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MEDICAL PRACTICE ON THE EASTCOAST: THE POSITION AT

GREAT YARMOUTH.

(BY OUR SPECIAL COMMISSIONER.)

Great Yarmouth, Feb. 8th.To counterbalance the inevitable economical pressure felt

by a nation at war we have generally some communitiesmore thriving than others, because they can provide some ofthe varied material-ships, guns, weapons, clothes-neededfor the prosecution of hostilities ; other localities receivingno such set-off will necessarily suffer as more and more moneyis consumed. Prominent among the English towns whichhave to bear the burden of war time stands Great Yarmouth,which has been attacked directly and twice by the enemy,and suffers indirectly by the collapse of its main sourcesof income. Fortunately, the first attack, a bombardment,did no harm. Presumably the German ships mistook thedistance, for all their shells fell short of the town. This firstattack occurred, it will be remembered, at the beginning ofNovember, and its memory was fading away when on thenight of Jan. 19th airships hovered over the town droppingbombs-this time with fatal effect in that several liveswere lost, but no great destruction of buildings occurred.Financially speaking, rumour did vastly more harm toYarmouth than the German bombs.The netting of fish and the letting of lodgings are the

principal sources of income at Yarmouth, and the war hasdealt hardly with both. A considerable proportion of theinhabitants rent houses with the intention to secure lodgersfor a part of them, and render themselves liable to pay rentand rates far and away above what they would pay in eitherdirection for their personal use. Of course, they count onmaking up the difference advantageously by lettingrooms or by taking in boarders. The season atYarmouth is very short ; it reaches its climax in Septemberand was commencing at the end of July. War was

declared on Tuesday, August 4th. Of the visitorswho were already at Yarmouth hardly any remainedbeyond the end of that week and none came to take theirplace the following week. Gradually braver spirits returned,but the town never recovered its holiday population as somemore fortunate watering places further south appear to havedone. Perhaps, if there had been fewer sinister rumours

floating about, the season might not have been so completelyspoilt, but every parent who looked at an atlas recognisedthat if attack was possible Yarmouth was a very vulnerablespot, and decided not to venture there with children.Mere digging of trenches would not have frightened thepublic away from Yarmouth any more than it did fromBroadstairs. But being nearly opposite the German navalbase, it was but too correct to conclude that Yarmouth wouldbe attacked, if attack became feasible, while experts wereaware of the possibility of a dash from fast enemy cruisers.Therefore, those who, in spite of the war, were not disposedto forego their seaside holiday selected some place thatseemed less exposed than Yarmouth.

. The Effe(Jt on the Local Industries.

The next source of income in Yarmouth is the fishingindustry, especially the herring trade. This gives employ-ment to a large number of fishermen, and also to regimentsof Scotch women, who follow the fishing smacks along thecoast to clean and pack the herrings. They arrive just afterthe sea-bathing season concludes, and in the South Sidenear the fish-docks fill the lodgings abandoned by theholiday folks. But as most of the herrings are packedin barrels, preserved in brine, and exported to the NorthSea and Baltic ports this trade is paralysed by the war. Itso happens that the herring women have found during thecollapse of their trade a valuable method of earning money.exposed to all weathers, they know how to knit them-selves warm woollen underclothing. To-day they can findemployment knitting clothes for the soldiers at the front ;but they do this at home in Scotland, not at Yarmouth. The

poorer lodging-house keepers, those, for instance, who usedto receive the women employed in fish-cleaning, are doingvery well in billeting soldiers. On their side the soldiersare more comfortable than usual ; for being housed bylodging-house keepers the cooking and attendance generallyare better than in private families which do not make abusiness of receiving strangers.

The Prosperous Inhabitants Suffer Most.The lodging-house keepers, however, who are able to

balance the loss of their ordinary business by attending tosoldiers do not belong to the class which best pays itsmedical attendants. The central and richer part of the townsuffers most, and its inhabitants are not likely to ask forhelp. Employees of different sorts in commercial spheresprovided modest payments for board and lodging during thewinter months on condition that they retired to small roomsduring the summer holiday rush. Last year there was nosummer rush, and many of these winter clients have enlisted.The health authorities, I found, do not think there is asmuch poverty as usual among the labouring class and thosesections of the community who in normal times suffermost. But other sections who, as a rule, do not suffer at allare badly hit, and they are the best ratepayers and themedical practitioners’ principal source of income. Themunicipal authorities are greatly concerned, for they do notlike to prosecute good citizens. The medical practitionerfeels the same compunction about pressing for his fees.Thus one medical practitioner told me that a patient couldnot pay what she owed him because her lodger owedher 18, and the lodger could not pay because hisoccupation had practically ceased at the outbreakof war. Then those connected with the law havelittle or nothing to do. No one is going to institutelegal proceedings while the war lasts. Jewellers, tailors,dressmakers all suffer. The war is a good reason for wear-ing out all the old clothes. Persons who have privatemeans cannot realise their investments, and those whohave placed money in German or Austrian enterprisesmay never see any of it again. Tradespeople who dealin objects that are not absolutely necessary do very littletrade, and it will be seen that these are just the veryclasses among whom medical practitioners find theirbest paying patients. Even those who have money feelunsafe and think it more prudent to economise. Therefore,they only send for their doctor when it is absolutely neces-sary. Or, worse still, they profit by the fact that they havethe means to leave the town altogether, though this is notthe general rule.The personal economy and the cessation of trade in

certain directions could of course be paralleled all over thecountry, but in Yarmouth the depression is accentuated bythe collapse of the two great industries.

Vast Grat1dtolls Medical Attendance.The poorer sections of the community are, if anything,

better off than before the war. The labourers readily findemployment, while many of them have enlisted, and thereis a good deal to do for those who remain. But the abolitionof the militia by the establishment of the Special Reserve hasbeen a great loss to the town of Yarmouth. The NorfolkMilitia was almost a crack regiment. His late Majesty,Edward VII., was their colonel, and he used to come downto Yarmouth to review them, thus bringing much moneyto the town. Many of the old militiamen accepted a

small fee to become reservists. From the town of Yarmouthalone, out of its 57,000 inhabitants, no less than 500 werecalled to the flag as reservists. A large proportion, not onlyof these reservists but of those who enlisted since the’beginning of the war, were insured persons, but their wivesand children were paying patients. Now this importantsource of income is lost to the profession, for the wives and3hildren of those with the Flag are being attended in themain gatuitously.

The Dependents of the Soldiers.Yielding to a generous and patriotic impulse, practically

ill the practitioners at Yarmouth agreed to attendgratuitously the dependents of those who enlisted. The;hemists, on their side, offered not to charge for the work oflispensing the drugs, and the Prince of Wales’s Relieffund was looked to to reimburse the bare cost of the drugsionsumed. But quite a large proportion of these dependentsLre better off than they were before the outbreak of war. Theallowance they get from the War Office is in many casesiigher than what their husbands could afford to give beforehey enlisted, and yet in those days they had to pay for medical,ttendance. Now the dependents can claim the services not onlyIf the panel but of the non-panel doctors, and neither chemisttor doctor receives any remuneration. The Yarmouth practi-ioners are beginning to wonder why dependents who are,generally speaking, better off than they were formerly

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should come upon them for gratuitous advice. This is allthe harder to ’bear as so many patients who used to givereasonable fees are now so impoverished that they reallycannot pay anything. There is as much, indeed more workto be done, but much less to receive than formerly. Thus

I called on a non-panel doctor who I found had been

kept from his dinner by nine army dependents. After givingthem gratuitous advice a tenth visitor came, but instead of apaying patient he proved to be the water-rate collector.

Ajter-fjfeots of the Air Bombs.It may not, perhaps, be generally realised that the

airship bombs have materially increased the amount ofwork falling upon the medical practitioners. It is not thecasualties that count: two killed, three wounded, and minorinjuries make but little difference in the total number of

patients ill from all causes. But there has been a great amountof illness and some deaths among those who were not struck.People with weak hearts, startled by the noise and alarm,had violent attacks of palpitation, and several of the deathsa few days after the bombardment were due to the shock. Thenthere are the highly nervous or neurotic persons One case wasthat of a woman who could not be induced to sit still but wasconstantly springing to her feet, pacing up and down theroom, wondering what she would do if Zeppelins droppedmore bombs. In another patient the pulse, previouslynormal, continued beating at 105 per minute a fortnightafter the explosions. These certainly did make a verygreat noise, and being absolutely unexpected were all themore startling. Now that the people are a little moreaccustomed to such aggression, it is probable that anotherattack would occasion much less disturbance. Nevertheless,.the emotion they cause must seriously affect persons withweak hearts or highly nervous temperaments.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE undermentioned has been granted a temporary com-

mission as Surgeon in His Majesty’s Fleet: Arthur ErnestIles.The following appointments have been notified :-Staff-

Surgeon : B. R. Bickford to the Pembroke, additional.Temporary Surgeons: G. M. Oakden to the Prince George ; ;D. R. Bedell-Sivright and G. S. Aspinall to the Victory, addi-tional, for Haslar Hospital; W. B. Cunningham and W. L.Glegg to the Pembroke, additional, for Chatham Hospital, allas additional medical officers ; A. G. Stewart and D. S.MacKnight to the Vivid, additional, for disposal.

ROYAL NAVAL VOLUNTEER RESERVE.

Surgeon: W. H. Bleaden to the Pembroke, additional.ARMY MEDICAL SERVICE.

Colonel John C. Culling is retained on the Active Listunder the provisions of Article 120, Royal Warrant for Payand Promotion, 1913, and to be supernumerary (datedFeb. 7th).

ROYAL ARMY MEDICAL CORPS.Brevet-Colonel Frederick Smith, D.S.O., is retained on the

Active List under Article 120, Royal Warrant for Pay andPromotion, and to be Supernumerary (dated Feb. 8th).The undermentioned are granted temporary rank as

follows :-To be Lieutenant-Colonel : Dated Jan. 19th:Robert Thomson Leiper. To be Lieutenants: Dated Jan. 19th :Reginald Percy Cockin and John Gordon Thomson.The undermentioned relinquish their temporary com-

missions with the Allied Forces Base Hospital :-DatedFeb. 1st: Major Arthur G. Whitehorne-Cole, Major BarnardHudson, Major Philip M. Heath, Captain Ernest D. Roberts,Lieutenant Oswald T. Dinnick, and Lieutenant WilliamM. S. Robinson.Sydney George Leyland Catch love to be temporary

Captain (dated Jan. llth).Lieutenant Gwilym L. Pierce relinquishes his temporary

cofnmission (dated Jan. 23rd).Temporary Lieutenant James G. Ferguson resigns his

commission (dated Feb. 4th).The undermentioned to be temporary Lieutenants :-Dated

Jan. 16th : Dominic Francis Curran, John Hastings Glover,William Pritchard-Airey, and James Morrison. DatedJan. 18th: Herbert William Fankhausen, James ChurchillDunn, Wilfred Conrad Stanley Wood, Donald Watson,Fergus Hay Young, George Allan Maling, Stanislaus Reader,Walter Netherwood Rishworth, Leonard Andersen PearceBurt, and Samuel Ridley Mackenzie. Dated Jan. 20th:Charles Patrick Valentine MacCormack, Archer Ryland,Charles James Glasson, James Ninian George William

McMorris, and Henry William Doll. Dated Jan. 21st:James Tate, Frank Llewellyn Gill, William AlfredTaylor, Charles Birch, Arthur William Hunter Donaldson,Henry Sydney Colchester Hooper, John Frederick Venables,Edward Benjamin Sunderland, Clive Watney Roe,Frank Cyril Greig, John Phillips Blockley, DesmondWilliam Beamish, William Leslie, Robert WalpoleMurphy, James Parker, Arthur Poole, Gerald Robinson,Cyril Carlyle Beatty, Patrick Steele, William ArmourBrown, Reginald Hannay Fothergill, and Desmond ManusMacManus. Dated Jan. 22nd: William Gerald Ridgway,Robert Aikin Wright, James Hill, Bevil MolesworthCollard, Thomas Joseph Redmond Maguire, and HaroldMyrie Cory.

SPECIAL RESERVE OF OFFICERS.

Royal Army Medical Corps.Lieutenant Robert Dunlop Goldie to be Captain.Supplementary to Regular Units or Corps : Royal Army

’ Medical Corps.’, The undermentioned Lieutenants are confirmed in theirrank: John S. Dockrill, Henry P. Whitworth, Thomas 13. S.Bell, Francis A. Duffield, John J. D. La Touche, Joseph H.Baird, John J. Molyneaux, John Stephenson, James Purdie,Clark Nicholson, William S. Wallace, Samuel D. G.McEntire, Gerald G. Alderson, Arthur A. Smalley, Wilfrid B.Wood, Francis A. Roddy, Harold A. Crouch, Herbert S.Milne, John S. Pooley, Quentin V. B. Wallace, William H.Nicholls, Henry Alcock, John Kennedy, and Thomas F.Kennedy.I The undermentioned to be Lieutenants (on probation) :Henry Richard Sheppard, Cadet of the Officers TrainingCorps, and Robert Harvey Williams, ex-Cadet of the OfficersTraining Corps.

TERRITORIAL FORCE.

Royal Army Medical Corps.2nd London (City of London) Field Ambulance: Captain

(Honorary Lieutenant in the Army) William E. Rielly, fromthe Territorial Force Reserve, to be Captain.2nd London (City of London) General Hospital: Maynard

Horne to be Captain (temporary). Lieutenant HoraceG. L. Haynes, from 2nd North Midland Field Ambulance, tobe Lieutenant.Sanitary Service: Alfred Ernest Williams to be Captain,

whose services will be available on mobilisation.3rd Northern General Hospital: Norton Milner to be

Captain, whose services will be available on mobilisation.lst Southern General Hospital: Robert Beatson Dennis

Hird to be Captain, whose services will be available onmobilisation.South-Eastern Mounted Brigade Field Ambulance:

Captain Charles Holt Caldicott, from Attached to Unitsother than Medical Units, to be Captain. Captain ArthurLewis Heiser, from Attached to Units other than MedicalUnits, to be Captain.2nd Home Counties Field Ambulance: Captain James

Dundas, from Sanitary Service, to be Captain. LieutenantErnest Mannering Morris, from Attached to Units otherthan Medical Units, to be Lieutenant.

1st London (City of London) Sanitary Company: AndrewAlexander McWhan to be Lieutenant.2nd North Midland Field Ambulance: Lieutenant Hubert

Pinto-Leite, from the 2nd London (City of London) FieldAmbulance, to be Lieutenant.2nd Lowland Field Ambulance: To be Lieutenants:

Stephen Anderson MacPhee and Colin Cameron Philip (lateCactet, Edinburgh University Contingent, Senior Division,Officers Training Corps).2nd Northumbrian Field Ambulance: William Smith to

be Lieutenant.Attached to Units other than Medical Units.-To be

Lieutenants: William Brown and William Alfred Phillipps.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns with populationsexceeding 50,000 persons at the last census, 8680 births and6995 deaths were registered during the week ended Saturday,Feb. 6th. The annual rate of mortality in these towns,which had been 188, 180, and 19’2 per 1000 in the three pre-ceding weeks, further rose in the week under notice to 20-1per 1000 of their aggregate population, estimated at 18,134,239persons at the middle of 1914. During the first five weeksof the current quarter the mean annual death-rate in thesetowns averaged 19-1, against 20’0 per 1000 in London. Theannual death-rate last week ranged from 10’3 in llford,10-9 in Swindon, 11-8 in Southampton, 12-5 in Edmontonand in Warrington, and 12-9 in Wakefield, to 29-9 in GreatYarmouth, 3l6 in Brighton, 32-5 in Merthyr Tydfil, 35-2in, Stockton-on-Tees,. and 40- in Cambridge. , .