450

by the conception of its ubiquity and variety as to relegateto its sphere conditions that have no relationship with it

whatever.

Annotations.

THE PUBLIC HEALTH IN 1897.

.. :!!iTa quid nimiB." z

THE Registrar-General in his quarterly return for the last Ithree months of 1897, just issued, is able to give a brief butsatisfactory summary of the vital statistics of last year.The death-rate in England and Wales in 1897 did not exceed17’4 per 1000, which, with the exception of the unpre-cedentedly low rates (166 and 17-1 in 1894 and 1896), waslower than the rate in any previous year on record.The death - rate last year was 1’2 per 1000 belowthe mean rate in the ten preceding years 1887-96.

Notwithstanding the fatal effect of epidemic influenza,more especially in 1891-92-93, the annual English death-rate in the seven completed years of the. decennium1891-1900 has been so low as 18-3 per 1000, against225, 21-4, and 191 respectively in the three precedingdecennia of the thirty years 1861- 90. These figurespoint conclusively to continuing satisfactory health progress and to increasing longevity. The birth-rate in

1897 was the same as that in the preceding year-

namely, 29’7 per 1000; and with the single exception of

1894, when the minimum rate of 19’6 was recorded, waslower than in any year on record. The English birth-rateaveraged 35-3 per 1000 in the twenty years 1861-80 and fellto 32’5 in 1881-90 ; while in the first seven years of thecurrent decennium the mean annual rate had farther fallento 30 3. To return to the mortality statistics, the un-

satisfactory feature of an increase of infant mor-

tality . should be noted. The deaths of infants underthe age of one year were in 1897 in the proportion of156 per 1000 of the registered births, which exceeded

by 8 per 1000 both the rate in the preceding year and themean rate in the ten years 1887-96. This excess of infant

mortality is in a certain sense explained by the increase ofdiarrhoea in 1897, to which 26,857 deaths were attributed inEngland and Wales against but 17,114 in 1896. There is

probably no disease which may more correctly be described.as "preventable" than infantile diarrhoea: this annualsacrifice of infant life therefore distinctly discounts our

claim to satisfactory health progress, more especially when werecognise the fact that the mortality from this disease is

almost exclusively confined to that section of the population.generally known as the working or weekly-wage classes.

Notwithstanding the marked excess of diarrhoea fatalitylast year the deaths attributed to all the so-called principalzymotic diseases corresponded to a rate which did notexceed 2 15 per 1000, against 2’17 and 2 21 in the two

preceding years. This zymotic rate was 2’87 in the

thirty-three great towns, 241 in sixty-seven other largettowns, and only 1’62 in the rest of England and

Wales. Whereas diarrhoea mortality showed a marked

increase, due mainly to high summer temperature, therecorded death-rateg from measles, scarlet fever, diphtheria,whooping-cough, and enteric fever were lower in 1897 thann 1896. Only 25 fatal cases of small-pox were registere inEngland and Wales in 1897, against 534 in the precedingyear owing to the severe epidemic in Gloucester. Nearly20,000 deaths last year were caused by different forms ofviolence, but the death-rate from this cause was slightly lowerthan in either of the two preceding years. Inquests wereheld in 33,999 cases, or in 6 6 per cent. of the registered

deaths, showing a slight increase upon the proportion in theprevious year. In rather more than 11,000 cases the causeof death was not certified either by a registered medicalpractitioner or by a coroner. It should, however, beremembered that a very large proportion of these uncertifiedcases were referred by the registrar to the local coroner, who,in the exercise of his discretion, decided that an inquest wasunnecessary.

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KISSING THE BOOK.

WE have frequently 1 commented upon the dangers wbichmay accrue to a witness from kissing a copy of the Gospelswhich has been before kissed and handled by all sorts andconditions of people possibly suffering from infectiousdiseases. We have pointed out that this danger is in noway an imaginary one but very real and have urged the useof the Scotch form of oath in preference to the English. Ata case which was tried in the Westminster County Courton Feb. 3rd a woman who bad been subpoenaed as a witnessproduced her own copy of the Gospels to be sworn uponand we can only congratulate her upon her forethoughtand good sense. Over and over again we have pointed outthat everyone has the right to be sworn after the Scotchfashion if he so desires it, but as the magistrates’ clerks aresometimes ignorant of this form it would be well for witnessesto follow the above example and bring their own Testament.We cannot see either why it should not be made permissible(and, in fact, his honour, Judge Emden, has, we believe,allowed it) for the swearer to take the oath by laying bishand upon the copy of the Gospels. Kissing it is a com-

paratively modern and useless innovation.

A MARTYR TO THE NEW REGULATIONS OFTHE GENERAL MEDICAL COUNCIL.

THE new Notice of the General Medical Council on the

subject of unqualified assistants is causing great excitementand disturbance in various parts of the country where theunqualified assistant has been a sort of institution. One

practitioner in Wales seems to have become a veritable

martyr to the edict. Mr. John Jones held appointments inClydach of the annual value of from 500 to .8700 a

year. Mr. Jones’s assistant was Mr. Jenkins, who hadbeen in the district for thirty years and had worked undervarious practitioners. Opinions vary as to Mr. Jones’srelation to Mr. Jenkins and Mr. Jones argues that whenhe first came to terms with Mr. Jenkins the offence of" covering " had not been formulated by the General MedicalCouncil. Be this as it may, when the new notice appearedMr. Jones felt called on to dismiss his old assistant indeference to the views of the Council. He also resigned hisposition as " works-doctor" at Clydach, but offered himselffor re-election. Such, however, is the resentment of theworkmen at the treatment of the unqualified assistant thatthey have elected to the post a stranger, Dr. Harvard Jones,of Festiniog, by a large majority. They have no fault to findwith Mr. John Jones’s services and they admit him to be aman of great ability ; but they are so attached to Mr.Jenkins, the unqualified assistant, as to think that Mr. Jonesshould have retained him even at the risk of the erasure ofhis own name from the Medical Register 1 This is, of

course, absurd. Mr. Jones s position is a very hard one.There can be no doubt about the substantial soundnessof the regulation of the General Medical Council. It is inthe interest of the people themselves, who are entitled tohave qualified medical men to attend them in their illness.For years past the General Medical Council has been con-fronted with the unqualified assistant backed or " covered’by registered medical practitioners. The arrangement and

1 THE LANCET, Jan. 18th, Feb, 22nd, and April 11th, 1896.