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On the motion of the Ministries of Finance, Labour,and the Interior, a census of the French populationhas been fixed for March 7th, 1926.A regional anti-cancer centre has just been installed

and opened at Rheims. The centre will promoteactive educational propaganda on the prevention andtreatment of cancer.The new legislation defining the rights of occupants

and proprietors of houses cannot come into forceuntil April 1st, 1926. After that date occupantsmust meet the advanced rents or vacate.

Prof. Widal’s clinic at the Hopital Cochin openedon Dec. 15th. Clinical lectures are given daily at9 A.M.; lectures in the amphitheatre every Tuesdayat 11 A.M.At the Sorbonne, Dr. Sicard de Plauzolles is giving

free public instruction on syphilis, gonorrhoea, tuber-culosis, and other social diseases ; on Tuesdays inthe Milne-Edwards amphitheatre, and on Saturdays inthe amphitheatre Edgar Quinet. The time is 5.30 P.M.These conferences are under the auspices of theNational Office of Social Hygiene.

UNITED STATES OF AMERICA.

(FROM AN OCCASIONAL CORRESPONDENT.)

The Doctor and the Changing Order.THE President of the Rockefeller Foundation,

Dr. George E. Vincent, spoke on the above themerecently to the New York Academy of Medicine.A chiefly urban, minutely specialised, and highlyinterdependent industrial, commercial, and socialsystem confronts the modern doctor, he said, withnew problems. His former individualistic neighbours,the merchant, banker, manufacturer, even lawyer andteacher, have been drawn into organisations and havelargely lost their independence as self-sufficing units.Must the doctor, who can now master only a part ofthe vast total of medical knowledge and skill, followin their footsteps ? It is recognised that effectivemedical care demands insistently an individualrelationship between doctor and patient. There isthus created a conflict between the social need forteam-work on the one hand and the demand forhuman insight and sympathy on the other. In seekinga solution Dr. Vincent reviewed the voluntary healthinsurance schemes of Denmark and Norway and thecompulsory insurance in Germany and Great Britain,concluding that " the medical care is probably on thewhole inadequate and certainly unorganised." Onlyin university clinics, in well-developed hospitals,dispensaries, and pay clinics, in true group practice,and in health centres is there to be found genuinelyorganised medicine. But these organisations, too,are subject to criticism. Are they not mechanisingmedicine, eliminating the personal relation ? Perhaps,replies Dr. Vincent, but it is clear in any case that theold order is changing. It looks as if society meansto insist upon a more efficient organisation of medicalservice for all groups of people, upon distribution ofthe costs of sickness over large numbers of familiesand individuals, and upon making prevention ofdisease a controlling purpose.

Alcoholism in 1925.

The very impartial report on prohibition recentlyissued by the Federal Council of Churches was in itselfso inconclusive as to the final outcome of the presentlegislation that the Council has found it necessary toissue a special announcement of its unchanged advocacyof prohibition and law enforcement. The figures onalcoholism for the first nine months of the present yearissued by the Metropolitan Life Insurance Companyshow that the death-rate from alcoholism is 2-8 per100,000, compared with 3-2 per 100,000 for the corre-sponding period of 1924. The deaths from cirrhosis ofthe liver have, however, increased from 673 to 823,a rate of 6-3 for the first nine months of last yearand 6-6 for the same period in 1925. Poisonings by

wood or denatured alcohol have also increased.Since the beginning of 1922 alcoholism (excludingcases of poisoning from wood or denatured alcohol)has accounted for the deaths of 1528 industrial policy-holders in this company. Other items from this reportshow that the death-rate from typhoid fever con-tinues to decline among the white population but hasactually increased among the coloured population,standing at the appallingly high rate of 11-4 per100,000 in the latter case. There is a continueddecline of tuberculosis deaths in both white andcoloured. The deaths from automobile accidentscontinue to increase.

Periodic Physical Examination.The conference of secretaries of State medical

societies to study and promote a scheme of periodicmedical examinations was a lively occasion. At thepresent time while the American Medical Association,the National Health Council, and the Gorgas Memorialare all promoting such examinations, the work islargely done by business organisations for gain.One such corporation speaks of employing upward of8000 medical examiners, others are no more than theone-room commercial laboratory. The conference

deprecated the need for any middleman betweenphysician and patient, and set its face strictly againstthe commercialisation of medical practice.

Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.THE following are some of the health statistics

for 1924 of a group, comprising three counties, threecounty boroughs, and three cities :-

C.B. = County borough. C. = City.

Kent.Dr. Alfred Greenwood reports that the death-rate

from cancer remained at the same high level as in thepreceding year. Some very high rates were recordedin the various districts ; thus, Deal borough had arate of 2-13 for 1924, New Romney a rate of 2-03,and among the rural districts Elham had a rate of2-11 and Tenterden a rate of 2-20. Dr. Greenwoodassisted the publicity work by giving popular lectureson this subject to the lay public in various centres ofpopulation in the county. These lectures, illustratedby lantern slides and framed in simple language,proved to be a great attraction. The arrangements

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were made by the local medical officers of health ineach case. Very large audiences were addressed andthe modest cost was borne by the local council.

Successful administration of the county tuberculosisscheme continues, but, says Dr. Greenwood, " stillfurther benefits may accrue when it is possible toally with our work in this direction greater expeditionin the provision of houses, with consequent improve-ment in home conditions and less overcrowding.i1Further accommodation for patients suffering frompulmonary tuberculosis in its early stages is now beingarranged at the county sanatorium at Lenham, owingto the training section at that institution being dis-continued by the Ministry of Health. Forty additionalbeds will become available shortly. An outbreak ofparatyphoid fever in the borough of Dover was traced, Iafter a considerable amount of difficulty owing tothe complicated methods of milk distribution, to a" carrier " working on a farm outside the borough.The sanitary defects found on the farm contributedto the spread of infection. The " carrier " was isolatedin hospital for two months and left at his own request,giving an undertaking that he would not in futurefollow an occupation which involved the handling ofany foodstuffs used by the public. The work ofthe county bacteriological and pathological labora-tories at Maidstone continues to elicit the cordialappreciation of the medical profession throughoutKent, and the number of examinations again showsan increase.Continued efforts are being made to provide an

efficient midwifery service throughout the countyeither by making grants to assist in the formation ofdistrict nursing associations, or by placing subsidisedmidwives in districts where a livelihood cannot beobtained from midwifery alone. Some 18 districtsare now served by subsidised midwives. A verysuccessful post-certificate course for midwives, com-prising lectures and demonstrations, was held atGillingham from. Oct. 6th to 10th, and was attendedby 125 practising midwives and 24 health visitors. I

Staffordshire.Dr. W. D. Carruthers reports that there are now only

47 untrained midwives and 225 trained midwives ascompared with 438 untrained midwives and 18 trainedat the time of the passing of the Midwives Act. Theprovision of an efficient service has been one of thechief concerns of the public health committee for aconsiderable period. In the more populous districts,if the midwifery service is inadequate, either a midwifeis trained at the expense of the county council on thecondition that she practises in a selected area for threeyears, or a trained midwife is established with aguaranteed income of .6120 a year on condition thatshe does not select her cases. The latter method is theone usually adopted, and experience has shown thatsuch midwives do not require a subsidy for as longas three years. There are 62 local nursing associationsaffiliated to the County Nursing Association, andeight non-affiliated which undertake midwifery. Thesmaller nursing associations in the county employnurse-midwives, who are generally called villagenurses. In addition to holding the certificate of theC.M.B., these village nurses have received a six months’training in general sick nursing at the Tipton TrainingHome. At the October meeting of the health com-mittee a special scheme of post-certificate trainingwas adopted for the practising midwives under which70 practising midwives annually will attend a refreshercourse of a fortnight’s duration at the Tipton TrainingHome. Arrangements will also be made to give thepupil midwives one month’s practical training inhealth visiting. Antenatal work is also to be developedat all centres as far as possible.An examination of the returns of the district medical

officers of health has shown that in 9 out of 48sanitary districts there were more deaths frompulmonary tuberculosis than notifications. Work withregard to the prevention of rivers’ pollution makesprogress and many of the districts in the county havebio-aeration schemes in hand.

Huntingdonshire.Dr. C. B. Moss-Blundell says a great deal more

should be done to improve the condition of thechildren. The education committee have provided forthe treatment of eye defects, but tonsils and adenoidsare neglected. Dental treatment is a crying need.Verminous heads are quite unpardonable, and Dr.Moss-Blundell thinks it would be’ a " Heaven-sentblessing if fashion dictated the Eton-crop for all timefor all school-children." For venereal diseases anadditional centre is needed in the north of the county,as also for tuberculosis ; and a new clinic for school-children should be established at Fletton. The prob-lem of mental deficiency becomes more acute as

there is no suitable institution available. Dr. Moss-Blundell is sorry that the Fowlmc aerodrome wasnot acquired for this purpose, and suggests thatHuntingdon should combine with one or more othercounties to acquire a suitable place.

Birkenhead.

Dr. D. Morley Mathieson reports that the regularbacteriological examinations made a the Alwen water- 0’supply showed that the water was of remarkablepurity and remained so throughout the year. Therevision of the tuberculosis register shows that atthe end of 1924 it included 1600 cases of tuberculosisof all types. This is rather more than five times thenotifications for 1924, which number 294. Only 62-5of the cases were notified to the department threemonths or more before death, but this is a slightimprovement on the three preceding years. Owingto the fact that more beds are now available for adultsat the Cheshire Joint Sanatorium at Burntwood, it ispossible to admit more children suffering from surgicaltuberculosis to the Thingwall Sanatorium. Thesechildren do very well at Thingwall, and the lighttreatment has been adopted with much success.

Twelve beds are also reserved at Leasowe Hospital forsurgical tuberculosis.

A scheme has been approved by the educationcommittee for dealing with crippled children, com-prising an orthopaedic clinic, hospital accommodationfor non-tuberculous cases, the provision of splints, &c.,and the services of an orthopaedic surgeon, an ortho-paedic nurse, and a masseuse. The clinic will be heldon Saturday mornings at the central premises occupiedby the Birkenhead and Wirral Invalid Children’sAssociation, which association is already subsidisedby the corporation and employs a masseuse. Hospitalaccommodation will be provided at Leasowe on the"

patient-day " basis and .B150 is included in theestimates for the first year. Mr. Hartley Martin,the senior surgeon of Leasowe Hospital, is recom-mended as the orthopaedic surgeon, and for the firstyear it is estimated that one attendance by him permonth at the clinic will be sufficient. On the inter-mediate days the orthopaedic nurse will be in attend-ance. The added cost of the scheme for the first yearis estimated at .8270, half of which will be receivedback in the form of a grant to the education com-mittee. Dr. Mathieson draws attention to the limitedscale of the dental inspection and treatment providedfor the school-children. Only one group is dealt with-namely, children born in the years 1914, 1915, and1916. The result to these is excellent, but the otherchildren in the elementary school remain outside thescope.

South Shields.

Dr. W. Nicoll states that the devastating effectsof the influenza epidemic, which prevailed in theearlier part of the year, were severely felt on Tyneside.Excluding the memorable epidemic of 1918-19, SouthShields was more severely affected during 1924 thanin any year of the last 30. Nearly a third of all thenotified cases of primary pneumonia died, and abouthalf of the cases of influenzal pneumonia. Theinfluenza epidemic was followed by cases of encepha-litis lethargica; nine cases were notified, eight ofwhich died.

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As a sequel to the visit of a Medical Inspector ofthe Board of Education, the question of the schooldental service was raised anew and a full-time dentistappointed in place of two part-time dentists. Asecond full-time dentist will be needed quite soon.Another need of South Shields is increased andimproved hospital accommodation for infectious cases.As a makeshift, huts have been erected in the groundsof the hospital. There is no observation block fordealing with doubtful cases and there are no segrega-tion cubicles at the hospital. The death-rate fromtuberculosis, which has been very high for some time,showed a drop during 1924. Among the 205 deathsfrom tuberculosis there were ten of Arab seamen,and Dr. Nicoll points out that they suffer more thanthe rest of the population. Arabs only constituteabout 0-4 percent. of the total inhabitants. A letterhas been addressed to all the midwives, pointing outthat when medical aid is required they should sendfor the medical practitioner desired by the patient.An antenatal clinic, under the charge of Dr. SusanJamieson, was opened in June.

Bournemouth.Dr. A. D. Edwards points out that the infant

, mortality was the lowest ever recorded in Bourne-mouth, and expresses his appreciation of the excellentwork done by the Bournemouth Voluntary Associationin all the centres. A fifth centre had to be openedtowards the end of the year. The public analyst,Mr. R. A. Cripps, discusses the question of shreddedsuet. The rice flour in the samples submitted variedfrom 0 to 23 per cent. The object of the addition isto prevent the granules of fat becoming massedtogether. For this purpose from 10 to 15 per cent.(according to the hardness of the suet) of rice flour isample. Consequently, all samples containing more than15 per cent. must be regarded as adulterated. As theresult of the action taken during 1922 and 1923 theuse of preservatives is decreasing. Eleven out of29 sausages contained boron, but only in one casein excess of 0-25 per cent. Five samples of fish pasteand 22 of sponge cake were all free from boron. Tensamples of margarine contained boric acid in excessof 0-2 per cent., while 10 out of 11 samples of butterwere also boricised but in only three in excess of0-2 per cent. Nine samples of lemon squash, lime-juice, &c., all contained either sulphurous or salicylic

, acid. Mr. Cripps expresses his surprise that boricacid, " which has been used for many years underofficial sanction in preserved cream, butter, &c.,and salicylic acid, which has been similarly favouredin various beverages, are now to be forbidden." Heis doubtful as to whether the substitution of sulphitesfor boric acid will be advantageous, especially as theconsumer will be liable to take a medicinal dose withless than -12 lb. of sausages.

Norwich.Dr. H. Cooper Pattin reports that provision has

now been made for the dental treatment of nursingand expectant mothers and is already proving bene-ficial. There is need for increased ward accommoda-tion at the maternity home. The development ofthe Stanninghall colony progresses slowly. TheMinistry does not quite approve of this being used forall types of tuberculosis, but appears to have a pre-ference for a combined eastern counties hospital forsurgical tuberculosis. The school dental officers finddefects in 65 per cent. of all the children examined.With the appointment of a second dental officer morechildren now receive treatment, and it is hoped thatarrears will ultimately be overtaken. New houses donot meet the needs of the natural increase of thepopulation. The housing scarcity, therefore, becomes ’aggravated, and the difficulty is rendered greater by ’,the worn-out condition of much of the house propertyin the city.

Carlisle.

Dr. Joseph Beard reports six notifications ofencephalitis lethargica. One was a non-resident whodied in the infirmary. Of the remainder three made

complete recoveries, one recovered except for a slightdilatation of the pupil, and the fifth made an apparentrecovery, which was followed a month later by difficultyin swallowing and other grave symptoms leading toa fatal end. Dr. A. C. B. McMurtrie reports thatsyphilis is declining and looks forward with confidenceto the time when syphilis in Cumberland will be almosta thing of the past. Gonorrhoea, on the other hand,he thinks is increasing. His opinion is illustrated bycharts showing the number of new cases treated at theCumberland Infirmary since 1920.

Gloucester.Dr. Ronald B. Berry draws attention to the inade-

quate and extremely inconvenient accommodationprovided for the health and school medical depart-ments. During the year there was an outbreak ofenteric fever of a mild type among children. Investi-gations showed that the children had probably becomeinfected by drinking from a brook contaminated bysewage from the second county asylum. The out-break led to an examination of the city water-supply,some of which was found to be unsatisfactory. Theundesirable water came from the Robinswood Hillsupply, and, after a survey of the gathering grounds,it was decided to dispense with the water from thissource. The report on the dental scheme for expectantand nursing mothers shows that this work is growingin popularity, and that prejudice is disappearing.Treatment consists mostly in extractions, but occasion-ally the " Ivory Cross," a philanthropic associationsubscribed to by dentists, helps to provide artificialdentures. The present state of the housing problemmakes all branches of the work of the health departmentexceedingly difficult. Dr. Berry thinks much morecould be done in the way of open-air classes at theelementary schools. The school dental officer, Mr. L.Machin, reports that the dental scheme has receiveda very decided check from the system of chargesinstituted towards the end of the year. The majorityof parents refuse treatment rather than pay.

SCHOOL MEDICAL SERVICE.

THE following table summarises the statistics forManchester, Birmingham, and Northampton :-

* Not given. t Excluding dental defects and uncleanliness.

Manchester.

In addition to the routine work, Dr. A. BrownRitchie and his staff examined between 6000 and7000 children prior to their visit to Wembley exhibition-no light task when it is seen that the routine workhas been fully and efficiently carried out. Theincreasing interest and knowledge of the medical workamongst the teachers are shown by the early recogni-tion and notification of many cases of infectiousdiseases, but cases of defective vision and hearingstill escape the teacher’s notice. Extensive treatmentis carried out by the staff at the various treatmentcentres-even minor orthopaedic cases being treated.Many special classes, residential, and day schools

exist for the abnormal children, but Dr. Brown Ritchiestates there is still a shortage of accommodation forblind, deaf, and mentally defective children. Dr.H. Herd reports on the after-results of encephalitislethargica in 57 children in whom he found 20 casesof Parkinsonian syndrome (14 serious). Dr. J. G.