A PLEA FOR THE PLATITUDE.

THE NEW CABINET AND THE PUBLIO HEALTH.

1221

In default ofmore from these Cabinet promotions in the past than effecting any reduction in the number of rats present in a the Local Government Board, and in a recent leading article in our columns we protested against the removal place the access of rats to man must be minimised by the of Mr. Burns from that office at a time when he had latter vacating places where rats, and especially plague-sick introduced important public health measures into Parliarats, have been found. Evacuation should take place imme- ment and when several others were likely to follow shortly. This measure, as it is At the same time we did not for a moment suggest that have died. diately after the pointed out, is efficient for preventing the development of Mr. Burns should forego any promotion to which his services plague amongst man, provided it is adopted early enough- have justly entitled him, and we suggested that his promotion take the shape of an exaltation in status of the that is, before or immediately after rats have been found should office which he now holds. We are therefore very pleased dead in a house. But it is dangerous when it encourages to see that events have justified our prophecy and that Mr. those who have been living in the midst of infected sur- Burns is to remain at the Local Government Board to pilot roundings to seek refuge in healthy towns and villages in through the House his important Housing Bill as also we order to avoid the discomfort of a camp life. trust, amongst others, measures relative to the better and if we could only insure its universal applica- control of milk and meat and to the creation of river Lastly, tion, the method of inoculation which has been brought boards by means of which public health authorities be better able to deal with the pollution of rivers, to such a pitch of perfection by Mr. HAFFKINE is the may the purity of water-supplies, and, not least, to surest means of prevention. Everywhere throughout India secure the wholesomeness of the numerous forms of shellthe results obtained, contrasted with control experiments, fish which are consumed in such large quantities and show this, and no greater benefactor to the Indian people has often with such disastrous results to the consumers. ever visited that country than this distinguished savant; even The continued reign of Mr. Burns at the Local Governafter five years some trace of protection remains. Testimony ment Board will afford him opportunities of redeemhis pledges to deputations in these respects, and for thi3 to its good effects is afforded not only by the communities ing reason we cordially congratulate him upon his re-appointinoculated but also by the police, the railway companies, ment as also upon the fact that he has been given as a and the mill-owners amongst other bodies. Captain LISTON Parliamentary Secretary Mr. C. F. G. Masterman who takes concludes his admirable advice by showing that no single, great interest in natural science and in all schemes for the anti-plague measure should be adopted to the exclusion of, moral advancement of the people. We have yet to learn others; each has its advantages. Where danger is imminenti what are the precise proposals which the Prime Minister will present to the re-assembled Parliament relative to inoculation can best be practised; where it is wished toI the status of the Local Government Board and the Board of anticipate the possible epidemic in any village destruction of Trade. We see, for instance, suggestions that the pay rats is most advantageously carried out. Evacuation is also a of each of these Ministers is to be raised to Secretary useful adjunct to inoculation. Evacuation and inoculation of State level but that they are not to enjoy the promptly carried out will stop any epidemic. Professorr accompanying rank. We trust that no such invidious SIMPSON narrates a striking case occurring in Cape Town distinction will be made, as it seems clear from the recent debate which took place in the House of Commons on the where plague was becoming serious amongst the Kaffirs. Itb subject that Mr. Asquith fully recognised the absurdity of having been decided to remove them from their insanitary the existing disparities in so far as the Local Government dwellings some 7000 to 8000 were so removed and all were’ Board and the Board of Trade were concerned and that both inoculated, The epidemic at once ceased. In conclusion, sides of the House were in complete harmony on the subject. it may be mentioned that Professor SIMPSON strongly7 A department such as the Local Government Board, which recommends the disinfection of a plague-stricken domicileI deals with public health, pauperism, local expenditure, and a host of matters affecting intimately the daily life of by sulphurous acid gas by means of the Clayton method. the wholeother should enjoy a status second to no population, This will destroy not only the plague germ but also rats, other department of the State and we trust that full justice fleas, bugs, and other agents capable of conveying theI will at last be meted out to it. infection, and, moreover, does away with the irritating procedure of removing all the different effects and chattels of A PLEA FOR THE PLATITUDE.

method to one-quarter of the original number.

rats

last but

,

,

.

’

,

the natives elsewhere for disinfection, thus dealt with in sit.

as

everything

is

Annotations. It lire quid nimil."

THE NEW CABINET AND THE PUBLIC

THE Glasgow Southern Medical Society has for its badge clamant cockerel beneath the defiant motto " While I live I’ll crow." We are happy to say that the society has carried out its purpose for 64 years already and has recently shown by a lusty note raised from the presidential chair that it is still animated by the spirit of its founders. The occasion to which we allude was an address delivered by Dr. James Mackenzie of Burnley under the title " Some Platitudes and the X Disease," in which he upheld with convincing vigour the claims upon the gratitude of Medicine which have been earned by the great body of her general practitioners, and the purpose of his address was to set forth the way in which it seemed to him the continuance of those claims might be assured. He brought forward his advice under three headings, to which he made deprecating allusion as "Platitudes of Medicine." A certain standard dictionary gives us three meanings for platitude: (1) a written or spoken statement that is flat, dull, or commonplace ; (2) an insipid truism, especially when a

HEALTH.I our

WE have on several occasions recently discussed in columns the status of the Local Government Board and we have pointed out the disabilities which attach to any offices other than those of Secretaries of State by virtue of the promotions which take place from time to time in any given Cabinet and which have often the effect of depriving some important Government department of the services of its president just as such president has had time to learn the work of the department. Probably no other department has suffered

1222

URBAN MORTALITY IN IRELAND.

uttered didactically; and (3) twaddle ; whilst Dr. Mackenzie’sI the population of but three of the 1’rish towns exceeded definition was " a statement of ignored trifles or thingsI 50,000, while in each of 16 of the 22 town districts the taken for granted." We can certainly acquit his platitudes! population was considerably below 20,000. Notwithstanding, of having any part in the dictionary’s final alternative, andI however, the inclusion of so many small towns in the Irish if we accept the other two definitions in this special con- list the mean rate of mortality in the 22 town districts nexion, truth, no less than courtesy, demands the deletion ofduring last year was equal to 21’ 1 per 1000, exceeding the their contemptuous adjectives. Combining, then, our modi- rate in the 76 far larger English towns by no less than 5’77 fied authority with the meaning which Dr. Mackenzie him- per 1000 ; thus the rate of mortality in the Irish urban self gives to a platitude, we may define it as "a statement population exceeded that in the principal urban population which is so true as to be obvious, dealing with things so of England and Wales by 37 per cent. The contrast between commonplace as to be taken for granted and which the London and Dublin death-rates was still more startling. have consequently come to be ignored as trifles." We The recorded rate of mortality in the Administrative County submit that this meaning puts a different complexion of London during last year did not exceed, as is stated upon the despised platitude, and even though we allow above, 14’6 per 1000 ; whereas in the Dablin registration area the death-rate was equal to 24’2, thus exceeding the our dictionary to add that it is "uttered didactically," London rate by 9’6 per 1000, and by no less than 66 per not formal invest its lesson with a such force may delivery cent. are in casual utterance ? We to our Moreover, this excessive death-rate in Dublin was lacking prepared justify defence of platitudes by quoting the three on which Dr. 1’1 per 1000 below the average rate during the ten preMackenzie based the paper in question : " Carefully observe ceding years. It is also worthy of note that the death-rate your patient and understand what you see." "Treat the last year was equal to 21’ 3 per 1000 in Belfast, and that patient and not the disease." 11 observe what becomes of among the smaller Irish towns it exceeded 20 per 1000 in your patients." How often has young Laertes, M.B., freshly Cork, Ga.lway, Kilkenny, Newbownards, and Waterford. " capped and doctored and a’," listened to such platitudinous These high rates of mortality in the Irish towns can only counsels from the tedious lips of Dr. Polonius, his profes- reflect the defective health condition of the urban population Oh yes, he’s heard all that a hundred which calls for careful investigation. It is only possible sional father I times and only wants to be spurring on his way. And yet, here to note one or two facts disclosed by this summary of if he ponder upon this trilogy of truisms (of which, by the the Irish weekly returns. In the first place, it is clear that way, the third deserves more attention than it generally the excessive rate of mortality in the Irish towns is not due receives), he may fuse them into a golden rule for the prac- to exceptional fatality of epidemic disease, as the rate of tice of medicine, a very compendium of its science and art. mortality during last year from the seven principal epidemic It is, as Poe insisted, the name writ largest on the map diseases was identically the same-namely, 1 - 6 per 1000, which we fail to find, the obvious which escapes our both in the 76 English towns and in the 22 Irish town attention, and it is well to be now and again formally districts. It is true that the rate of infant mortality, which reminded of the importance of the commonplace principles did not exceed 127 per 1000 births during last year in the upon which experience shows we may best conduct the English towns, was equal to 135 per 1000 in the Irish towns; business of our lives. And a platitude has this great this excess of infant mortality, however, accounts for but a claim to respect, that granted it embraces a truism, small proportion of the excess in the crude death-rate in the urban population of Ireland. As the birth-rate last year a fortiori it contains a truth, and in the practice of medicine the establishment of an unassailable fact raises a new rock of in the Irish towns was equal to 28’4 per 1000, against safety out of a shifting quicksand. The man who can find 27’00 in the English towns, it is improbable that the nothing but tedium in the contemplation of such platitudes excess of mortality in the former is due to any very s we have quoted, if asked his candid opinion of Newton’s exceptional age constitution of the population, but it may statement of the laws of motion, would not improbably be pointed out that while the proportion of deaths of persons confess that to his intelligence they appeared a somewhat aged upwards of 60 years to total deaths did not exceed pedantic expression of obvious natural phenomena, in fact. 265 per cent. in the Irish towns, it was equal to 29’2 per own

.

dynamical platitudes. It would never occur to this cent. in the large English towns. These figures appear to superior person that had the philosopher not embodied his suggest that the main excess of mortality in the Irish towns observations in convenient formulas the knowledge of these occurs among adults aged between 20 and 60 years. The phenomena would not have been his own birthright. And true explanation, however, of this excessive mortality is not so it is with the platitude, for which, in place of thedisclosed by the Irish Annual Summary under notice, and dictionary’s scornful utterance, we now venture the morecould only be ascertained by a full and careful analysis of respectful and handier definition of "crystallised ex- more detailed statistics of the mortality in this Irish urban population, at various groups of ages and with due regard perience." mere

I

I

-

to its URBAN MORTALITY IN

IRELAND.

sex

and age constitution.

THE recently published yearly summary of the weekly returns issued by the Registrar-General for Ireland during THE EXISTENCE OF FORMS OF THE TUBERCLE BACILLUS WHICH ARE NOT ACID-FAST. last year records a rate of urban mortality in that part of the THE existence of forms of the tubercle bacillus which United Kingdom in marked excess of the rate that prevailed the same urban of in the become decolourised in the course of the ordinary Ziehlduring period population principal In each Nielsen of staining is affirmed by Dr. Hans Much of and Wales. the method 76 towns, England large English having an estimated population exceeding 50,000, the mean Hamburg, in an interesting paper published in the Berliner rate of mortality during last year did not exceed 15 4 per Klinische Woe3Censohrift of April 6Gh. He has found that 1000, while in London, with a population little short of on making post mortem examinations of cattle infected with 5,000,000, the unprecedentedly low death-rate of 14’66 per tubercle bacilli of known origin and of ordinary character?, 1000 prevailed. The return referred to contains statistics and presenting typical nodules in the lungs, the most careful relating to 22 town districts of Ireland, with an examination may in certain cases fail to reveal ordinary aggregate estimated population of little more than acid-fast tubercle bacilli, in spite of the fact that inoculation 1,000,000 ; and the population of the individual town districts experiments may demonstrate the tuberculous nature of the ranged from 300,850 in Dublin city and 370,163 in lesions and that from some of the cases tubercle bacilli may Belfast, to 7909 in Queenstown and 7588 in Armagh. Indeed be obtained by culture. Similar results may be observed with