Mortality Statistics and Public Health.

402 interference. Indeed, in Professor SCHAUTA’S cliniea Vienna in no less than 80 per cent. of the cases of cor tracted

pelves only does

labour

occurs

spontaneously

at

full tern

labour terminate in

these cases withou surpass those obtainel by any other mode of treatment than Caesarean section Sir JOHN BYERS shares the dislike which is felt by so man: German and American obstetricians to the induction of pre mature labour in the treatment of contracted pelves. Thi gradually increasing opposition to this operation is mos curious and is opposed to the opinion held as to its merits by the London school, who practise it extensively with verJ good results, both to the mothers and the children. ThE recommendation given for the performance of pubiotomy ir cases where the child is alive and uninjured will not find much endorsement among English obstetricians, for this operation appears to have made but little headway in this Not

artificial aid, but

the

results

country. In

considering the future development of obstetrics the speaker referred to the more thorough practical training of students and pupil midwives, the public health aspect of

problem of better training for the medical man and the nurse is an important one, but not one whit less important is the training of the mothers themselves, so that the advantages of the skilled advice given by the trained practitioner and nurse may not be entirely thrown away. Much has been done in this direction of late years, but much remains to be accomplished. The large amount of assistance which

the

physician of the present, age derives from pathological laboratory is one of the

in the

the worker most strik-

Who can doubt but features of modern medicine. that many of the problems in connexion with such a disease,

ing

example, as eclampsia, will be solved ultimately by the joint cooperation of the clinician and the research worker in the laboratory ? To attempt to practise scientific medicine without the assistance of the physiological chemist or of the clinical pathologist is an impossibility, and if the for

science of obstetric medicine is to advance in the future so as to enable us to solve the many problems which still

confront us it must be of all these workers.

by

the cordial and combined efforts

obstetric medicine, and the more intimate association in the Statistics and Public future of the physiological chemist and the pathologist with Health. the practical obstetrician. The movement for the more FAMILIARITY with the history of sanitary progress in Ie practical training of students, initiated by a committee appointed by the Royal College of Physicians of London andd England during the last quarter of a century makes it e also by the General Medical Council, has made considerable impossible to doubt the beneficial effect which the publication g of mortality statistics has exercised on public health progress; and at the present time examining bodies, following the lead given them by the University of Cambridge, aree administration throughout the country. It would, indeed, beginning to move in the matter. The University of Belfastt be difficult to over-rate the influence on public health of has adopted the recommendations of the General Medical1 the 70 annual reports issued since 1837 by successive Council, and has decided to hold a clinical examination in Registrar-Generals, with the help of their medical advisers, midwifery and gynaecology. But we fear that the sug- Dr. FARR, Dr. OGLE, and Dr. TATHAM. The present time, gestions put forward by Sir JOHN BYERS as to raising when the General Register Office is passing under the the standard of general education among midwives and1control of a new Registrar-General and a new Medical his proposal to increase the duration of their training Superintendent of Statistics, seems opportune for seriously to six months or even to one year are quite imprac- considering whether, in the interests of the public health, the That a midwife should have had a surgical and! value of these annual reports could not be further increased ticable. medical training if possible we quite agree, but in view of, and their influence on sanitary progress strengthened.

Mortality

.

.

the great difficulty number of

women

which exists in

obtaining the necessary profession any attempt to upon the training is bound

to take up this

Medical officers of health and who

are

interested

in

mortality

those of statistics

the can

public scarcely

increase the expense attendant fail to regret that the main statistical units in the to meet with failure. Registrar-General’s annual reports still continue to be the necessities of an the the future are Among urgent registration districts, and the aggregations of those districts, increased knowledge of the many problems connected with called registration counties, instead of sanitary districts ante-natal pathology and an increased knowledge of the best and administrative counties as they should be. This defect The modern obstet- is due to the fact that the system for the registration of means for combating these conditions. rician, as Sir JOHN BYERS truly says, has two duties con- births and deaths was, by the Act of 1836, based upon stantly impressed upon him : he must look after the interests the Poor-law organisation, because at that time no systeof the mother, not merely in her hour of trial at childbirth, matic sanitary, organisation existed. The value of the but also before and after that event, and he must also have Registration Act, as a basis for vital statistics and for a thorough acquaintance with the best means of preserving promoting public health, was, indeed, scarcely recognised the life and promoting the growth and welfare of the new- by its promoters, and even the provision of a column born infant. If the ideal of a healthy mother and a healthyin the Death Register for recording the cause of death child is to be realised, then more and more among the people was an afterthought. The Act provided that each Poormust be spread the knowledge of motherhood. Much of the law union should be divided into registration sub-districts a that a registrar of births and deaths should be apheavy infant mortality which to-day prevails in all our largeand cities is due to the entire absence among the mothers of the pointed for each sub-district. Since 1837 every change most of the even of i in is the of a what Poor-law union has necessitated a poor elementary knowledge boundary required for the proper rearing of healthy children. The (corresponding change in the registration district, and

403

registration county. Thus in the reports by the preparation and publication of statistics for earlier annual reports of the Registrar-General the vital administrative counties, and for so many of the larger statistics necessarily dealt almost exclusively with Poor-law sanitary districts as may from time to time be found areas. Since the creation of sanitary districts and of adminis- desirable.

frequently

°

also in the

trative counties, which are but seldom co-extensive with registration districts and registration counties, a desire has naturally arisen for official statistics relating to adminisIt cannot be denied that the omission of trative areas. such statistics detracts from the practical value of these annual reports, since the local influence of official mortality

statistics for the promotion of public health is

"Secret" Remedies. WE

published recently1

a valuable letter from Mr. G. P.

foRRrusTER upon the restriction of unqualified practice and the sale of secret remedies in Germany. This week a somewhat similar letter has reached

us from a correspondent in and the two communications may well serve both to call attention to the character of the traffic in ″ secret" remedies as it is carried on in Germany and in Sweden,

inappreciable Sweden,

unless the statistics relate to the exact boundaries of the

It is, moreover, impossible several administrative areas. to overlook the importance of authoritative statistics and also to the efforts which are being made in those for administrative areas to the Medical Department of countries, either by public authorities or by professional the Local Government Board, which department, it may bodies, to diminish the evils which this traffic brings in its be hoped, will one day form part of an independent train. The tendency to purchase quack medicines, and to ministry of public health. It is true that the weekly believe in the representations of quacks, has existed from and quarterly returns of the Registrar-General, and his time immemorial, and was satirised by GOLDSMITH, 150 years annual summary, contain valuable, although somewhat ago, in terms which would require little alteration in order rudimentary, statistics relating to 76 of the largest English to render them equally applicable to the conditions of the towns, directly derived from returns furnished by the local were it not for the increased facilities for present day, registrars of those towns. The annual reports, however, advertising which have been created by modern conditions, contain no particulars of ages and causes of death in and for the somewhat increased deference now paid to financial sanitary administrative areas (except in London), although prosperity, without reference to the manner in which it has these statistics-would be infinitely more useful than the been attained. GOLDSMITH’S Chinese philosopher regarded statistics now prepared for registration districts and counties it as marvellous that, although there was no disease which This defect applies in which no one is really interested. was not curable by a specific which could be bought for halfequally to the decennial supplements to the annual reports, a-crown, there were still people who thought it proper to be the value of which would undoubtedly be increased by the ill or even to die ; and he also wondered that so many of the substitution of tables relating to sanitary areas and adminismost highly gifted of the quacks of the time had remained trative counties for those relating to registration districts and unconscious of their powers of healing until a bankruptcy or counties, which in Dr. TATHAM’S last Decennial Supple- a residence in jail had called those powers into exertion. ment, for the years 1891-1900, occupied more than 700 pages. In the present day theproprietors"of quack medicines The sex, ages, and causes of death have been invariably drive about in carriages, are permitted to mix with decent classified at the General Register Office for each registration people, and endow charities when they die ; but the essential But the best interests of sanitary district separately. nature of the creature remains unchanged. He is still a progress would seem to require that future reports of the useless and dangerous parasite upon the body politic ; he Registrar-General should contain additional mortality tables robs the sick poor of sums of money which in the aggregate relating to a certain number of the larger towns, which are enormous and which in detail are often obtained for him tables might be somewhat similar in character to those at the cost of much privation ; his preparations, comrelating to registration districts in the last Decennial only posed of the most familiar drugs and sold at 50 times their Supplement. are often (as in the case of many drastic purgatives) We are informed that in certain instances the regis- value, to those who make a practice of swallowtration districts are already co-extensive with urban absolutely injurious ing them ; and are still more often negatively injurious by sanitary districts, and that the separate classification of with proper treatment. A familiar example of small numbers of deaths in cases where portions of a interfering this is furnished by the preparations which, under various sanitary area are situated in two registration districts are sold for the cure of ° ° blotches " and other affecwould not involve serious additional labour, whilst it names, tions of the skin, and which generally owe a totally decepwould add materially to the utility of the results. tive efficacy to iodide of potassium. They frequently do If tabulated statistics relating to all towns that are now for which ’’ cure " the condition they are adminisco-extensive with one or more registration areas were at once apparently and they leave thecured"" person to infect wife added to the annual reports, the separate classification of tered ; and children with syphilis, or possibly to die himself from parts of registration areas that would render statistics availAnother difference between some of its tertiary forms. able for other towns could be added from time to time. In GOLDSMITH’S quack and our own is that the former was anticipation of probably far-reaching changes in Poor-law often ignorant of the mischief he was likely to be instruorganisation in the near future, which may facilitate the mental in effecting; while in the present day the putting up substitution of sanitary districts for the present registration of a "secret " remedy in a permanent and attractive form

districts,

it

seems

not

to increase the value

only

desirable but

of the

quite practicable, Registrar-General’s annual

1

THE

LANCET, July 17th, p. 183.