1162 CONGRESS OF THE ROYAL INSTITUTE OF PUBLIC HEALTH.’

her practice, or one place where efforts have beenmade to see that she makes some attempt to carryout her duties.The Victoria Memorial Scholarships Fund was

founded 18 years ago with the object of improving theindigenous dai class. With an income of little over92000 a year it has done something in an experimentalway, and has for some years past concentrated allefforts on public propaganda and the endeavour tosecure the registration and supervision of theindigenous dai. But it should be recognised that asmall charitable association with insufficient funds,until recently under lay control, cannot carry out thegigantic task of reorganising the midwifery practiceof a country like India. The great obstacle to modernprogress is ignorance on the part of the people, andthis the Government, with its newly reformedPublic Health Department, is now in a position tocombat. But, since men are in almost all cases

debarred from attending labour cases and penetratinginto the zenanas, a medical woman should be appointedto assist the Commissioner for Public Health, and toorganise measures for coordinating existing agenciesand forming public opinion throughout the country.The need for medical women to advise on measuresfor improved conditions of childbirth and infancy hasbeen recognised in England, and it is still greater inIndia.

Future historians may well blame us for the smallrelief which we have given to the physical ills ofIndian women. For the past hundred years theconditions I have described have been known toGovernment officers. But no effort has been madeto relieve them. The Dufferin Fund, founded by aViceroy’s wife. in 1886, was a purely charitableorganisation ; the Victoria Memorial ScholarshipsFund was the same. Both were entirely inadequateto the need. In 1914 the Government of Indiacommenced an annual grant of :610,000, since increasedto z25,000, to carry on a Women’s Medical Service,and in 1916 it gave a grant of JE7000, since increasedto 314,000, to support a medical college for women atDelhi. Both these grants are far less than is required.Most Provincial Governments give small doles to

hospitals staffed by women in their Provinces,but in every case the grants are too small, andthe hospitals all lead a struggling and precariousexistence.The infantile mortality taken over the whole

country in 1919 was 270 per 1000. The Com-missioner for Public Health in his last report statedthat in Bengal 70 per cent. of this mortality occurs inthe first month of life, and two-thirds of that againin the first week, showing the urgent need for improvingthe maternity conditions. In spite of these facts, nota single medical woman is employed by the Govern-ment of India in the Medical or Public HealthDepartments. Out of all the Provincial Governmentsonly one (the Punjab) employs a woman in the Medicalor Public Health Department.

Conclusion.

These remarks are not made with any criticalintention, but with the desire to draw pointed attentionto a great need. Already in the Legislative Councilsof the Provinces questions are being asked as to theGovernment’s intentions with regard to the conditionsof childbirth. Surely it would be best that reformshould come from above as the work of an expertappointed by Government for the task, rather than beforced out of Government by the uninstructedLegislative e Councils, who are not aware whatshould be done, but only conscious of the acuteneed of their women and children, and of the sufferingwhich they know in other countries is beingrelieved.

HARVEIAN SOCIETY.-The annual dinner will tak(place on Thursday, June 15th, at the Cafe Royal, Regentstreet, London, at 7.30 P.M. Sir William Willcox, th<President, will preside.

ROYAL INSTITUTE OF PUBLIC HEALTH:CONGRESS IN PLYMOUTH.

THE Congress of the Royal Institute of PublicHealth opened with an inaugural meeting in theGuildhall at Plymouth on May 31st. The scene wasas brilliant as the weather, the uniforms of the militaryand naval authorities combining with the robes of thedelegates to form a striking display. The inter-national character of the Congress was emphasisedby the presence of delegates from all parts of theworld.The delegates were welcomed by the Mayor of

Plymouth (Mr. J. F. Winnicott), who expressed thehope that the deliberations of the Congress would beof direct benefit to the town, which was endeavour-ing to effect a unification of its various healthservices.

Sir WILLTAAT SMITH, vice-president and principal ofthe Royal Institute, presided in the absence of thepresident, Lord Leverhulme, who was unavoidablydetained in America, and inducted the president forthe year, the Earl Fortescue, Lord Lieutenant of thecounty of Devon.

The Presidential Address.Lord FoRTESCUE, in his presidential address,

recalled the fact that the Institute had not met inDevon since their meeting at Exeter 20 years ago.He referred to the awakened interest in public healthand made a passing reference to the former healthprogramme of Disraeli and his mot, that for theEnglish people not " vanitas vanitatum," but" sanitas sanitatum, omnia sanitas," should be itswatchword. He drew attention to the war-timerecruiting figures to emphasise the dangers of nationaldeterioration in physique, and of the need for healthycitizens, especially in relation to the dearth of popula-tion in the great empty spaces of our Empire and thedangers to the Empire consequent thereon. Thematernity and child welfare work and county nursingassociations he considered of special importance a&

agencies not only for the prevention of disease butfor bringing to the very homes of the people theelementary rules of health and the necessity for-attention to them. It was their aim to put a certifiedmidwife and a competent nurse within the reach ofevery family. Financial stringency was the cause ofdelay in the provision of houses, but at the firstopportunity more ought to be done in this direction,since a shortage of houses was the basis of many ofthe present problems of public health. If thoseengaged in public health work were able to reduce thenumber of individuals of the C3 class, the people ofthis country would be better fitted for the responsi-bilities of our Empire.

Delegates Addresses.Delegates from various nations then gave short

addresses, the company standing while the NationalAnthem of each delegate was played. Prof. CRUCHET,vice-president of the municipality of Paris, speakingin French, indicated the close relation between scienceand administration on matters of public health. Hespoke of the cordial relations between the two countriesduring the war in matters affecting the healthof the two nations. Dr. KING, of the Americanpublic health service, stated that America nolonger held a position of isolation in public healthmatters, but was vitally interested in Europeanconditions.The Congress was welcomed to Plymouth by

Surgeon Rear-Admiral MCNABB, who pointed outthe special problems relating to public health fromthe point of view of the services.

Colonel SOLTAU, one of the organising secretaries,detailed an attractive list of recreations and

, visits to places of interest which had beenorganised for the benefit of members of the Con-

, gress. The proceedings then ended with the NationalAnthem.

1163MEDICINE AND THE LAW.

THE PROGRAMME OF THE CONGRESS.The work of the Congress has been divided into four

sections. 1. State Medicine and Municipal Hygiene.2. Naval, Military, and Air. 3. Bacteriology andBiochemistry. 4. Women and Public Health.An interesting and important series of papers and

discussions commenced at 9.30 A.M. on Thursday inthe various sections and continued on Friday andthe Monday following, Saturday being devotedto various excursions to places of interest in theneighbourhood.On Thursday evening, June 1st, the Mayor and

Corporation of Plymouth held a reception in theGuildhall, at which a large number of people, bothdelegates to the Congress and local residents, attended.A most enjoyable evening was spent.

The Care of the Expectant Mother.A suggestive paper in Section IV. by Prof. Louiss

MCILROY on the Expectant Mother showed thesubject of obstetrics to be merging into the domainof preventive medicine, the care of the pregnantwoman being the responsibility of the State ratherthan that of the voluntary institutions. Moreinvestigation of reproduction and child welfarefrom the normal standpoint as well as from theabnormal and pathological should be undertaken. Atpresent the whole system of the teaching and treat-ment in obstetrics was one of chaos and until the wholesubject came under complete State control progresswould be retarded. Maternity and child welfare wasthe most important piece of work a nation couldundertake. Prof. McIlroy suggested that an efficientsupervision of cases of pregnancy would diminish to agreat extent much of the present surgical procedurenecessary at childbirth. Puerperal septicaemia hadnot appreciably diminished recently. It was more bythe supervision of the patient during pregnancy andavoidance of operative interference than by preventiveaseptic methods that improvement will be effected.Children born without the aid of operative measureshave a much better chance of life than those who haveundergone severe delivery by forceps. It is theviability of the child that matters, not its merelyremaining alive for a few days while under theobstetrician’s care. She advocated compulsorynotifications of all terminations of pregnancy. Untilthen we cannot make any positive statements aboutthe death-rate before birth. Investigation of diseasessuch as toxaemia will lead to beneficial results, just asin the case of syphilis. Ante-natal care will reducethe number of blind and feeble-minded and unfitwho require life-long institutional accommodation.Failure in breast-feeding can be prevented by atten-tion during pregnancy to teeth and digestive organs.Prof. McIlroy suggested as an ideal maternity scheme:

1. The hospital as a centre for treatment, teaching, andresearch, containing (a) in-patient department, withlying-in-wards, and ante-natal beds for observa-tion. Isolation beds for cases of sepsis and obstetricwards for V.D. cases. (b) Out-patient department,with ante-natal consultation and post-natal, dental,and V.D. clinics. 2. Infant welfare and treatment.3. Laboratory for biochemical examinations of urine,blood, &c. Auxiliary aid could be utilised by incorpo-rating the accommodation in hostels and rest homes forexpectant and nursing mothers, convalescent homes,home visiting, and registration of patients in attend-ance. The inspection of pregnant women in industrieswould lead to a modification of the work, rest hours,and the safeguarding of the mother’s interests as awhole. We must raise the status of the expectantmother and make childbearing easier for marriedwomen who frequently get forgotten in our endeavourto be charitable and generous to the unmarried mother.Compulsory notification of pregnancy was unimportant.Pregnant women will notify their condition to themedical authority when they become convinced of thegreat advantage of doing so. With regard to midwivestheir training lacks the study of ante-natal conditions.They should have facilities for sending cases to beseen by specialists when necessary.

An interesting discussion followed. The chiefpoints emphasised were the need for coordination ofservices, the necessity of the higher training ofmidwives, and the education in health matters ofmothers and girls in school.

MEDICINE AND THE LAW.

DYING DECLARATIONS.

THE law with regard to dying declarations appearsto be the same in Canada as in this country, and awell-known Canadian judge, Mr. Justice Riddell, indrawing up a practical guide for persons, not lawyers,who may have to receive the confidences of a dyingman, has covered useful ground. Save, perhaps, toministers of religion, such declarations are more oftenmade to doctors than to any section of the public,though nurses receive, on occasion, in this wayconfidences of the first importance to justice. Adying declaration is not to be confused with a dyingdeposition. A deposition is a formal documentdrawn up by or in the presence of a magistrate whereit is believed that the deponent is not likely to recover,and the formalities to be observed with regard to itare the concern of the magistrate who takes down thestatement. Here it is provided that if the personagainst whom the deposition is to be used is notpresent, so as to have the opportunity of cross-

examining the deponent, it must be proved that hehad notice that the deposition would be taken, andthat he could have been present had he so chosen.The deposition can be used whatever the charge ; thedeclaration only against a person who may be chargedwith causing the death of the declarer. The declara-tion is not made on oath or affirmation, as is thedeposition, but is received as the words of a dying man,uttered at a time when, in the language of one of ourjudges, " every motive to falsehood is silenced andthe mind is induced by the most powerful considera-tion to speak the truth."

It is the duty of every good citizen to disclosecrime and to preserve evidence of it. A medicalman, therefore, attending a patient who is likelyto die in circumstances indicating that the deathmay be caused directly or indirectly by act ofomission or commission, should endeavour to obtainsuch evidence from the dying man as is avail-able. This is not, as it is sometimes offensively put,to act the part of a detective, but rather it is to actthe part of a good citizen, and it is called for only incases where foul play is reasonably suspected. Itmust be remembered also that the dying declarationmay be as useful to protect the innocent accused ofcrime as to convict the guilty.Such is Mr. Justice Riddell’s reasonable statement

of the ethics of the case ; it is made from a layman’sstandpoint, rather than from that of a medical man.The medical man’s time and cares have a prior claimupon them. His first duty must be directed to savinglife ; failing that he must strive to relieve avoidablepain. The endeavours to extract evidence from thepatient, which now may follow, will be modifiedaccording to the medical man’s conscience and hisjudgment. There certainly can be no wish in themind of any medical man who sees a man or womandying before his eyes from a cruel crime to see thecriminal escape detection. As far as he can reasonablydo so, his duty and his inclination must be to aidjustice like any other citizen. It may be that in so

doing he will help to save the lives of other potentialvictims. We need only refer to cases of criminalabortion or of poisoning in order to suggest examplesof this. Mr. Justice Riddell says : " Speakinggenerally, it is always wise for the doctor as soonas he thinks that a case is hopeless, to inform thepatient of the fact-he may have affairs to settle, awill to make, directions to give, &c." Difficulties maysometimes arise as to which it is impossible to laydown any fixed rule-for example, the patient maybe of such a temperament that a statement of this