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MEDICAL SERVICE IN THE HIGHLANDS AND ISLANDS.
406 !since the
inspection of the fund being on the same MEDICAL SERVICE IN THE HIGHLANDS Rs.14,94,7836-7, out of the total grant of Rs.21 AND ISLANDS. lakhs, including Rs.50,000 for the Central Research Institute and Rs.50,000 for plague experiments IN many of the districts within the large area of northern in Bangalore made by the Government of India. The Government body are greatly indebted to the Scotland, known as the Highlands and Islands, the law of an adequate members of the Scientific Advisory Board and to the supply and demand has never been able to secure a poor and sparsely distributed populamedical service for various officers and subordinates who have been tion. This has long been acknowledged by others besides employed under their orders. The President (Sir those medical practitioners who with scanty remuneration Harcourt Butler) expressed his high apprecia- have struggled to alleviate human suffering in localities - date
tion of the excellent work done by the board, the members of the bacteriological department, and other officers employed under the association, and paid a special tribute to the chairman of the board (the Hon. Sir Pardey Lukis, K.C.S.I.) forJthe clear, practical, and beneficent way in which he has directed research in India, and to Major Norman White for the valuable work which is being done by the Indian Journal of Medical Research under his
where lack of means of communication and locomotion have combined with severity of climate to render their task arduous and sometimes hopeless. State assist-
- editorship.
the documents referred to is devoted entirely to the subject of grants towards the extension of telegraph and telephone facilities. Modern scientific inventiveness has thus aided in bringing about the practical expression by the State of modern sympathy with suffering, as it has promoted and increased public appreciation of medical science and its
Assam Lunatic
Asylum.
From the Chief Commissioner’s resolution on the working of the Provincial Lunatic Asylum in Assam for the triennium 1912-14, which, together with the report by the Inspector-General of the Civil Hospitals, Assam, is published in the Assam Gazette, we find that the number of lunatics confined at the Tezpur Lunatic Asylum during the three years was 298, 303, and 355 respectively. Admissions and re-admissions numbered 66 in 1912, 74 in 1913, and 95 in 1914. The increase in the latter two years was mainly due to the admission of lunatics from Sylhet and Cachar, who used to be sent to Dacca, but have been received at Tezpur from the latter part of 1913. Overcrowding
ance
is, however,
now
rendered
more
practicable owing
extending telegraphic and telephonic communications which the State controls, and owing to the cheapening of vehicles and boats propelled by motors," Consequently, in a series of explanatory papers now issued by the Highlands and Islands Medical Service Board we naturally find reference to the latter, and one of to
the
possibility
of
"
practitioners. Reference
was
made in THE LANCET of
July 31st
to the
report of the Highlands and Islands Medical Service Board covering the period up to the end of last year, and the series of memoranda mentioned above may be regarded as explanations of its future policy from a practical point of view, divided, according to the subjects treated of, into six small pamphlets, which can be bought for ;d. each through any bookseller or from the usual official publishers. The first one, A, gives the proposals of the Board with regard to medical practitioners in administering the ’’Medical Service Fund." This fund has been created, in the words of the Highlands and Islands (Medical Service) Grant Act, 1913, "for improving medical service, including nursing, in the
remedied by provision of temporary accommodation, while a project for reconstructing the Highlands and Islands of Scotland, and otherwise providing .asylum buildings at a cost of over three and a half and improving means for the prevention, treatment, andallevialakhs of rupees has been prepared and work com- tion of illness and suffering therein." It is explained that, whatmenced. In spite of the increase in the number ever other schemes may be in contemplation, the first and of inmates, it is satisfactory to note that the most pressing need, in the opinion of the Board, is for the of means whereby an efficient medical service can deaths decreased from 47 in 1912 to 17 in 1914, adoption was
and fatal cases of tuberculosis from 23 to In this connexion it is worthy of mention that 1914 the rate of mortality amongst the inmates the asylum was lower than in any province India.
7. in of in
The Late Lieutenant- ColoneZ Ewens, -T.311.S. In a Government review of the working of the Punj ab Lunatic Asylum for the triennium ended 1914 the following reference is made to the death of Lieutenant-Colonel Ewens, I.M.S.: "Lieutenant-Colonel Ewens, who has held charge of the asylum since its foundation some 15 years ago, died on Sept. 9th, 1914. The Lieutenant-Governor heartily endorses the remarks made in the report and by the Inspector-General of Civil Hospitals on his work as superintendent. The institution owes its progress in efficiency and popularity almost entirely to his untiring efforts and sympathetic care of the inmates, and in him Government has lost a most capable officer and the patients a true friend."
THE HEALTH
OF
FALMOUTH
IN
1914.-The
medical officer of health for Falmouth (Dr. A. Gregor) in his annual report for 1914 states that the birth-rate was 18-08 per 1000, an increase over the last three years. The crude - death-rate was 13-37 per 1000, the net death-rate being 12-56. The number of deaths under 1 year was at the rate of 69.10 per 1000 births, which was a substantial reduction, and compared favourably with other urban areas.
be brought within the reach of persons of the crofter and cottar class at fees which they can reasonably be expected to pay, it being understood that the cost of such medical attendance shall not be increased by reason of distance from the residence of a medical practitioner. The sum of money available for carrying out this and other branches of the Board’s scheme is not overwhelmingly large when the task to be performed is taken into To an annual sum of £10,000 allocated consideration. in aid of mileage and other special charges, which has been previously voted, a sum of £32,000 has been added, making a total of £42,000 for the various purposes of the Medical Service Fund. The document (A) to which we are referring sets out in some detail the conditions upon which the payment of grants to medical practitioners is proposed to be made, and touches upon the various other points which unavoidably present themselves for consideration in connexion with the introduction of an important new factor into the business relations between a large class of medical men and their patients. The medical man in poor districts has already under his care many patients the fees for whose treatment do not come out of their own pockets, and the Board has had to declare as its policy that the new grant is for the purpose of improving medical and kindred services and not for relieving those who at present bear, in whole or in part, the cost of those services. The parish council, for example, will have to pay a salary where it paid one before, and the inhabitants of the district will gain by having a better remunerated medical service and one rendered more efficient by speed in methods of locomotion, and improved means for securing prompt attendance. Immediate arrival at the results finally to be achieved is, however, not to be expected ; a footnote warns us of the conditions hostile to in which we are now living, and explains that progress ’ districts which in normal times of peace might reasonably
407 to see a medical man established in their midst must be content, for the present, with the help that the board can give in the shape of additional travelling facilities for the existing practitioners. The important subsidiary topics dealt with in the other ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH. explanatory memoranda include (B) the question of nursing, the general conditions being set out under which district Urban District of Willesden.-Dr. G. F. Buchan’s annual nursing associations will be eligible to participate in grants for the year 1914 contains a variety of interesting from the Medical Service Fund ; and (C) the circumstances report information. The population of Willesden estimated atin which contributions towards hospitals and for the mid-summer 1914 was 166,634, as compared with the Census provision of ambulance services will be granted. The population 154,344 in 1911. The number of births in the needs of the Highlands and Islands are not, however, district during the year was 4115, giving a birth-rate of confined to the subsidising of medical men and nurses 24’ 7 1000 of the population. The birth-rate, which equals per to care for the sick or injured population in their of last year, remains the lowest recorded. There were; that homes, and of ambulances and hospitals so that they 1752 deaths in the district during the year, giving a deathcan be duly cared for when their homes are unsuitable. rate of 10’51 per 1000, as compared with 10 24 in 1913 and Grants have to be considered, and the Board is prepared to 9’ 8 in 1910, when the death-rate in Willesden was lowest. make them, towards the provision or improvement of housing The infant mortality rate was 82 per 1000. The number of and for men These accommodation medical nurses. grants, cases of compulsory notifiable infectious diseases was 1665, the conditions of which are set out in Pamphlet D, will be which is the highest on record, being due, in the main, toregulated in accordance with the necessity of providing or im- increased prevalence oi scarlet fever The and proving a house in order to render better the medical service type of diphtheria prevailing was more thandiphtheria. virulent, usually of a particular district in which no suitable building exists. and the fatality rate rose to 79 per 1000 cases, which is the Here the cooperation of local authorities will be invoked and recorded since 1902, when the fatality rate was 122. model plans for their guidance will be issued by the Board. highest Dr. Buchan gives a brief review of the work which has Again, the circumstances of medical practice in thinly been done by the council in past years for the improvement populated and mountainous localities and in islands off the of the health of the population, and comments on the resultsScottish coast are not favourable to the establishment of achieved. After alluding to the legal enactments relating; "specialised services," a general term applied by the Board to public health which have been passed during the lastto medical consultations, assistance at operations, and the 40 years, he states : "It would be difficult to assess theprovision of surgical appliances, dentistry, and school exact part that each of the measures passed since 1875 has. The consideration of these (E) involves the question clinics. in improving the national health, but so far as played of the provision of laboratory facilities, the object in view Willesden is concerned the broad fact is that the death-rate; being to bring the practitioner into touch with the in 1875 was 21-4 per 1000 and in 1914 10-51 per 1000. laboratories at the great medical schools, instead of In other words, if Willesden people had died at the sameleaving him to maintain a small pathological laboratory rate in 1914 as in 1875, 1814 additional deaths would have and to provide his own vaccines, if his individual been recorded. This saving of lives has a commercial and should him to enable do so. opportunities powers value. Dr. Farr in 1876, in the thirty-ninth annual report. Finally, the Board has to contemplate the devotion of a of the Registrar-General, reckoned that the mean net value= strictly limited portion of its funds to the connecting up of of each male person in the community was £150, as estithe houses of medical men and of nurses, as well as hosmated the standard of the agricultural labourer of that pitals, with central telephone call-offices and with post-offices day. by For the whole population, including females, he where suitable arrangements can be made. In Pamphlet F, the standard might be lowered to £110. It should which is devoted to the subject, will be found an interest- thought be noted that Willesden is an urban and generally educated ing official communication from the Postmaster-General community as compared with the agricultural labourer showing the lines upon which the post-office will aid in the class of 1876, and that consequently these figures. extension of telegraph and telephone facilities where the understate the value of the unit of the population volume of trade or agriculture is not sufficient by itself to when applied to Willesden in 1914. But taking the secure the desired privilege. lower figure above given it will be seen that the When we remember that the matters enumerated above of 1814 lives in 1914, as compared with 1875, have to be considered in relation to a very extensive area it saving a means saving of 199,540 during the year 1914. will be seen that the task of the Highlands and Islands I do not wish it to be thought that the diminished deathMedical Service Board is not simple. We have spoken rate is wholly the result of the activities of the council. of the law of supply and demand. The demand is there, the period of 1875-1914 the birth-rate has fallen in the sense that medical service is urgently needed by a During from 44.7to 24.7per 1000 of the population, and thisscattered and poor p pulation, but the supply has fallen diminution in the birth-rate has led to a reduction in the short because the poverty and sparsity of the population of persons living under 5 years of age when the have rendered it impossible for those who would provide proportion death-rate is highest. It should not, however, be deduced medical attendance and nursing to make a decent livelihood from this statement that a high birth-rate is incompatible by so doing. How far the sum mentioned above may suffice with a low death-rate, for under normal healthy conditions a for the purpose for which it has been voted remains to be birth-rate would mean that a large proportion of the high seen, but there can be no reason why the first experiments were living between the ages of 5 and 45, when in distributing it should not lead to satisfactory results and population death-rate is lowest. Properly speaking, therefore, ancl the why those results should not encourage Parliament to further under the best conditions of living, a high birth-rate and a generosity in so worthy a cause. low death-rate are synonymous terms, and it is a matter for consideration under what conditions they may become so. THE LATE DR. R. OF PLYMOUTH - This problem is not easy of solution, but can be simplified At the last meeting of the Plymouth borough council the by resolving it into three cardinal questions : 1. How can the mayor stated that the Misses Freeman had presented to the falling birth-rate be restored to its former level ? 2. How town the silver snuff-box presented by the corporation can the high death-rates under 5 years of age be diminished ? of Plymouth to their father, the late Dr. Freeman, in 3. How can the death-rates at ages over 5 years be still recognition of his valuable services during the cholera further diminished ? The first of these questions presents epidemic in 1832. The snuff-box has the following inscrip- considerable difficulty. An examination of Table lA of tion :"To Richard Freeman, M.D., in testimony of the Appendix A, which gives the birth-rates in each ward, shows gratitude and esteem of his fellow-townsmen for his humane that these are least in Brondesbury Park and Cricklewood’ and unceasing attention to the poor during the awful wards, and highest in Stonebridge and South Kilburn—that visitation of malignant cholera at Plymouth, A.D. 1832." is to say, the birth-rates are lowest in the best residential The mayor described the heroic services of the late Dr. areas of Willesden and highest in the poorest, and Freeman during the epidemic, when 1894 persons were generally it may be said that the lack of fertility is: The fall in the attacked with cholera, and of these 779 died. It was greatest in the most valuable stocks. decided to place the box with the museum committee for birth-rate, especially amongst the middle and upper classes, It is not wholly explained on is difficult to explain. safe custody and public exhibition.
hope
Public Health.
FREEMAN,
inspection of the fund being on the same MEDICAL SERVICE IN THE HIGHLANDS Rs.14,94,7836-7, out of the total grant of Rs.21 AND ISLANDS. lakhs, including Rs.50,000 for the Central Research Institute and Rs.50,000 for plague experiments IN many of the districts within the large area of northern in Bangalore made by the Government of India. The Government body are greatly indebted to the Scotland, known as the Highlands and Islands, the law of an adequate members of the Scientific Advisory Board and to the supply and demand has never been able to secure a poor and sparsely distributed populamedical service for various officers and subordinates who have been tion. This has long been acknowledged by others besides employed under their orders. The President (Sir those medical practitioners who with scanty remuneration Harcourt Butler) expressed his high apprecia- have struggled to alleviate human suffering in localities - date
tion of the excellent work done by the board, the members of the bacteriological department, and other officers employed under the association, and paid a special tribute to the chairman of the board (the Hon. Sir Pardey Lukis, K.C.S.I.) forJthe clear, practical, and beneficent way in which he has directed research in India, and to Major Norman White for the valuable work which is being done by the Indian Journal of Medical Research under his
where lack of means of communication and locomotion have combined with severity of climate to render their task arduous and sometimes hopeless. State assist-
- editorship.
the documents referred to is devoted entirely to the subject of grants towards the extension of telegraph and telephone facilities. Modern scientific inventiveness has thus aided in bringing about the practical expression by the State of modern sympathy with suffering, as it has promoted and increased public appreciation of medical science and its
Assam Lunatic
Asylum.
From the Chief Commissioner’s resolution on the working of the Provincial Lunatic Asylum in Assam for the triennium 1912-14, which, together with the report by the Inspector-General of the Civil Hospitals, Assam, is published in the Assam Gazette, we find that the number of lunatics confined at the Tezpur Lunatic Asylum during the three years was 298, 303, and 355 respectively. Admissions and re-admissions numbered 66 in 1912, 74 in 1913, and 95 in 1914. The increase in the latter two years was mainly due to the admission of lunatics from Sylhet and Cachar, who used to be sent to Dacca, but have been received at Tezpur from the latter part of 1913. Overcrowding
ance
is, however,
now
rendered
more
practicable owing
extending telegraphic and telephonic communications which the State controls, and owing to the cheapening of vehicles and boats propelled by motors," Consequently, in a series of explanatory papers now issued by the Highlands and Islands Medical Service Board we naturally find reference to the latter, and one of to
the
possibility
of
"
practitioners. Reference
was
made in THE LANCET of
July 31st
to the
report of the Highlands and Islands Medical Service Board covering the period up to the end of last year, and the series of memoranda mentioned above may be regarded as explanations of its future policy from a practical point of view, divided, according to the subjects treated of, into six small pamphlets, which can be bought for ;d. each through any bookseller or from the usual official publishers. The first one, A, gives the proposals of the Board with regard to medical practitioners in administering the ’’Medical Service Fund." This fund has been created, in the words of the Highlands and Islands (Medical Service) Grant Act, 1913, "for improving medical service, including nursing, in the
remedied by provision of temporary accommodation, while a project for reconstructing the Highlands and Islands of Scotland, and otherwise providing .asylum buildings at a cost of over three and a half and improving means for the prevention, treatment, andallevialakhs of rupees has been prepared and work com- tion of illness and suffering therein." It is explained that, whatmenced. In spite of the increase in the number ever other schemes may be in contemplation, the first and of inmates, it is satisfactory to note that the most pressing need, in the opinion of the Board, is for the of means whereby an efficient medical service can deaths decreased from 47 in 1912 to 17 in 1914, adoption was
and fatal cases of tuberculosis from 23 to In this connexion it is worthy of mention that 1914 the rate of mortality amongst the inmates the asylum was lower than in any province India.
7. in of in
The Late Lieutenant- ColoneZ Ewens, -T.311.S. In a Government review of the working of the Punj ab Lunatic Asylum for the triennium ended 1914 the following reference is made to the death of Lieutenant-Colonel Ewens, I.M.S.: "Lieutenant-Colonel Ewens, who has held charge of the asylum since its foundation some 15 years ago, died on Sept. 9th, 1914. The Lieutenant-Governor heartily endorses the remarks made in the report and by the Inspector-General of Civil Hospitals on his work as superintendent. The institution owes its progress in efficiency and popularity almost entirely to his untiring efforts and sympathetic care of the inmates, and in him Government has lost a most capable officer and the patients a true friend."
THE HEALTH
OF
FALMOUTH
IN
1914.-The
medical officer of health for Falmouth (Dr. A. Gregor) in his annual report for 1914 states that the birth-rate was 18-08 per 1000, an increase over the last three years. The crude - death-rate was 13-37 per 1000, the net death-rate being 12-56. The number of deaths under 1 year was at the rate of 69.10 per 1000 births, which was a substantial reduction, and compared favourably with other urban areas.
be brought within the reach of persons of the crofter and cottar class at fees which they can reasonably be expected to pay, it being understood that the cost of such medical attendance shall not be increased by reason of distance from the residence of a medical practitioner. The sum of money available for carrying out this and other branches of the Board’s scheme is not overwhelmingly large when the task to be performed is taken into To an annual sum of £10,000 allocated consideration. in aid of mileage and other special charges, which has been previously voted, a sum of £32,000 has been added, making a total of £42,000 for the various purposes of the Medical Service Fund. The document (A) to which we are referring sets out in some detail the conditions upon which the payment of grants to medical practitioners is proposed to be made, and touches upon the various other points which unavoidably present themselves for consideration in connexion with the introduction of an important new factor into the business relations between a large class of medical men and their patients. The medical man in poor districts has already under his care many patients the fees for whose treatment do not come out of their own pockets, and the Board has had to declare as its policy that the new grant is for the purpose of improving medical and kindred services and not for relieving those who at present bear, in whole or in part, the cost of those services. The parish council, for example, will have to pay a salary where it paid one before, and the inhabitants of the district will gain by having a better remunerated medical service and one rendered more efficient by speed in methods of locomotion, and improved means for securing prompt attendance. Immediate arrival at the results finally to be achieved is, however, not to be expected ; a footnote warns us of the conditions hostile to in which we are now living, and explains that progress ’ districts which in normal times of peace might reasonably
407 to see a medical man established in their midst must be content, for the present, with the help that the board can give in the shape of additional travelling facilities for the existing practitioners. The important subsidiary topics dealt with in the other ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH. explanatory memoranda include (B) the question of nursing, the general conditions being set out under which district Urban District of Willesden.-Dr. G. F. Buchan’s annual nursing associations will be eligible to participate in grants for the year 1914 contains a variety of interesting from the Medical Service Fund ; and (C) the circumstances report information. The population of Willesden estimated atin which contributions towards hospitals and for the mid-summer 1914 was 166,634, as compared with the Census provision of ambulance services will be granted. The population 154,344 in 1911. The number of births in the needs of the Highlands and Islands are not, however, district during the year was 4115, giving a birth-rate of confined to the subsidising of medical men and nurses 24’ 7 1000 of the population. The birth-rate, which equals per to care for the sick or injured population in their of last year, remains the lowest recorded. There were; that homes, and of ambulances and hospitals so that they 1752 deaths in the district during the year, giving a deathcan be duly cared for when their homes are unsuitable. rate of 10’51 per 1000, as compared with 10 24 in 1913 and Grants have to be considered, and the Board is prepared to 9’ 8 in 1910, when the death-rate in Willesden was lowest. make them, towards the provision or improvement of housing The infant mortality rate was 82 per 1000. The number of and for men These accommodation medical nurses. grants, cases of compulsory notifiable infectious diseases was 1665, the conditions of which are set out in Pamphlet D, will be which is the highest on record, being due, in the main, toregulated in accordance with the necessity of providing or im- increased prevalence oi scarlet fever The and proving a house in order to render better the medical service type of diphtheria prevailing was more thandiphtheria. virulent, usually of a particular district in which no suitable building exists. and the fatality rate rose to 79 per 1000 cases, which is the Here the cooperation of local authorities will be invoked and recorded since 1902, when the fatality rate was 122. model plans for their guidance will be issued by the Board. highest Dr. Buchan gives a brief review of the work which has Again, the circumstances of medical practice in thinly been done by the council in past years for the improvement populated and mountainous localities and in islands off the of the health of the population, and comments on the resultsScottish coast are not favourable to the establishment of achieved. After alluding to the legal enactments relating; "specialised services," a general term applied by the Board to public health which have been passed during the lastto medical consultations, assistance at operations, and the 40 years, he states : "It would be difficult to assess theprovision of surgical appliances, dentistry, and school exact part that each of the measures passed since 1875 has. The consideration of these (E) involves the question clinics. in improving the national health, but so far as played of the provision of laboratory facilities, the object in view Willesden is concerned the broad fact is that the death-rate; being to bring the practitioner into touch with the in 1875 was 21-4 per 1000 and in 1914 10-51 per 1000. laboratories at the great medical schools, instead of In other words, if Willesden people had died at the sameleaving him to maintain a small pathological laboratory rate in 1914 as in 1875, 1814 additional deaths would have and to provide his own vaccines, if his individual been recorded. This saving of lives has a commercial and should him to enable do so. opportunities powers value. Dr. Farr in 1876, in the thirty-ninth annual report. Finally, the Board has to contemplate the devotion of a of the Registrar-General, reckoned that the mean net value= strictly limited portion of its funds to the connecting up of of each male person in the community was £150, as estithe houses of medical men and of nurses, as well as hosmated the standard of the agricultural labourer of that pitals, with central telephone call-offices and with post-offices day. by For the whole population, including females, he where suitable arrangements can be made. In Pamphlet F, the standard might be lowered to £110. It should which is devoted to the subject, will be found an interest- thought be noted that Willesden is an urban and generally educated ing official communication from the Postmaster-General community as compared with the agricultural labourer showing the lines upon which the post-office will aid in the class of 1876, and that consequently these figures. extension of telegraph and telephone facilities where the understate the value of the unit of the population volume of trade or agriculture is not sufficient by itself to when applied to Willesden in 1914. But taking the secure the desired privilege. lower figure above given it will be seen that the When we remember that the matters enumerated above of 1814 lives in 1914, as compared with 1875, have to be considered in relation to a very extensive area it saving a means saving of 199,540 during the year 1914. will be seen that the task of the Highlands and Islands I do not wish it to be thought that the diminished deathMedical Service Board is not simple. We have spoken rate is wholly the result of the activities of the council. of the law of supply and demand. The demand is there, the period of 1875-1914 the birth-rate has fallen in the sense that medical service is urgently needed by a During from 44.7to 24.7per 1000 of the population, and thisscattered and poor p pulation, but the supply has fallen diminution in the birth-rate has led to a reduction in the short because the poverty and sparsity of the population of persons living under 5 years of age when the have rendered it impossible for those who would provide proportion death-rate is highest. It should not, however, be deduced medical attendance and nursing to make a decent livelihood from this statement that a high birth-rate is incompatible by so doing. How far the sum mentioned above may suffice with a low death-rate, for under normal healthy conditions a for the purpose for which it has been voted remains to be birth-rate would mean that a large proportion of the high seen, but there can be no reason why the first experiments were living between the ages of 5 and 45, when in distributing it should not lead to satisfactory results and population death-rate is lowest. Properly speaking, therefore, ancl the why those results should not encourage Parliament to further under the best conditions of living, a high birth-rate and a generosity in so worthy a cause. low death-rate are synonymous terms, and it is a matter for consideration under what conditions they may become so. THE LATE DR. R. OF PLYMOUTH - This problem is not easy of solution, but can be simplified At the last meeting of the Plymouth borough council the by resolving it into three cardinal questions : 1. How can the mayor stated that the Misses Freeman had presented to the falling birth-rate be restored to its former level ? 2. How town the silver snuff-box presented by the corporation can the high death-rates under 5 years of age be diminished ? of Plymouth to their father, the late Dr. Freeman, in 3. How can the death-rates at ages over 5 years be still recognition of his valuable services during the cholera further diminished ? The first of these questions presents epidemic in 1832. The snuff-box has the following inscrip- considerable difficulty. An examination of Table lA of tion :"To Richard Freeman, M.D., in testimony of the Appendix A, which gives the birth-rates in each ward, shows gratitude and esteem of his fellow-townsmen for his humane that these are least in Brondesbury Park and Cricklewood’ and unceasing attention to the poor during the awful wards, and highest in Stonebridge and South Kilburn—that visitation of malignant cholera at Plymouth, A.D. 1832." is to say, the birth-rates are lowest in the best residential The mayor described the heroic services of the late Dr. areas of Willesden and highest in the poorest, and Freeman during the epidemic, when 1894 persons were generally it may be said that the lack of fertility is: The fall in the attacked with cholera, and of these 779 died. It was greatest in the most valuable stocks. decided to place the box with the museum committee for birth-rate, especially amongst the middle and upper classes, It is not wholly explained on is difficult to explain. safe custody and public exhibition.
hope
Public Health.
FREEMAN,