336 communication, which, one would have imagined, would in towns have so greatly exceeded that which obtains in rural areas. These and similar contributions to our knowledge of the etiology of disease come most; appropriately from medical officers of health acting for wide areas, and they add special interest to their reports. Huddersfield.-Dr. Spottiswoode Cameron in his report on the fourth quarter of 1886 points out that although, speaking generally, Huddersfield compares well as regards
... well as regards infectious diseases with the twenty-eight large towns and cities quoted by the Registrar-General, yet the rate of mortality in the borough from diphtheria has been half as much again as in the towns referred to, and that the rate from whooping-cough was three times that with which it is compared. Diphtheria is essentially a disease to be dealt with by early isolation of first attacks, and though some cases are received into the Birkby hospital, yet this sanitary institution is, notwithstanding excellent additions to it, not sufficiently complete to deal with this disease. Whooping-cough is, unfortunately, a disease which is at present almost beyond the scope of sanitary measures. Salford.-Dr. Tatham, in reporting for the last quarter of 1886, finds it necessary to issue a warning,as to the spread of scarlet fever in his district; this spread being largely due to deplorable carelessness. Of 603 cases reported to the Health Department during the quarter, 307, or 51 per cent., were removed to the infectious hospital. This is very satisfactory, but unless those responsible for the remaining 49 per cent. take note of the warning issued, especially as regards children during the school age, scarlet fever will continue to spread. The numbers of those attacked during the past four quarters have been 177, 230, 550, and 603 respectively. It is certainly time for the inhabitants to aid the health officers in controlling this scourge. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN twenty-eight of the largest English towns 5846 births and 34:70 deaths were registered during the week ending Feb. 5th. The annual death-rate in these towns, which had declined in the preceding four weeks from 26'5 to 211 per 1000, further fell last week to 19-6. During the first five weeks of the current quarter the death-rate in these towns averaged 22-8 per 1000, and was 1'9 below the mean rate in the corresponding periods of the ten years 1877-86. The lowest rates in these towns last week were 13'5 in Nottingham, 13 in Brighton, 16'3 in Norwich, and 17'1 in Birkenhead. The rates in the other towns ranged upwards to 25 0 in Preston, 25'3 in Bradford, 263 in Manchester, and 28'4 in Plymouth. The deaths referred to the principal zymotic diseases in the twenty-eight towns, which had been 485, 392, and 371 in the preceding three weeks, further declined last week to 367; they included 111 from whooping-cough, 104 from measles, 54 from scarlet fever, 40 from "fever" (principally enteric), 29 from diphtheria, 27 from diarrhoea, and 2 from small-pox. These principal zymotic diseases caused the lowest death-rates last week in Nottingham, Cardiff, and Wolverhampton; and the highest rates in Bristol, Plymouth, and Blackburn. The greatest mortality from whooping-cough occurred in Bradford, Sunderland, and Plymouth ; from measles in Bristol and Newcastle-upon-Tyne; from scarlet fever in Salford, Sheffield, Blackburn, and Birkenhead; and from "fever" in Plymouth. The 29 deaths from diphtheria in the twenty-eight towns included 16 in London, 3 in Portsmouth, 3 in Liverpool, and 2 in Preston. Small-pox caused 1 death in Manchester and 1 in Blackburn, but not one in London and its outer ring, or in any of the twenty-five other large provincial towns. Only 1 small-pox patient was under treatment on Saturday last in the metropolitan hospitals receiving cases of this disease. The deaths referred to diseases of the respiratory organs in London, which had declined in the preceding four weeks from 731 to 432, further declined last week to 364, and were 279 below the corrected average. The causes of 75, or 2'2 per cent., of the deaths in the twenty-eight towns last week were not certified either by a registered medical practitioner or by a coroner. All the causes of death were duly certified in Manchester, Nottingham, Leicester, and in six other smaller towns. The largest proportions of uncertified deaths were registered in Halifax, Oldham, and Hull. HEALTH OF SCOTCH TOWNS. The annual rate of mortality in the eight Scotch towns, which had been 23-7 and 24-7 per 1000 in the preceding two weeks, declined to 19-8 in the week ending Feb. 8th; this rate exceeded by 0'2 the mean rate during the same week in the twenty-eight large English towns. The rates in the Scotch towns last work ranged from 12-2 and 14'6 in Leith and Perth, to 21'3 in Aberdeen and 237 in Glasgow. The 495 deaths in the eight towns last week showed a decline of no fewer than 121 from the numbers in the previous week, and included 23 which were referred to whoopingcough, 12 to measles, 10 to "fever" (typhus, enteric, or simple), 8 to scarlet fever, 7 to diphtheria, 6 to diarrhoea, and not one to small-pox; in all 66 deaths resulted from these principal zymotic diseases, against 65 and 75 in the preceding two weeks. These 66 deaths were equal to an annual rate of 2'6 per 1000, which exceeded by 0'5 the mean rate. from the same diseases in the twenty-eight English towns. The fatal cases of whooping-cough, which had declined in the preceding five weeks from 27 to 19, rose again last week to 23, of which 17 occurred in Glasgow, 3 in Edinburgh, and 2 in Paisley. The 12 deaths from measles showed a decline of 6 from the number in the previous week, and included 9 in Glasgow and 2 in Aberdeen. The deaths referred to " fever," which had been 5 and 6 in the preceding two weeks, further rose last week to 10, of which 5 occurred in Glasgow, 2 in Edinburgh, and 2 in Greenock. The 8 fatal cases of scarlet fever, on the other hand, showed a considerable further decline from recent weekly numbers, and included 4 in Edinburgh and 3 in Glasgow. The 7 deaths from diphtheria, of which 4 occurred in Glasgow, corresponded with the number in the previous week. The 6 deaths attributed to diarrhoea, showed a decline of 4 from the number in the previous week. The deaths referred to acute. diseases of the respiratory organs in the eight towns, which had steadily declined in the first four weeks of the year from 213 to 155, further fell last week to 126, and were 9 below the number returned in the corresponding week of last year. The causes of 76, or more than 15 per cent., of the deaths in the eight towns last week were not certified, HEALTH OF DUBLIN. The rate of mortality in Dublin, which had been 36'2,32'2, and 28'2 per 1000 in the preceding three weeks, rose again to. 29'7 in the week ending Feb. 5th. During the first five weeks of the current quarter the death-rate in the city averaged 31'5; the mean rate during the same period being but 21'8 in London and 21-4 in Edinburgh. The 201 deaths in Dublin last week showed an increase of 1& upon the number returned in the previous week, and included 4 which were referred to scarlet fever, 3 ta whooping-cougb, 3 to diarrhoea, 2 to "fever" (typhus, enteric, or simple), 1 to diphtheria, and not one either to small-pox or measles. Thus the deaths from these principal zymotic diseases, which had been 21,13, and 14 in the preceding three weeks, were last week 13; they were equal to an annual rate of 1'9 per 1000, the rates from the same diseases being 1'8 in London and 20 in Edinburgh. The fatal cases of scarlet fever, whooping4 cough, and " fever showed a decline from the numbers in the previous week, while those attributed to diarrhaea were more numerous. The deaths of infants exceeded the number : returned in any previous week of this year, while those of i elderly persons showed a further decline. Seven inquest . cases and 8 deaths from violence were registered; and 54, . or more than a quarter, of the deaths occurred in public institutions. The causes of 32, or nearly 16 per cent., of the deaths l registered during the week were not certified. THE SERVICES.