527LORD LISTER’S FUNERAL.

why a considerable proportion of this should not go to themedical profession.

Maternity bcnefit.-In estimating remuneration on a capita-tion basis per insured person, some part of the paymentfrom maternity benefit should be excluded, since it will be

paid in many cases in respect of persons outside the

13,000,000. The Chancellor of the Exchequer estimatedthat .8500,000 would go to the medical profession from thissource, but the grounds for this opinion were not stated. Iffees are raised very much, societies may encourage theirmembers to obtain the services of midwives rather thandoctors. The profession should, however, secure a sub-stantial increase in the fees paid for attendance upon cases

Ito which they have been summoned under the Midwives Actof 1902.

_______________

LORD LISTER’S FUNERAL.

ON Friday last, Feb. 16th, the body of the late LordLister, the greatest Englishman of his century, the mastersurgeon, was buried at Hampstead Cemetery near that of hispredeceased wife. So much his country, which would fainhave done him the highest honour that lay in its power byburial in the national Pantheon, was constrained to yieldto his own personal wishes. But it claimed at least the pre-rogative of first paying final homage by a solemn memorialservice in the historic great Abbey of Westminster. ForLister was a maker of history, not for England only, butfor the human race. No personal skill as a surgeon, howevergreat, could have gained for him the homage and gratitude ofthe entire world. It was the keen observation, the years ofpatient questioning of Nature’s ways, the illuminatinginsight, the patient demonstration that finally enabled him tolay a firm foundation for the surgical art-never to be super-seded no matter what developments in superstructure it maybe called on to sustain-that called forth the splendid tributeof reverence to the remains of Lord Lister from rulers andnations, from the scientists and savants of the earth, andfrom representatives of every rank and class in life among hisown countrymen.

Before 1 P.M. the lantern and choir of Westminster Abbeywere filled with official representatives, and a goodly portionof the general public occupied the north transept and aisleand the nave. The King was represented by Sir FrederickTreves, Queen Alexandra by Sir Francis Laking, and PrincessLouise (Duchess of Argyll) by Mr. Oswald Balfour. ThePrime Minister in person offered the tribute of the nationat large. Austria-Hungary, France, Germany, Italy, andRussia sent their Ambassadors ; Belgium, Denmark, Greece,Sweden, Norway, and Portugal their Ministers ; the ChineseMinister was represented by Dr. Wu Lien-Teh ; and Serviaby its Charge d’Affaires. The Government was representedthrough the Medical Departments of the Local Government iBoard and the Board of Education, the Army and NavyMedical Services, and the West African Medical Staff.representatives of scientific bodies, foreign as well as

British, were present; the Swedish Academy of Science, theNorwegian Society of Science, the Madrid Academy ofMedicine, the Accademia dei Lincei of Rome, the ImperialAcademy of Sciences of St. Petersburg, the British Academy,the Royal Institution, the British Science Guild, the R)yalInstitute of Public Health, the Hunterian, Royal Micro-

scopical, and Zoological Societies, and Kew Gardens, in addi-tion to those enumerated below which sent special delegatesto the procession. The Royal Colleges of Surgeons and ofPhysicians of the three kingdoms and the Society of

Apothecaries were represented, as was every University inGreat Britain and Ireland, the medical societies, the Edin-burgh and Glasgow University Clubs, the Merchant Taylors’Company, Epsom College, University College of SouthWales, the constituent colleges of the University of London,the Norfolk and Norwich Hospital, and the general andspecial hospitals and medical schools of London, Oxford,Edinburgh, and Glasgow.The scene in the Abbey during the interval of waiting was

truly impressive. A spirit of reverence dwells within thoselofty grey walls, and in very truth it hovered over the entirecongregation there gathered together. The silence was pro-found. Notwithstanding a continuous stream of newcomers’hardly a sound could be heard, and the demeanour of all wasgrave. Presently Parcell’s exquisite music, composed for the

funeral of Queen Mary in 1694, broke in upon the silencefrom the organ. Tnis was followed by Cnopin’s "MarcheFunebre," and finally trombones, stationed high up in thetriforium, played the Tres Equali of Beethoven. Thencame, faintly at first, the voices of the choir singing thehymn "Brief life is here our portion," as the coffin wasborne from the Chapel of St. Faith, where it had rested duringthe previous night, to a high bier at the foot of the altar rails,surrounded by six burning candles. In the front of the

procession came the clergy, with the Dean of Westminster,Bishop Ryle, at their head. A magnificent wreath of orchidsand lilies, sent by the German Emperor, and deposited onthe coffin by the German Ambassador while it’ lay inSt. Faith’s Chapel, was carried in front of the coffin.Splendid wreaths were also displayed at the altar rails fromthe Institut Pasteur of Paris, the Congress of GermanSurgeons, and the Medical Society of Amsterdam. Thecoffin was covered with a purple pall, and on it were laidLord Lister’s three most distinguished orders-the Orderof Merit, the Prussian Order Pour le M(3fito. and theGrand Cross of the Order of the Danebrog. The pall-bearers, in their various official robes, escorted the body.They were Lord Rayleigh, O.M., representing the Order ofMerit; Lord Rosebery, for the University of London ; LordIveagh, for the Lister Institute; Sir Archibald Geikie,President of the Royal Society ; Sir Donald MacAlister,Principal of Glasgow University ; Sir Watson Cheyne, Bart.,for King’s College, London; Mr. Rickman J. Godlee, Presi-dent of the Royal College of Surgeons of England ; andProfessor F. M. Caird, for Edinburgh University. Imme-

diately following were the principal mourners, consistingof Mrs. Lister, Mr. and Mrs. J. J. Lister, Dr. A. H.Lister, Mr. and Mrs. W. T. Lister, Miss Lister, MissE. M. Lister, Miss G. Lister, Dr. and Mrs. A. G.Phear, Mrs. R. J. Godlee, Mr. and Mrs. J. Lister Godlee,Mr. and Mrs. A Godlee, Mr. F. Godlee, General Burn, Mr.T. Godlee, Miss Godlee, Mr. J. Harold Pim, Mrs. Goodbody,Miss Pim, Miss C. Pim, Mr. A. Lister Harrison, the RightHon. J. W. Wilson, Mr. and Mrs. Alhright, Mr. and Mrs.C T. Barclay, and Mr. Ernest Beck. The Lord Mayor ofLondon (Sir Thomas Crosby, M.D.) and the Lord Provost ofEdinburgh came next, and were followed by the official

delegates from various scientific and learned societies. TheFrench Academy of Science sent its President (ProfessorLippmann), and also Professor Chauveau and Professor Dastre;the Institut Pasteur of Paris sent Professor Roux; the FrenchAcademy of Medicine, Professor Pozzi; the German Congressof Surgeons its President (Professor Garr6) ; the Société deChirurgie de Paris, Sir Victor Horsley ; and the MedicalSociety of Amsterdam, Professor Treub. The Royal Societyof London sent its treasurer, Sir Alfred Kempe ; its secre-taries, Sir Joseph Larmor, M.P., and Sir John Rose Bradford;and its foreign secretary, Sir William Crookes, O.M. ; whilethe Royal Society of Edinburgh sent Sir James Dewar. TheRoyal College of Physicians of London sent its President,Sir Thomas Barlow, Bart.; its Senior Censor, Dr. J. Mitchell

Bruce ; its Registrar, Dr. J. A. Ormerod ; and Sir RichardDouglas Powell, Bart. The Royal College of Surgeons ofEngland sent its Vice-Presidents, Mr. C. W. Mansell Moullinand Mr. C. T. Dent ; that of Edinburgh, its President, Mr.G. T. Berry; and that of Ireland, its President, Mr. R. H.Woods. The delegates from the University of London wereSir Edward Busk (chairman of Convocation), Sir H. Miers(Principal), and Sir Philip Magnus, M.P. ; from the Universityof Edinburgh, Professor Alexis Thomson; and from theUniversity of Glasgow, the Lord Rector, Mr. Birrell. Otherdelegates were Sir Henry Morris, President of the RoyalSociety of Medicine ; Mr. Edmund Owen, for the BritishMedical Association ; Sir William Ramsay, President of theBritish Association; the Bishop of Exeter, Principal theRev. A. C. Headlam, D.D., and Professor J. M. Thomson,F.R S., for King’s College, London; Sir David Ferrier andDr. Nestor Tirard for King’s College Hospital. UniversityCollege sent its Provost, Dr. Gregory Foster ; and UniversityCollege Hospital Medical School its Dean, Mr. RaymondJohnson.

The service was brief but impressive. After the NinetiethPsalm, .DoMt, Refugitl1n Nost-ritni, had been chanted by thechoir to Purcell’s music, and the lesson from I. Corinthians,xv., had been read by the Dean, the choir sang Handel’sWhen the ear heard Him," the concluding sentence ofwhich-" His body is buried in peace, but his name liveth

528 OFFIC(AL MANUAL OF CAUSES OF DEATH.

evermore "-was splendidly appropriate. Goss’s anthem,11 I heard a voice," followed, and after the prayers had beenrecited by the Precentor, and the hymn, "0 God, our helpin ages past," had been sung by the congregation, theprocession was reformed and the body borne on the way toits final resting place to the solemn roll of the Dead Marchin I Saul."To the onlooker, perhaps, the most significant characteristic

of the assembled congregation was the spirit of reverencethat seemed to permeate all present. In a mixed assemblageof all religious creeds, containing many, perhaps, owning nocreed, official attendance on an important function is commonlysatisfied with the preservation of due decorum. In the presentinstance, however, there was more than that visible in thedemeanour of everyone. To those of the Church of England theever beautiful service spoke its accustomed words of hope,but in a voice of unusual sweetness. Those of other faiths,doubtless, translated its significance into terms of their own.But all at least were alike impressed with that view of

immortality which sees the survival of personality in the

enduring work of one who devotes his life to furthering thewelfare of the human race ; and this was particularly evidentin the case of him who established the relief of human

suffering on an everlasting basis.

OFFICIAL MANUAL OF CAUSES OFDEATH.

IN his Supplement to the Fortieth Annual Report of theLocal Government Board, already noticed in these columns, 1Dr. A. Newsholme foreshadows the removal of some of thedefects in our national vital statistics that detract from theirusefulness for purposes of sanitary administration.

Sanitary and Registration Districts.Owing to lack of correspondence between the areas dealt

with by the Local Government Board and the NationalRegister Office respectively, comparison among the vitalstatistics of these areas has hitherto been impracticable.These defects will shortly disappear, for the Registrar-Generalhas undertaken to substitute sanitary districts for registrationor Poor-law districts as the areas for which returns of birthand death will be published from the year 1911 onwards.

Moreover, as the cooperation of the Central StatisticalOffice may presumably be relied on for the calculation oflocal rates of mortality, we doubt not that in such event thecounty as well as the district medical officers everywherewill be glad to be relieved of that irksome part of their duty,so that more time may be available for the discharge of theirdefinitely preventive functions.The medical officer of the Local Government Board further

states that the Registrar-General has undertaken to issue toevery medical officer of health a " Manual of Causes ofDeath " which will contain the new standard tables, and willdefine the contents proper to the various items in the list,showing how each form of death certificate should beclassified.

Nature and Objeot of Man1bul.In fulfilment of this undertaking the present manual has

been issued by authority of the Registrar-General. The work ,,

has been compiled by Dr. T. H. C. Stevenson, the super-intendent of statistics, Mr. Bernard Mallet’s contributionthereto being limited to a brief minute officially submittingthe document to his parliamentary chief. A work on similarlines but more comprehensive in scope has recently beenpublished by Dr. Cressy Wilbur, chief statistician to theUnited States Census Bureau. It is upon this work, a copyof which lies before us, that the English manual is avowedlybased, although in preparing the latter many exclusivelyAmerican expressions have been omitted, whilst numerousterms have been added which are in common use here butnot in the United States.

In projecting the present work it has been the compiler’sendeavour to secure the nearest approach to uniformity oftabulation of facts throughout the United Kingdom. Forreasons given in the introduction the form of the Scottishand Irish list of causes will not be identical with that of the

English list, though the differences will be slight. But in

1 THE LANCET, Nov. 25th, 1911, p. 1501.

England and Wales complete uniformity will be obtained bythe adoption of the standard list at Somerset House andWhitehall respectively, and the use of the same list willdoubtless be required in the reports of all medical officers ofhealth. This standard list is already published, and will becirculated with the manual itself among medical officers ofhealth generally. Included in the manual will be foundrevised suggestions to medical practitioners in filling up theirdeath certificates. We presume that a copy of these sug-gestions will be sent to every medical practitioner on theRegister, and it would certainly be desirable that this shouldbe accompanied by a copy of the manual itself.

Classifioation of Causes ot Death.In Dr. Stevenson’s judgment the only classification of

diseases that is essential in a standard list is that it shouldsecure the correct assignment of a given cause to one orother of the included titles. The order of titles in the listhe regards as of less importance, inasmuch as that orderadmits of alteration according to individual requirements,whereas the user has no means of modifying the grouping ofdeath causes under titles.

Readers of the earlier reports of the Registrar-Generalwill be aware that the order of causes originally adoptedby Dr. Farr about the middle of last century was basedon anatomical rather than on etiological considerations.On this point, however, it seems reasonable to conjecturethat Farr’s preference may have been determined by theprimitive and unsettled state of etiological knowledge atthe time. In any event, the author of the present manualhas decided to revert to Farr’s practice, and he does so onthe ground of the greater convenience to statistical studentsthat he believes to attach to a regional as compared with acausal arrangement. Whether this decision is the wisestin the circumstances experience alone can determine.Meanwhile it is due to Dr. Stevenson to note his acknow-ledgment that " the grouping of causes of death is a subjectin regard to which there is room for differences of opinion ;and, further, that the individual points which require con-sideration in preparing such a manual as this are so numerousand in some cases so complicated that it will not be sur-

prising if critical use of the work reveals a number of defectsin regard to detail, whether the general principles followedprove acceptable or no."

Cr-itwis1n of Nerv Depa’J’tllre.In justification of the action of the Registrar-General’s

predecessor, who in the year 1901 revised the official list ofdeath causes, it may be pointed out that in so doing hesimply followed the example of the Royal College of Phy-sicians of London in the decennial revision of the nomencla-ture then in course of preparation. On account of theadmittedly infective nature of certain diseases, such as

pneumonia, cerebro-spinal fever, epidemic diarrhoea, &c., the

College deliberately transferred them to the class of I I generaldiseases " from their original places among purely localaffections. If the College in its approaching fourth decennialrevision, pursues the same course respecting several of theso-called " local " diseases, we shall be in nowise surprised.Among adverse criticisms of the new departure may be

noted one by Sir John W. Moore, of Dublin, the eminentsanitarian and ex-President of the Irish College of Physicianswho in a letter to us severely condemns the changesinitiated recently in the Registrar- General’s mortality returns.The gravamen of his charge is that the transference tomerely local affections of such unquestioned acute infectionsas cerebro-spinal fever, pneumonia, epidemic diarrhcea, andpuerperal fever from their rightful position under the headingepidemic diseases places a formidable block in the path ofsanitary reformers and medical officers of health. The handsof the State-medicine clock are being put back a quarter ofa century at least-to pre-notification days. Writing as aresident in Ireland, Sir John Moore regards with concern amodification in the list of causes of death which will probablydelay the inclusion under the Notification Act of such death-dealing yet preventable maladies as pneumonic fever andepidemic diarrhoea.

Continuity with Past National Reoords.Dr. Stevenson assures us that the difficulty of arranging

for the continuity of official records has been almost entirelyovercome by subdividing some of the titles in the new

2 THE LANCET, Jan. 21st, 1911, p. 189.