104 THE POOR-LAW MEDICAL OFFICERS’ ASSOCIATION OF ENGLAND & WALES.

21 - 29 per cent. were over 60 years of age. Provision of

asylum accommodation is usually followed by a rise in thenumber of certified persons, and the payment of the fourshilling grant to the guardians creates a tendency to sendpaupers to asylums who otherwise would be kept in the work-houses. Dr. Wolseley-Lewis quotes a most apposite passagefrom the report of the Royal Commission to the effect thatlunatic asylums are crowded with patients who do not requirethe careful hospital treatment that well-equipped asylums nowafford and who might be treated in many other ways moreeconomically and as efficiently. At Barming Heath 39’40per cent. of the direct admissions had previously been dis-charged recovered. Of the 139 relapsed cases 83 were under45 years of age (i.e., within the child-bearing age) and ofthese 38 were married. In 44 per cent. of the direct admis-sions hereditary predisposition was ascertained, notwith-standing the reticence and imperfect knowledge of thefriends of the patients. A consideration of these facts forcesus to the conclusion that some means should be taken to

prevent these recurrent cases continuing their degeneraterace and, according to Recommendation LVIII. of the RoyalCommission, legal powers should be given for the permanentcontrol of such persons.-At Chartham Asylum the averageincrease of patients steadily rises, the average increase forthe years since 1902 being 21. The recovery rate is 24 percent. The last decade showed a death-rate of 10 per cent.

St. Andrew’s Hospital for Mental Diseases, Northampton(Annual Report for the I’ear 1908).-The total number ofpatients under treatment at this hospital was 483. 23 personswere discharged recovered, the percentage of recoveries onthe total number of admissions being 32-85. The percentageof deaths on the average number resident was 4 ° 10.

THE POOR-LAW MEDICAL OFFICERS’ASSOCIATION OF ENGLAND

AND WALES.

THE annual meeting of the Poor-law Medical OfficersAssociation of England and Wales was held on Tuesday last,July 6th, when the Lord Mayor of London presided at theopening of the proceedings which took place at theGuildhall.The recent publication of the Reports of the Royal Com-

mission on the Poor-laws and Relief of Distress madethis meeting one of particular interest, having regard tothe drastic propositions set forth by both the Majority andMinority Commissioners for dealing with the medical serviceof the Poor-law. Surgeon-General Evatt, the President ofthe association this year, in the course of his inauguralwords, regretted the absence of a responsible central bureauof public health; when papers followed from Dr. MajorGreenwood, Mrs. Sidney Webb, Dr. G. F. McCleary, Dr.F. S. Toogood, and Mr. C. S. Loch on various aspects ofparochial medical assistance.

Dr. Major Greenwood then brought forward a motion inwhich it was declared (1) that in any system of Poor-lawmedical reform there must be a distinct medical serviceto attend to the sick State poor; (2) that the securityof the ratepayer and the welfare of the suffering Statepoor imperatively demand the isolation of that class ofthe people requiring State assistance, so that the latter maybe administered with a due regard to economy and maynot tend to the pauperisation of the public by the grantingof free medical attendance to a large portion of the com-munity ; and (3) that except in cases of emergency in

thinly inhabited rural districts, where access to the

relieving officer is difficult, all persons requiring State aid,medical or other, must first make application to a specialofficer, with whom should always rest the responsibility ofdeciding as to the right of the applicant to State assistance.These various motions were all adopted and becameunanimous resolutions of the meeting.

THE ANNUAL DINNER.

The annual dinner was held at the Waldorf Hotel, withthe President, Surgeon-General G. J. H. Evatt, in thechair. The dinner was well attended and the honorarysecretary, Dr. Major Greenwood, and the assistant honorary

secretary, Mr. F. A. Greenwood, were most heartily con-gratulated on the successful result uf their work. Amongstthose present were Sir Walter Foster, M.P., Sir DyceDuckworth, Sir Shirley F. Murphy, Mr. J. Smith

Whitaker, Dr. S. M. Copeman, and Dr. R. Deane Sweeting.In proposing the toast of the " Poor-law Medical Officers’Association " Sir Walter Foster said the association did goodwork in taking up cases for investigation. They were on theeve of great changes, and care must be taken to keep localself-government in contact with Poor-law administration. Dr.Major Greenwood, in replying to the toast, said that he hopedthe Poor-law medical officers would continue to remain a dis-tinct service. Dr. W. A. Dingle (Mayor of Finsbury) proposed" The Corporation of the City of London," and declared hehad been a district medical officer for 30 years, was satisfiedwith his position, and did not consider that he was underpaid.Alderman Sir Thomas Crosby, in replying, said that thecorporation had existed for centuries and had always strivenfor liberty and progress not only for the City but also forthe greater London outside. Mr. W. Holder (Hull), whosubmitted the toast of "The Local Government Board,"spoke of its work in preventing the spread of disease. Dr.A. H. Downes, in responding, praised the sturdy independ-ence of the part-time medical officer. Dr. A. Drury (Halifax)in proposing The Royal Commissioners " responsible for therecent report upon Poor-law, said that they had agreed inone thing, and that was that though the Poor-law medicalofficers had done their work well in the circumstances and inthe conditions, neverthess these conditions were so intolerablethat the service was inefficient. He advocated that insteadof demolishing the Poor-law medical service the existingmachinery should be utilised. He did not think the matterwould be settled for years to come. Mr. C. S. Loch, inresponding, complained that in the medical profession therewas a want of consistency of opinion, a want of unity ofthought, and a want of steadiness of purpose. He hopedthat the Poor-law Medical Officers’ Association would cometo some definite opinion on the matter and then would doitself the honour of sticking to it. The public want

guidance, for no layman can understand the problem ofmedical relief. He hoped that the medical profession wouldevolve some firm line in regard to medical relief. The Rev.

Prebendary Russell Wakefield also replied and rendered agraceful tribute to the medical profession for their work

among the poor. The toast of "Our Guests " was

eloquently put by the chairman and was duly acknowledgedby Sir Dyce Duckworth, Dr. J. A. Macdonald, Mr. SidneyWebb and Mrs. Sidney Webb.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.’

IN 76 of the largest English towns 8565 births and 3733deaths were registered during the week ending July 3rd.The annual rate of mortality in these towns, which hadbeen equal to 12 - 6, 12 - 3, and 12 1 per 1000 in the threepreceding weeks, further declined to 11 - 8 in the week undernotice, and was lower than the recorded rate in any previousweek of this year. During the 13 weeks of the past quarterthe annual death-rate in these towns averaged 14’ 0 per 1000,against 14 - 9 and 13 - 7 in the corresponding quarters of 1907and 1908 ; the mean rate in London during last quarter didnot exceed 13 5, against 14’ 0 and 12.7 7 in the two precedingcorresponding quarters. The lowest recorded annual death-rates in the 76 towns last week were 3 8 in Hastings, 4.4 4 inHornsey, 4,5 in Handsworth, and 4-9 in Stockton-on-Tees ;the rates in the other towns ranged upwards, however, to17 - 3 in Wigan and in Middlesbrough, 19’5 5 in Coventry,and 19’6 in Swansea. In London the recorded death-ratelast week did not exceed 11 1, and was lower than in anyprevious week of this year. The 3733 deaths in the 76 townsfrom all causes last week showed a further decline of 71from the declining numbers in recent weeks, and included324 which were referred to the principal epidemic diseases,against 393, 364, and 353 in the three previous weeks; ofthese 324 deaths, 129 resulted from measles, 70 fromwhooping-cough, 52 from diarrhoea, 32 from scarlet fever,28 from diphtheria, and 13 from 11 fever " (principallyenteric), but not one from small-pox. The 324 deaths fromthese epidemic diseases last week were equal to an annual