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354 Public Health Services. DEFAULT IN NOTIFICATION OF BIRTHS AND OF TUBERCULOSIS. IN his presidential address to Section I. of the Royal Sanitary Institute Sir Arthur Newsholme emphasised the need for much more general and complete fulfilment of the duty of prompt medical notification of cases of tuberculosis, and expressed the view that with increasing sense of communal duty the via dolorosa to the ideal of a hygienic conscience-constituted by appearance in a police court in default of notification-ought seldom to be necessary. In a recent circular issued to medical practitioners in Surrey Dr. H. J. Cates, county medical officer of health, draws attention to the same subject, remarking that not infrequently, the death certificate is the first intimation a medical officer of health receives of cases of tuberculosis. This is a subject of great public importance, and we hope that complaints of non-notification or much belated notification will, ere long, become much less justified by facts. The extent to which the legal obligation of notification is acted upon has importance beyond the actual figures of notification ; for it is an index of the extent to which medical practitioners and medical officers of health are cooperating in securing the best treatment for every patient and in promoting the hygienic welfare of every afflicted family. In the circular mentioned above, Dr. Cates states that in Surrey during the year 1921 there was a failure to notify births in more than 10 per cent. of the total number of births registered. It is not mentioned to what extent the failure to notify was on the part of doctors, midwives, or parents, and this figure probably could not be given, as the Notification of Births Act imposes a dual responsibility on the parent and on the person in attendance on the mother. There can be no doubt as to the importance of the doctor impressing on the parent of the child the necessity of immediate notification of its birth when he himself is not willing to notify. Unless the doctor has cause to believe that notification is being made by the parent, the legal obligation to notify devolves upon him. This duty has never been acceptable to the medical profession, and we hope that it may, come soon within the range of practical politics to consider whether notification and registration of births might not be unified, registration being expedited to an extent which would justify abolition of the present .dual machinery. ____ REPORTS OF MEDICAL OFFICERS OF HEALTH. Norwich. THE annual report for 1921 states that the popu- lation of the city is 122,400, the birth-rate 22-1 per 1000, and the death-rate 11-3 per 1000. The death- rate of infants under 1 year is 75 per 1000, deaths of legitimate infants 72-5, and of illegitimate 129-5 per 1000. Dr. H. Cooper Pattin remarks that the only general features affecting the health of the community calling for special comment were (a) the prolonged prevalence of unemployment and the consequent relative underfeeding of sections of the population ; and (b) the taking over by the community of the public water-supply, the direct control of which is now vested in a committee of the city council. As to maternity and child welfare work, 298 confinements were attended-20 in the ward, 278 outside, and 220 of the mothers attended the ante-natal clinics. There were 193 sessions of the infant welfare clinics, 1250 new babies were brought, and the total number of attendances was 11,614. Dr. Pattin considers that the final effects of restrictions relating to milk issued by the Ministry of Health may prove to be anything but economical in the long run, since the money value of the time taken up in the investigation of claims, in the signing, registering, and revising of the orders, and auditing of the accounts is considerable. Medical inspection in the schools of some 8000 children revealed defects sufficiently serious to need medical treatment in 11 per cent. of the total number examined ; 379 of these were enlarged tonsils and adenoids, 420 defects of vision, and the school dentist found defective teeth in 75 per cent. of children examined. The total deaths during the year from tuberculosis were : pulmonary tuberculosis, 147 ; other forms, 26. Since May 1st, 1921, the city council has undertaken the responsibility for the treatment of tuberculosis in both insured and uninsured persons, and more systematic efforts have been made to get early knowledge of the disease, by clinics held after working hours. 160 notifications of all forms of tuberculosis were received, and information obtained from 134 of these cases revealed evidence of family taint in 35-8 per cent. Officers of the department paid 1592 visits to the homes of the patients reported, and found that at the time of the first visit 36 per cent. occupied a separate bedroom, 12 per cent. a separate bed in a double-bedded room, and 52 per cent. shared a bed with another, presumably non-consumptive person. There, is a considerable amount of overcrowding in the city and numbers of unsatisfactory habitations, only 149 new houses having been erected during the year. Edinburgh. Dr. A. Maxwell Williamson tells us in his report that the statistics for 1921 apply for the first time to the city as recently extended by the inclusion of Leith, and a considerable suburban area, and that statistics for recent years have been corrected in accordance with the information afforded by the Census. A comparison of the Census of 1921 with that of 1911 shows that the population of Edinburgh declined slightly, while that of Leith and the added suburban area increased during the intercensal period. The net decrease of the three combined districts was 3782, and the total population of the extended city 420,264. The area of the city is now 32,526 acres. For 1921 the birth- rate was 21-5, the death-rate 14’4, the infant mortality rate 96, the cancer death-rate 1,5, and the phthisis death-rate 0-9. The policy of the Public Health Committee has been to build on the outskirts and to clear slums and reconstruct in the centre. Dr. Williamson considers that success in public health efforts in the past has been largely due to improved housing, and that if the present stoppage in housing schemes continues the result is bound to be disastrous. For the moment he advocates the clearing away of old unoccupied obstructive buildings ; that owners be required to make their property fit for human occupation, and that the corporation, unaided by Government, provide on a fairly liberal scale new and reconstructed houses in the central districts of the city, where the need is now most acutely felt. The hospital arrangements have been reorganised. The Victoria Hospital is still used for early cases of pulmonary tuberculosis, the old Leith Fever Hospital being set apart for advanced cases. All ordinary infectious cases are taken at Colinton Mains Hospital, the shelters at Colinton Mains being utilised to provide accommodation for 63 cases of non-pulmonary tuber- culosis. Polton Farm Colony provides accommoda- tion for 21 convalescent tuberculous cases, while the Craiglockhart Poor-house pavilions take in 48 parish cases of pulmonary tuberculosis. Dr. Williamson thinks that for disciplinary reasons the last-named cases would be better under the parish authorities. He records a rather unusual scarlet-fever milk epidemic ; no less than four milk-supplies were involved and 337 cases occurred. The need for a measure of compulsion to secure continuity of treat- ment for venereal diseases is insisted on. The increase in the cancer mortality continues ; the deaths from cancer very nearly approximated the total number of deaths from pulmonary tuberculosis, measles, whooping-cough, and all other forms of infectious disease. Dr. Williamson points out that milk adulteration in Edinburgh pays, owing to the inadequate penalties inflicted when a conviction is
