, while another was eventually refused by thesanatorium as too advanced. This is rather a harrowingtale of rejection. Seven cases completed treatment

during 1908. Dr. McCrindle thinks that sanatoriumtreatment alone, unaccompanied by rigorous after-care, issomewhat disappointing among the poorer classes, andthis was apparently the opinion of his predecessor,who inaugurated the system and who wrote in 1906 : ’’ Theresults are decidedly disappointing to those who pin theirfaith to sanatorium treatment, but they illustrate the correct-ness of this view put before the sanitary committee, thatamongst the poor sanatorium treatment, unless followed up byhome treatment with sufficient food and outdoor work of nottoo severe a character, is likely to prove unsuccessful." Dr.McCrindle furnishes the after-history of the patients sent tosanatoriums during previous years. At periods varying from13 months to 2 years four months after discharge 11 outof 23 patients were at work (barely 48 per cent.). Over26 per cent. were dead and the same proportion quite in-capacitated for work. But provision is also made in thelocal isolation hospital for ten advanced cases, the idea

being that of segregation. But under the rest and dietobtained at the hospital the patients improve so much thatthey desire to return home.

6’oMK!’</ Borough of St. -flele22s.-Dr. J. J. Buchan, in thecourse of some interesting observations relative to infantilemortality in this town, refers to the question of the insuranceof infants under one year of age. There has been somedecrease in this practice since the comments made in thelast annual report. Although, Dr. Buchan remarks, the

practice may have much to commend it on grounds of fore-thought and prudence, it does not act in beneficial fashion tothe infants. It is not, he thinks, that the parents wish theinfants to die, but in many cases they wish to profit as muchas possible if it does die, and he refers to a case in which apremature weakly infant only lived a few hours, but long

enough to enable it to be insured for a considerable sum

even in the early morning hours. Of the number of infants

born in 1907, 80-6 per cent. were insured, as against,72’ 1 per cent. of those born in 1908.

Metropolitan Borough of Woolwich.-The Plum stead wellof the Metropolitan Water Board appears to be yieldinga water unduly high in chlorine and of considerable hard.ness, but it is found that by reducing the rate of pumpingthe chlorine has been reduced from 10 to 6 parts per100,000. The water examination committee does not regardeither the chlorine or the hardness as prejudicial to health,and the water is, in its opinion, satisfactory both from achemical and bacteriological standpoint. Question has, how-ever, arisen, as in the case of other wells in estuary valleysor near the coast, whether excess of chlorine may not be dueto insuction of polluted Thames water. Dr. Sidney Daviesthinks that the Water Board should not be content until ithas reduced the chlorine in the Plumstead well to the level ofthe Kent waters, as a well about half a mile from this containsonly 3. 1 grains per 100,000 of chlorine. Dr. Davies expressesthe opinion that the well should be closed until both thehardness and the chlorine are reduced to the Kent waterstandard. The council of this borough has for several yearspast sent patients suffering from pulmonary tuberculosis to a,sanatorium near Reading, and Dr. Davies has presented theafter-results in the only fashion which brings out the actualfacts-i. e., he keeps the cases for each year separate fromthose of others, so that the cases discharged in, say, 1904can be followed up and their condition in January, 1909,stated. Of 12 cases discharged in 1904 there were in

January, 1909, seven dead, three working, and two lost sightof ; of 16 discharged in 1900, nine were dead, two wereworking, two alive but not working, and three lost sight of.Of those recorded at work a few are employed at the sana-torium in various capacities, receiving board and a smallwage. Of those lost sight of some are believed to be welland working.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8285 births and 3632deaths were registered during the week ending August 14th.The annual rate of mortality in these towns, which hadbeen 10 6, 10’ 8, and 10’ 5 per 1000 in the three precedingweeks, rose again last week to 11 . 5 per 1000. During thefirst six weeks of the current quarter the annual death-rate inthese towns has averaged only 11.per 1000, the rate inLondon during the same period being as low as 10’7 per1000. The lowest rates of mortality recorded in the 76 townslast week were 2 ’8 8 in Leyton, 4’6 in Walthamstow, 5’7 7 inKing’s Norton and in Preston, and 5’8 in Barrow-in-Furness ; the highest rates were 15’ 7 in Walsall, 15’ 8 inHalifax, 16 - 4 in Swansea, 17-3 in Rhondda, 19 .2 in WestBromwich, and 23-3 in Newport (Mon.).. In London the re-corded death-rate last week was 11-.3 per 1000, being 1’2 per1000 above the rate for the previous week. The 3632 deathsin the 76 towns last week showed an increase of 321 overthe exceptionally low number in the preceding week, andincluded 413 which were referred to the principal epidemicdiseases, against 313, 315, and 336 in the three precedingweeks ; of these 413 deaths 208 resulted from diarrhoea, 87from measles, 37 from whooping-cough, 33 from diphtheria,32 from scarlet fever, and 16 from "fever" (principallyenteric), but not one from small-pox. The 413 deaths fromthese epidemic diseases last week were equal to an annualrate of 1’ 3 per 1000, against 1 1 in the preceding week. Nodeath from any of these epidemic diseases was registeredlast week in Bradford, Willesden, East Ham, Brighton, or in14 other smaller towns ; the annual death-rates therefromranged upwards, however, .to 3-2 in West Ham and inSalford, 3’4 in Plymouth, 3’5 in Middlesbrough and inRhondda, 5. 2 in West Bromwich, and 7. 3 in Newport (Mon.).The fatal cases of diarrhoea in the 76 towns, which hadincreased from 49 to 127 in the six preceding weeks, furtherrose last week to 208, and caused death-rates ranging upwardsto 2 1 in Plymouth and in Swansea, 2 ’ 2 in West Bromwich,and 2 3 in Bootle and in Rhondda. The deaths from measles,.which had been 95, 80, and 83 in the three preceding weeks,rose again to 87 in the week under notice, the highest death-rates from this disease being 1’7 in Salford, 2’5 in Wolver-hampton, 3 0 in West Bromwich, and 7’3 in Newport (Mon.)

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The fatal cases of whooping-cough, which had been 48 and52 in the two preceding weeks, declined again last week to 37 and were considerably fewer than the number in anyprevious week of the year. The deaths from diphtherianumbered 33 last week, against 41 and 34 in the two

preceding weeks ; the greatest proportional mortalityfrom this disease was recorded in King’s Norton. Thefatal cases of scarlet fever, which had been 32, 25,and 28 in the three preceding weeks, rose again lastweek to 32, and caused death-rates ranging upwards to1’ in West Hartlepool and 1’ 4 in Warrington. Thedeaths referred to "fever," which had been 11, eight,and 12 in the three preceding weeks, further rose to 16in the week under notice, and included three in Grimsby and Itwo each in London and in Manchester. The number ofscarlet fever patients under treatment in the MetropolitanAsylums Hospitals and the London Fever Hospitals, whichin the four preceding weeks had declined from 2737to 2564, had further fallen to 2518 at the end of last

week ; 298 new cases were admitted’ during the week,against 367, 296, and 280 in the three preceding weeks.Of the 1047 deaths registered in London last week, 125were referred to pneumonia and other diseases of therespiratory system, the average number for the correspond-ing period of the five preceding years being 126. The causes of21, or 0’ 6 per cent., of the deaths registered in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. The causes of all the deathsregistered during the week were duly certified in Leeds,Sheffield, Bristol, West Ham, Bradford, Newcastle-on-Tyne,Hull, and in 56 smaller towns ; the 21 uncertified causesof death in the 76 towns included five in Liverpool, threein London, and two each in St. Helens and in Rochdale.

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns 863 births and 452deaths were registered during the week ending August 14th.The annual rate of mortality in these towns, which hadbeen 12’5, 11-8, and 12.0 per 1000 in the three precedingweeks, further rose to 12’ 6 per 1000 last week. During thefirst six weeks of the quarter the death-rate in theseScotch towns averaged 12-4 per 1000, or 1 . 3 per 1000more than the mean rate in the 76 large English townsduring the same period. The death-rates last week in theseScotch towns ranged from 11.3 3 in Edinburgh and 11’ 7 7in Dundee, to 14 . 1 in Perth, and 16-4 in Leith. The452 deaths from all causes in the eight towns were

23 in excess of the number in the preceding week, and in-cluded 44 which were referred to the principal epidemicdiseases, against 39 and 50 in the two preceding weeks.These 44 deaths were equal to an annual rate of 1 - 2 per1000, which was slightly lower than the mean rate last weekfrom the same diseases in the 76 large English towns.Of the 44 deaths from these epidemic diseases, 17 wereattributed to diarrhoea, nine to whooping-cough, seven to"fever," five to scarlet fever, four to measles, and two todiphtheria, but not any to small-pox. The fatal cases ofdiarrhoea, which had been 13 and 20 in the two pre-ceding weeks, declined again last week to 17, ofwhich eight occurred in Glasgow, three in Dundee, twoin Edinburgh, and two in Greenock. The deaths fromwhooping-cough, which had been 15 and 14 in the two pre-ceding weeks, further declined to nine in the week undernotice, and included five in Edinburgh. The deaths referredto different forms of "fever," which had been three, three,and four in the three preceding weeks, increased to seven

last week ; of these seven deaths, one in Aberdeen wasattributed to cerebro-spinal meningitis, one in Glasgow totyphus, and four in Glasgow and one in Dundee toenteric. Of the five fatal cases of scarlet fever twowere registered in Glasgow and two in Edinburgh.The deaths from measles, which had been 14, three, andsix in the three preceding weeks, declined again lastweek to four, and included three in Glasgow. The deathsreferred to diseases of the respiratory organs in these eighttowns, which had been 49, 43, and 51 in the three preced-ing weeks, were 48 in the week under notice, and werethree in excess of the number in the corresponding periodof last year. The deaths in these towns included 23which were referred to different forms of violence ; of these13 occurred in Glasgow, three in Edinburgh, and three in

Aberdeen. The causes of 7, or 1. 5 per cent., of the deathsin the eight towns were uncertified ; in the 76 English townsthe proportion of uncertified causes of death did not exceed0’ 6 per cent.

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HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which had been14-4, 17 - 4, and 15 - 2 per 1000 in the three precedingweeks, further declined to 13.5in the week endingAugust 14th. During the first six weeks of the quarterthe death-rate averaged 15-5 per 1000, whereas the meanrate during the same period did not exceed 10’ 7 in Londonand 12 - 6 in Edinburgh. The 103 deaths of Dublin resi-dents registered during the week showed a decline of 13from the number in the preceding week, and included 1Zwhich were referred to the principal epidemic diseases,against nine, 15, and 12 in the three preceding weeks.These 12 deaths were equal to an annual rate of 1’6

per 1000, the death-rate from the principal epidemicdiseases being 1 - 0 in London and 1.5 5 in Edinburgh.Of the 12 deaths from these epidemic diseases in Dublinnine resulted from diarrhoea, two from whooping-cough, andone from measles, but not any from small-pox, scarlet fever,diphtheria, or enteric fever ; the nine deaths fromdiarrhoea exceeded by four the number returned in each ofthe two preceding weeks. The 103 deaths included 32 ofinfants under one year of age, and 25 of persons agedupwards of 60 years; the deaths of infants exceeded thenumber in the preceding week, while those of elderly personsshowed a decline. Five inquest cases and three deaths from’violence were registered during the week ; and 40, or nearlytwo-fifths, of the deaths occurred in public institutions. Thecauses of four of the deaths in Dublin last week were notcertified either by a registered medical practitioner or by acoroner ; in London three of the deaths, and in Edinburghtwo, were not certified.

THE SERVICES.

A NEW SCHEME FOR THE ORGANISATION OF RED CROSSAID FOR THE ARMY IN ENGLAND AND WALES.

THE Secretary of the War Office has sent a letter to thesecretaries of all Territorial County Associations in Englandand Wales in which he states that as a result of a conferencebetween the Army Council, the council of the British RedCross Society, and the chairman of certain of the countyassociations, the Army Council has prepared a detailed’’ scheme for the organisation of voluntary aid in Englandand Wales," with the purpose of affording relief to the sickand wounded in connexion with home defence. He hasforwarded this scheme with the letter to the countyassociations requesting them to communicate at once withthe council of the British Red Cross Society with a view toinitiating the formation of voluntary aid detachments, if it isnot their wish to themselves undertake the formation and

training of such bodies. The British Red Cross Society hasrecently been incorporated by Royal Charter, under the

patronage of His Majesty the King and the presidency ofthe Queen, Lord Rothschild being chairman of council andSir Frederick Treves chairman of the executive committee.The society exists to furnish aid to the sick and woundedin time of war " in which British troops may be engaged.The particulars of the scheme are set out in an official

publication, which with its appendices contains 43 pages andincludes three coloured diagrams explaining the administra-tive relations that will exist between the War Office, theBritish Red Cross Society, the county associations and theirvoluntary aid detachments in time of peace, and betweenthose detachments and the medical service of the army inthe field when on a war footing. The following summary is.given of the scheme, which, it will be noted, provides forthe active cooperation of medical women, nurses, and otherwomen workers :-

1. The scheme has been modelled upon those which already exist incertain foreign countries.

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2. The necessity for voluntary aid for sick and wounded in war in thehome territory is fully recognised by the inhabitants of the UnitedKingdom.

3. There is a tendency for societies, having in view the rendering ofassistance to sick and wounded in war, to act independently one of the,other. Efficiency cannot be attained unless all voluntary aid bacoordinated.