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one qualification may be appointed whether such qualifica-tion be medical or surgical.

It is now some years since a systematic effort was madeto obtain a special qualification in State Medicine. Manyyears ago a committee was appointed by the General MedicalCouncil to collect evidence upon this matter, and suggestionswere invited from most of the known authorities at thattime interested in sanitary work-medical, scientific, andlegal. No practical result appears to have followed this in-quiry, if we except the publication of a report in whichthe opinions of the various authorities were chronicled.Since that time, however, most of the universities andlicensing bodies have recognised the fact that the workof a medical officer of health requires special knowledge,and more particularly an intimate acquaintance withchemistry, physics, meteorology, &c. A medical studenthas no opportunity afforded him of obtaining this specialknowledge, even if he had the time, this latter being rightlytaken up in preparation for the examinations which testifyto his knowledge, not only of the anatomy and physiologyof the body, but an acquaintance with those principles whichshould guide his action in the adoption of remedial measuresin the great departments of medicine, surgery, and mid-wifery ; in a word, his training is in the direction of curativemedicine, using that term in its most comprehensive sense.The training required to efficiently fill any position as health,officer in the department of State Medicine is something more ;it is wholly in the direction of what has been aptly called"preventive medicine." The former training is of course.absolutely essential to enable any man to rightly appreciatethe details of the second. But what I want to insist uponis that, because a man possesses qualifications in eithermedicine or surgery, or both, it does not necessarily follow6e is in possession of that knowledge which is more espe-cially required of a medical officer of health. It is there-fore a great gain to public health work that our medicalcorporation now grant diplomas in Public Health, and,further that the State has recognised these qualifica-tions by according to them registration in the MedicalRegister under the 21st section of the Medical Act of 1886,.and this mainly through the action, and certainly uponthe initiation, of the Public Health Medical Society,membership of which is confined to medical men pos-sessing such diplomas. Two further steps, however,require to be taken: first, that the possession of sucha diploma should be rendered compulsory upon all medi-cal officers of health; and, secondly, that there shouldbe some uniformity in the requirements of the variouslicensing bodies. As regards the first point, I have reasonsfor hoping that a clause will be inserted in the LocalGovernment Bill rendering it compulsory for all appointedto office as medical officers of health on and after a certaindate to possess such a diploma. And in reference to thesecond, I know that recently the necessity for agree-ment upon the minimum requirements for public healthdiplomas has been brought before the General MedicalCouncil, and that the opinions of the examining bodies havebeen invited thereon. To my mind one stipulation shouldmost certainly be exacted, and that is that no candidateshould be admitted to the final examination for the diplomauntil an interval had elapsed of, say, three years fromthe date of his obtaining his ordinary medical qualifica-cation; the syllabus of subjects for the examinationappears to be generally agreed upon, but upon this otherpoint there is at present no such agreement. I distinctlyassert that no medical student can get that practicalacquaintance with the subjects generally embraced in thesecond part of the examination during his student career,and indeed his time is, or should be, wholly taken up inpreparation for the ordinary medical examinations.A diploma in Public Health is a qualification of great value;

it will probably be the means by which the most importantappointments in civil medical life can be obtained; whilstwe know the possession of such a qualification is alreadyrecognised by the War Office authorities, and exemptionaccorded to officers possessing it in the subject of Hygiene,which is required for the promotion examination. Therefore,such a diploma should not be lightly granted; the posses-sion of it stamps the possessor as a specialist, as havinga more than ordinary acquaintance with the subjects em-braced, an ordinary acquaintance with the laws of healthbeing now generally required in the Forensic Medicineexamination for most medical qualifications. The variousmedical bodies would never dream of giving a man a special

degree in medicine, surgery, or obstetrics at the end of hispupilage, such degree or diploma testifying to the person’sspecial knowledge in contradistinction to an ordinary know-ledge of these subjects. Then why should they do so in theDepartment of Public Health ? The special medical orsurgical qualifications obtainable are the M.D. degree of aBritish university, or the Membership of the College ofPhysicians, and the Fellowship of the College of Surgeons.In each case the candidate must for some years have been inpossession of the minor qualification; and to my mind thissubject is unfairly dealt with unless the principle be ex-tended generally to Public Health diplomas, as is alreadydone by some bodies, notably the University of Cambridgeand the Conjoint Board of the London Colleges, whohave tried to meet the case by imposing an agerestriction. It is on the face of it manifestly unfairthat any university or corporation should grant its diplomain this department upon easier terms, examination or other-wise, than its neighbours, an injustice alike being done tothose medical men who have obtained the qualificationunder greater restrictions and those bodies granting such;for be it remembered that, in the event of the possession ofsuch a diploma being rendered compulsory upon any personaspiring to obtain a medical officership of health, all candi-dates having such would be eligible to compete. What isreally wanted is an agreement amongst the various licensingbodies, not only as to the minimum requirements of theexamination test, but also to those general restrictionswhich ought fairly to be imposed. I trust that the GeneralMedical Council, to whom is entrusted the important dutyof approving the regulations &c. of the examining boards,will in their ensuing session carefully consider the subject.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Barnsley Urban District.-Dr. Sadler reminds his autho-rity that whereas in 1887 the average death-rate from

zymotic diseases in England and Wales was 2’29 per 1000,the same rate reached 4’09 in Barnsley. Of the deaths

making up this rate, 57 were from scarlatina; no less than278 scarlatina deaths having taken place 4uring the pastfour years. Of 376 cases of this disease which, under a

voluntary notification system, were heard of in 1887, twoonly are referred to as having been removed to the boroughfever hospital, and in the face of this the other efforts tostay the spread of the infection largely failed. In view ofsmall-pox in Sheffield and elsewhere the isolation hospitalhas been enlarged and two adjoining districts have acquireda right to utilise it. The buildings are, however, onlyadapted to receive one disease, and new accommodation issuggested as probably about to be made. A good deal ofcurrent work is in progress, and Dr. Sadler urges action inconnexion with the disposal of excrement and refuse, which,under the present system, must be credited with an im-portant influence on the diarrhoea death-rate. The generaldeath-rate for the year was 22’6 per 1000.Merthyr Tydfil Urban District.-Mr. Dyke records the

death-rate for this district during 1887 as 21’7"per 1000, arate less by 2’8 than the average of the twenty years from1866 to 1885; and, referring to the fatality from diarrboealdiseases, he says that it will, as in previous years, be foundthat the proportionate death-rate from this malady wasabout the least in any town population. Details of thesanitary circumstances of the several divisions are enteredinto; and as regards the town as a whole, it is stated thatthe water supply has throughout been of excellent quality,that nuisance removal has been efficiently carried out, andthat the areas of land set apart for filtration of sewage con-tinue to act perfectly. And, summarising the results ofsanitary progress in the past, Mr. Dyke says that he canunanswerably assert that the work done since the establish-ment of the local board in 1850 has conduced to the betterhealth, better housing, and longer life of the inhabitants ofthe district.

Belper Bural District.-Dr. Allen, in his fifteenth annualreport, reminds his authority that although they have

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recently seen neighbouring sanitary authorities almostparalysed in their action, owing to the absence of means forisolating infectious disease, yet they themselves remain inthis respect as unprepared as ever; and he again presses themnot to trust to action taken on an emergency, when thingsbeing done in a hurry are not done well. Amongst thelocalities where special sanitary work is needed, Denby andits deficient water supply, Holbrook and its bad drainage,and South Wingfield (which is injuriously affected byreason of the Alfreton urban sewage, which enters thebrook unpurified), may be referred to. The general death-rate for 1887 stood at 13 per 1000.Blackpool Urban District.--During the past year the

death-rate for Blackpool was 16 per 1000. a lower rate thanany on record; but, allowing for visitors, the corrected ratewas 14 only. The water supply for the district, althoughsufficient and wholesome, is subject to turbidity, which,renders necessary the use of domestic filtration-a practicewhich should not be imposed on people. Domestic filters,unless very carefully looked after, are apt to retain matterwhich certainly does no good to water subsequently passingthrough them, and Dr. Welch is right in urging that theneeded filtration should be carried out at the reservoirs, andalso that the mains should periodically be flushed out.A good deal of sewerage work is still in progress. Thebuilding bye-laws are better enforced than heretofore, andimprovements have been effected as to scavenging. Amongstthe practical difficulties met with in connexion with thecompulsory notification of infectious diseases, there remainsthe long-standing grievance of a defective and ill-placedinfectious hospital. This is a defect which, in a place likeBlackpool, should no longer be allowed to interfere withefficient sanitary administration. The dual system ofnotification is favourably reported on. ,

St. Asaph Rural District.-In this rural district Dr. Lloyd- ’,Roberts has a reduced death-rate of 16 per 1000 to record,but this is not low for such a district. A satisfactory reduc-tion in uncertified deaths is attributed to an increasing careof children and use of reasonable means to prolong life. Nonew works were undertaken or projected during the pastyear, and as regards certain specified work as to watersupply and drainage, which are much needed, the actiontaken is as yet limited to mere discussions. Should this ’,attitude be long maintained, it is evident, from the detailsrecorded, that conditions which must seriously endangerhealth and cause nuisance will be brought about. One thingis very certain, and that is that the authority cannot com-plain that the need for action has not been sufficientlybrought before them, for Dr. Lloyd-Roberts indicates veryclearly the more pressing wants of the district.

Scarborough Urban District.-Of 932 births during 1887there were 72 illegitimate, and of this number no less than34 died, a circumstance which leads Dr. Taylor to expressthe opinion that in his district the Infant Life ProtectionAct is almost a dead letter; he adds that he knows of nomeans by which this great mortality can be checked. Ofzymotic diseases the past year exhibited the lowest returnmade for fifteen years, a result which, following as itdoes on a still lower result in 1885, is alleged to be due tosteady improvement in the sanitary condition of the dis-trict. Dr. Taylor speaks well of the assistance which isgiven by a voluntary system of notification, but he urgesvery strongly the need for a compulsory system under whichall cases of infectious disease would be heard of. Thegeneral death-rate for the year was 16’6 per 1000, as opposedto a mean of 18 2 during the past fifteen years, and theso-called zymotic rate was only 0’8 per 1000.Ormesby 7r&Q!MjDMK.—Considerable difficulty is appre-

hended in this district, owing to the circumstance that anarrangement for the reception of infectious cases into theMiddlesbrough urban hospital has been discontinued ; andDr. Knott takes the opportunity of warning his authorityagainst the policy of attempting to save a little money inthe face of the risk they thus incur. As he very properlysays, it may cost .E20 to secure the isolation of a single caseof infectious disease, but that expenditure prevents the

closing of small shops, the crippling of many households,and a needless increase in the rate of sickness and death frompreventable causes. Back streets badly need paving in

Ormesby, and sanction has been obtained to a loan for thepurpose ; but action in this direction seems for some reasonto be poqtponed. The general death-rate for the districtduring 1887 was 16-9 per 1000, and that from the so-calledzymotic group 28 per 1000, Amongst infants under one

year of age the mortality amounted to a rate of 15 6 percent,of the registered births.

Willesden Urban District.-Assuming Dr. Branthwaite’sestimate of a population of 49,080 to be correct, the death-rate for 1887 was 14’3 per 1000, the lowest on record.During the year the compulsory notification of infectiousdiseases was secured under a local act, and so far the systemworks well ; but the need for proper local hospital accom-modation is more keenly felt than ever, and it is notcreditable to Willesden that so great a defect shouldany longer attach to the district. Amongst the causes ofenteric fever the direct communication of rain pipes withthe sewers is referred to-an arrangement that exists some-what widely in this country, and which very generally callsfor remedy, since the plan largely tends to deliver foul airin at bedroom windows. The amount of death amongstinfants, which was last year referred to, is not so grave amatter on this occasion. Action has been successfully takenunder the Infant Protection Act, and Dr. Branthwaite hopesto still further diminish the decreasing mortality.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5834 birthsand 3367 deaths were registered during the week endingMay 5th. The annual rate of mortality in these towns,,which had been 219, 19-9, and 18’9 per 1000 in the pre-ceding three weeks, further declined last week to 187, andwas lower than in any week since the middle of October last.During the first five weeks of the current quarter the death-rate in these towns averaged 19’9 per 1000, and was 2’5 belowthe mean rate in the corresponding periods of the tenyears 1878-87. The lowest rates in these towns lastweek were 12’7 in Portsmouth, 151 in Birkenhead, 15’8in Sunderland, and 16’0 in Nottingham. The rates in theother towns ranged upwards to 26’3 in Preston, 276 inManchester, and 28’1 in Salford. The deaths referred tothe principal zymotic diseases, which had been 364 and 328in the previous two weeks, were last week 329; theyincluded 146 from whooping-cough, 45 from scarlet fever.38 from diarrhoea, 32 from "fever" (principally enteric), 31from diphtheria, 25 from measles, and 12 from small-pox.No death from any of these zymotic diseases was

registered last week in Portsmouth or in Plymouth,whereas they caused the highest death-rates in Blackburn and Salford. The greatest mortality from whooping-cough occurred in Norwich, Blackburn, London, Manchesterand Salford ; from scarlet feverin Salford and Blackburn; from.measles in Bristol, Bradford, Preston, and Nottingham; andfrom "fever" in Manchester and Salford. The 31 deaths,from diphtheria included 15 in London, 2 in Brighton, 2 imBristol, 2 in Liverpool, 3 in Manchester, and 2 in Sheffield.Small-pox caused 8 deaths in Sheffield, 2 in Bristol, Iin Oldham, and 1 in Hull, but not one in any of thetwenty-three other large provincial towns or in Lon-don. The Metropolitan Asylum Hospitals contained its

small-pox patients at the end of last week, against21 on each of the preceding two Saturdays; the-Highgate Small-pox Hospital contained 2 patients atthe end of the week. The number of scarlet fever patientsin the Metropolitan Asylum Hospitals and in the LondonFever Hospital was 990 on Saturday last, against numbers’declining steadily in the preceding twenty-two weeks from2764 to 1047 ; the 77 cases admitted to these hospitalsduring the week showed a further decline of 12 from thenumbers in the previous two weeks. The deaths referredto diseases of the respiratory organs in London, whichhad been 444, 363, and 343 in the preceding three weeks,.further declined last week to 287, and were 70 below thecorrected average. The causes of 66, or 2’0 per cent., of’the deaths in the twenty-eight towns last week were notcertified either by a registered medical practitioner or by acoroner. All the causes of death were duly certified inNewcastle-upon-Tyne, Sunderland, Leicester, Portsmouth,Oldham, and in three other smaller towns; the largest pro-portions of uncertified deathll were registered in Bradford,Halifax, Cardiff, and Blackburn.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 21-3 and 21’0 per 1000 in the preceding