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Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

mary, Islington.-The birth-rate in Islington during1884 was the smallest since 1858-i.e., 32’S per 1000; andthe death-rate was the smallest on record-namely, 16’9 per1000. In dealing with the question of the isolation of in-fectious diseases, the vestry have passed a resolution to theeffect that the needed provision can best be made in a com-prehensive and systematic manner by one central authorityacting for the whole metropolis, and irrespective of thequestion of pauperism; and they further consider that thecentral authority should include the Metropolitan AsylumsBoard, and should have the powers of a sanitary authorityfor the purpose. Dr. Tidy’s view of the report of the RoyalCommission on the Iousing of the Working Classes is thatit contains much that is both fallacious and misleading, andthat some of the recommendations of the Commissioners, ifcarried into effect, would be utterly subversive of local self-government and of local self-respect, on account of the ten-dency it exhibits to secure additional centralisation by theplacing of important powers of interference in the hands ofthe Local Government Board. On the other hand, he findsin it some useful information and a few practical sugges-tions. New regulations as to tenemented houses have beendrawn up, but Dr. Tidy is not very encouraging to his autho-rity as to this, for his principal comment on the actiontaken is to the effect that it is very doubtful whether theresults will prove to be in any way commensurate to the in-creased labour involved or to the expectations of those whoanticipate much from them. Adulteration would appear tobe almost absent in Islington if the officially collectedsamples can be regarded as sufficing for a judgment on thispoint, for of 113 samples submitted by the inspectors of thevestry, Dr. Tidy found "none adulterated or containinginjurious admixture." Four only were samples of milk.Hampstead.-Excluding non-parishioners who died in

public institutions, and making allowance for parishionerswho died out of Hampstead, the death-rate for this districtwas only 12’5 for 1884; but even this exceeds the rate for1883, and this in an estimated population of some 58,000.Dealing with small-pox, Dr. Gwynn shows in a tabular formthat in the 1877-78 epidemic, and in that of 1884, when thedeaths in the metropolis from that disease were 3910 and1250 respectively, the mortality in Hampstead was 38 forfirst and 25 for the second period, whereas during theepidemic of 1881-82, and when the small-pox deaths in themetropolis were 2800, the mortality in Hampstead amountedto 6 cases only. During the first two epidemics referred toHampstead Hospital was in use; during the third it wasclosed. So, also, the incidence of small-pox on everyhundred houses round the hospital in 1884 when the

ouiifiing was in use amoun1>euo ;;:;V’,J, wilereas in losi wiien i,

the building was closed it was only 1’5. These statisticsafford a striking instance of the results brought about bymetropolitan small-pox hospitals. And those relating to1884 are the more important because on opening the hospitalin that year the Metropolitan Asylums Board announcedtheir intention of acting on the lines laid down by the RoyalCommissioners in their Report on Small-pox and FeverHospitals-namely, of limiting the number of small-poxbeds to forty.

Featherstone Urban District.-During 1884 this districthad birth- and death-rates of 33’6 and 19’6 per 1000 respec-tively ; it fortunately escaped any epidemic of scarlet fever,which was so prevalent in the neighbouring district ofNormanton, and diphtheria only occurred sporadically. Thedistrict was in considerable straits for water during thedrought of last year; and until Wakefield has an adequatesupply for itself no help can be expected from that borough.Dr. Buncle recommends the adoption of bye-laws as tohouses sublet in lodgings.

Pontefract Urban Dastrict.-This district is under thesame health officer as Featherstone. The birth- and death-rates amounted to 37’7 and 20’1 per 1000 respectively,corrections being made for deaths of outsiders in thebarracks and workhouses. The need for an improved water-supply is locally recognised, and the matter would appear tc

be receiving the genuine attention of the authority. Themain drainage of the town was completed during 1884, andsince the houses have now been connected with this system,whilst the old cesspools have been done away with when-ever they could be found, a material sanitary advance hasbeen made in the borough. A house-to-house inspection isat present in progress, with a view to more detailed im-provements.

Wednesbury Urban District.-Scarlet fever was, bothduring 1883 and part of 1884, very prevalent in Wednesbury,and Dr. Garman reminds the authority of their responsi-bilities in connexion with the provision of means of isolation.There is a steady mortality from enteric fever in the town,and though the excellent water-service is credited withbeing the main preventive of epidemics of this disease, yetit is urged that isolation is also wanted to prevent diffusion.Middens in this part of the country are, as a rule, a fertile-source of enteric fever spread, and though supervision maybe helpful in dealing with this evil, yet reconstruction ofmiddens on a proper plan is generally needed. The death-rate for 1884 was 20-3 per 1000.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5677 birth&and 3157 deaths were registered during the week endingOct. 24th. The annual death-rate in these towns, which hadbeen equal to 17’6 and 17’7 per 1000 in the preceding two.weeks, further rose last week to 18 5. During the first three-weeks of the current quarter the death-rate in these townsaveraged only 17’9 per 1000, and was 2’5 below the meanrate in the corresponding periods of the nine years 1876-84.The lowest rates in these towns last week were 11-4 inNorwich, 13’6 in Bradford, 13’7 in Huddersfield, and 14’0 inHull. The rates in the other towns ranged upwards to-22-4 in Liverpool, 22’5 in Newcastle-upon-Tyne, 22’7 inManchester, and 23’2 in Bolton. The deaths referred to the-principal zymotic diseases in the twenty-eight towns, whichhad been 303 and 340 in the previous two weeks, declinedlast week to 299 (a lower number than in any previousweek of this year); they included 62 from measles, 57 fromscarlet fever, 67 from whooping-cough, 52 from diarrhoea, 40’from " fever (principally enteric), 27 from diphtheria, and 4from small-pox. No death from any of these zymotic diseaseswas recorded last week either in Halifax or in Huddersfield;while they caused the highest death-rates in Cardiff, New-castle-upon-Tyne, and Preston. Measles caused the greatestmortality in 8afford, 1B ewcastle-upon-Tyne, and Brighton;scarlet fever in Preston, Cardiff, and Leicester; whooping-cough in Cardiff; and "fever" " in Preston, Norwich, Derby,.

and Portsmouth. The twenty-seven deaths from diph-

theria in the twenty-eight towns included 18 in London,3 in Birmingham, and 2 in Liverpool. Small-pox caused no,death in London or its outer ring, and only 4 in the twenty-seven provincial towns, of which 3 occurred in Liverpooland 1 in Sunderland. The number of small-pox patients inthe metropolitan asylum hospitals, which had declined in thepreceding twenty weeks from 1389 to 112, further fellto 99 on Saturday last; the admissions, which had been15 and 16 in the previous two weeks, declined to 11 lastweek. The Highgate Small - pox Hospital contained5 patients on Saturday last, 2 having been admitted during-the week. The deaths referred to diseases of the respi-ratory organs in London, which had increased in the pre-ceding five weeks from 152 to 301, further rose last week to356, and exceeded the corrected weekly average by 29. The

’

causes of 55, or 1’7 per cent., of the deaths in the twenty-’

eight towns last week were not certified either by a regis-; tered medical practitioner or by a coroner. All the causes- of death were duly certified in Portsmouth, Nottingham,.’ Bradford, Newcastle-upon-Tyne, and in eight smaller towns.) The largest proportions of uncertified deaths were regis-) tered in Hull, Leicester, and Preston.")

HEALTH OF SCOTCH TOWXS.

The annual rate of mortality in the eight Scotch towns9which had been 16’4: and 19’1 per 1000 in the precedingtwo weeks, declined again to 17’9 in the week ending the24:th inst., and was 0’6 below the mean rate during thesame week in the twenty-eight English towns. The ratesin the Scotch towns last week ranged from 12’9 in Dundee

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and 148 in Greenock, to 18’5 in Paisley and 20’5 in Glasgow.The 438 deaths in the eight towns included 12 which werereferred to diarrhoea, 9 to whooping-cough, 8 to "fever,"7 to scarlet fever, 5 to diphtheria, 2 to measles, and not oneto small-pox; in all, 43 deaths resulted from these principalzymotic diseases, against 49 and 59 in the preceding two iweeks. These 43 deaths were equal to an annual rate of1’8 per 1000, which was O’l above the mean rate from thesame diseases in the twenty-eight English towns. The12 deaths attributed to diarrhoeal diseases showed a decline- of 9 from the number in the previous week, and were

11 below the number returned in the correspond-ing week of last year; they included 4 in Glasgow,3 in Edinburgh, and 3 in Aberdeen. The deaths from

whooping-cough, which had been 8 and 11 in the pre-ceding two weeks, declined again to 9 last week, all ofwhich occurred in Glasgow. The 8 deaths referred toscarlet fever corresponded with the number in the pre-vious week, and included 4 in Edinburgh and 2 in Leith.Six of the fatal cases of scarlet fever and 4 of the 5 fromdiphtheria were returned in Glasgow. The deaths referredto acute diseases of the respiratory organs in the eighttowns, which had been 58, 64, and 93 in the precedingthree weeks, declined again last week to 83, and were 13below the number returned in the corresponding week oflast year. The causes of 69, or nearly 16 per cent., of thedeaths in the eight towns last week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal to21’1 and 21’4 per 1000 in the preceding two weeks, furtherrose last week to 23-8. During the past three weeks ofthe current quarter the death-rate in the city averaged22’1 per 1000, the mean rate during the same period did not,exceed 16’5 in Edinburgh and 17’5 in London. The 161 deathsin Dublin last week showed a further increase of 16 uponthe numbers returned in recent weeks; they included 4which were referred to "fever" (typhus, enteric, or simple),4 to whooping-cough, 2 to scarlet fever, 2 to diarrhoea, andnot one either to small-pox, measles, or diphtheria. In all,12 deaths resulted from these principal zymotic diseases,against 11 and 16 in the preceding two weeks; they were.equal to an annual rate of 1’8 per 1000, the rate from thesame diseases last week being 1’0 in Edinburgh and 1’6 inLondon. The deaths referred to "fever" " in Dublin, whichhad been 3 and 8 in the previous two weeks, declined againto 4 last week. The 4 fatal cases of whooping-cough, how-ever, showed an increase upon recent weekly numbers. Thedeaths attributed to diarrhoea were fewer than in any recentweek. Four deaths from violence and 4 inquest cases

were registered; 40, or a quarter of the deaths, occurred inpublic institutions. The deaths both of infants and ofelderly persons showed an increase upon the numbers in theprevious week. The causes of 26, or more than 16 per- cent., of the deaths registered in the city during the weekwere not certified.

THE SERVICES.

WAR OFFICE. -Army Medical Staff : Surgeon-MajorWilliam Alexander, M.D., is granted retired pay, with thehonorary rank of Brigade-Surgeon ; Surgeon Philip Gloverlevers retires from the Service, receiving a gratuity.

ADMIRALTY.—The following appointments have beenmade:-Surgeon Edward G. Swan, to the 2)MMca;M.’ and

Surgeons John Moore, M.D., Cyril.J. Mansneld, M.B., RobertHickson, Herbert P. Shuttleworth, John Lowney, George D.Trevor Roper, Octavius S. Fisher, and John S. Fogerty, M.D.,to the Duke of TVellington, for Haslar Hospital.YEOMANRY CVALRY. - pIampshire : Samuel Andrews,

Gent., to be Surgeon.RIFLE VOLUNTEERS.-2nd Volunteer Battalion, the South

Staffordshire Regiment: James Scott Wilson, Gent., M.D.,to be acting Surgeon.-6th Lancashire (1st Manchester),Surgeon Henry Reston resigns his commission.

A SUICIDAL mania has broken out in Berlin, andthe number of persons taking their own lives has of latebeen rapidly on the increase. On one day last week no fewerthan seven fresh cases of suicide took place in that city.

Correspondence.THE ROYAL COLLEGE OF PHYSICIANS AND

LONDON DEGREES.

"Audi alteram partem."

To the Editor of THE LANCET.SIR,-In the last number of THE LANCET a statement or

expression of opinion is attributed to me which has nofoundation in fact, and I trust that, with your well-knownfairness, you will allow me to correct it.May I venture to state briefly the more important argu-

ments which I did use against the scheme of the JointCommittee as it stood, in order to show the inaccuracy ofthe sentence put into my mouth ? :’ The scheme as it stoodadvocated the conferring of degrees in medicine and surgeryupon every person who passed the ordinary joint examina-tions for the licence and membership of the two Colleges. Asa ground for this it was further alleged that the study andexaminations for these diplomas were equal to those of mostof the universities. My main argument was this: to giveto everyone who passes an examination, which is the ordi-nary qualification to practise, a degree in medicine andsurgery would abolish all distinction of superiority whichhas been supposed to be indicated by a medical degree. Alike power, if conferred simpliciter on the London col-leges, would inevitably be also claimed by certain ofthe Irish and Scotch corporations, and with every

probability of success, with the result that a farlower grade of study and examination would suffice toobtain a medical degree, and thus degrees would becomeworthless. The College of Physicians has always regardeddegrees in medicine with respect, and is not likely to con-sent to such a levelling down process, which would to alarge extent nullify the efforts of those universities whichaim at a high degree of medical education and examination-the University of Edinburgh and the proposed teachinguniversity of London in particular. I will not enter intothe other arguments against the scheme, as they are ofsubsidiary importance. The course and result of the debatefully justified the position which I took up, and proved con-vincingly that only a very small minority of the Fellowswould consent to such a degradation of medical degrees. Itshowed, too, that the College is not likely to sanction anyscheme which would not tend to elevate rather than lowertheir value. The resolution as passed was totally distinctfrom that proposed, and the arguments which I have men-tioned would not have been applicable to it.

I may venture to add that I fully concur in the desirabilityof giving proper facilities to London medical students forobtaining medical degrees, and that the proposal to found ateaching university in London has my heartfelt sympathy.

I am, Sir, yours faithfully,Edinburgh, Oct. 24th, 1885. W. S. GREENFIELD.W. S. GREENFIELD.

THE LATE BISHOP OF MANCHESTER.To the Editor of THE LANCET.

SiB,—In accordance with your request, and by permis-sion of Mrs. Fraser, I send you the following facts; but as nopost-mortem examination was made, I am unable to clearup several obscure points in the history of the case. The

Bishop was a man of splendid physique, fond of walking andriding across country, and, except for an occasional attackof bronchial catarrh, did not know what illness was untilabout a year ago, and he used often to boast at publicmeetings how little he had spent in doctors’ bills. For sometime past, however, he had an idea that his heart was notsound, and more than once asked me to examine it; butbeyond a very slight possible roughness in the sounds atthe base, and this was doubtful, there was no evidence ofany disease. He had long suffered from a troublesomevarix in one leg, which caused him to wal>i less anddrive more during the past three or four years. About a

year ago, when reading aloud, he suddenly lost thepower of speech for five or ten minutes, and shortlyafter that, when officiating in church, he had an attackof renal colic, which in a few days passed away withthe elimination of uric acid ; no albumen had ever beenfound at any period. About the beginning of September