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pathological material which he has been able to obtain tosome extent corroborates the view of Harbitz and Scheeb thatthe condition begins by a patchy lepto-meningitis on theanterior aspect of the cord, and that the inflammatoryprocess spreads inwards to the highly vascular grey matter.Out of 135 cases six deaths were recorded, a mortality ofapproximately 42 per cent.

THE EDITORSHIP OF THE LANCET.

DR. SQUIRE SPRIGGE, who has been chief of the editorial (

staff of THE LANCET for 15 years, has been formally f f

appointed Editor. - :

IN connexion with the Fifth Centenary of St. AndrewsUniversity, the "Mater Studiorum" of Scotland, to be i

celebrated some 18 months hence, a prize of 100 guineas hasbeen offered by Dr. J. P. Steele of Florence for the best 1

essay on " Scotland’s Debt of Gratitude to her Parish ] JSchools, her Grammar Schools, and her Universities," thecompetition to be open to graduates of the four Scottish <<seats of learning and the conditions to be announced quam :

primwm. One of these conditions requires the essay to i

occupy not more than one hour on being read aloud. The z’

subject is one of interest to all the liberal professions-particularly to the medical, in which the Scottish recordholds a place of honour quite disproportioned to her popula-tion and her financial resources. ’

A PRESENTATION of his portait was made to Sir William HAllchin on March 31st in the board room at the Westminster

Hospital. A large number of friends and old pupils haveused this opportunity of signifying their high regard for SirWilliam Allchin.

____

WE regret to announce the death of Dr. Arthur Gamgee,F.R.S., the well-known physician and physiological chemist,which occurred in Paris on March 29th after a very short

illness. __

THE DEATH REGISTRATION ANDBURIALS BILL.

ON the first of the past month a Bill to amend the lawrelating to the registration of deaths and to the regulationof burials was presented to the House of Commons by Mr.George Greenwood, with the support of the Right Hon. SirWalter Foster, M.D., Dr. V. H. Rutherford, Dr. J. G.

Shipman, and others. 1From an explanatory memorandum we learn that the

object of the Bill is to give effect to the principal recom-mendations put forth by the Select Committee on DeathCertification which sat in 1893 under the chairmanship ofSir Walter Foster. That Committee reported that it was" much impressed with the serious possibilities implied in asystem which permits death and burial to take place withoutthe production of satisfactory medical evidence of the causeof death. It is a most important duty of society to guardits members against foul play, and it appears to your Com-mittee that, as far as may be, it should be made impossiblefor any person to disappear from his place in the communitywithout any satisfactory evidence being obtained of the causeof his disappearance. Your Committee, fortified with theweighty opinions of the witnesses who have appeared beforethem, have arrived at the conclusion that uncertified deathsshould, as a class, cease to exist, and that means should bedevised whereby a medical certificate should be obtained inevery case not certified by a registered medical practitionerin attendance." "

This Bill contains, but not always in a fortunate form,several provisions for the improvement of the registration ofdeaths which, with suitable modifications, we should gladly

1 See THE LANCET, March 13th, 1909, p. 806.

see placed on the Statute Book, but although based on therecommendations of the Select Committee referred to, theBill betrays a certain lack of familiarity on the part of thedraftsman with the present system of death registration andwith what is required for its amendment, having regardto what is either practicable or desirable under existingconditions.The first clause of the Bill prohibits the registration of any

death except under one of the following safeguards-either(1) the proper certification of the cause of death by the regularmedical attendant; (2) a coroner’s certificate after inquest ;or (3) a certificate of verification by the public certifier ofdeaths," for the compulsory appointment of which officer ineach registration sub-district provision is made in the Bill. Inevent of the death of a person attended in his last illness bya registered medical practitioner the medical attendant isrequired to furnish the registrar with a certificate of thefact, as well as of the cause of death. And here it must benoted that under this Bill the present custom of intrustingthe medical certificate to the relatives of the deceased for

presentation to the registrar is departed from. The certificateis to be sent direct to the registrar, with the intention, pre-sumably, of rendering it a State document, the propertyeither of the Crown or of some public authority to be

appointed for the purpose. That this is the intention of theframers of the Bill is clear from Section 3, which providesfor the payment of a definite fee for his certificate to themedical practitioner in attendance, whose responsibilitieswith respect to the case will as a consequence be considerablyincreased. Under the Bill he will be required to testify notonly to the cause but to the actual occurrence of death ineach case, and his certificate will not be accepted unless itbears evidence that the practitioner has attended his patienton at least two occasions, one of which must have beenwithin eight days of the death.A subsequent section of the Bill provides for cases in

which no medical practitioner has been in attendance on adeceased person. In the event of the registrar being in doubtas to whether such person has been attended in his last ill-ness by a registered medical man; or in case of his not havingreceived a proper medical certificate within the time limited

by the Act ; or, again, in case the registrar is dissatisfiedwith the medical certificate, he is required to communicatewith the public medical certifier of deaths, whose duty itthereupon becomes to inspect the body and to furnish theregistrar or the coroner, as the case may be, with the

necessary verification certificate."in &eacute;lle case or a person Lne cause or wnose aea&eacute;ll is un-

certain, or is believed to be due to violence or to other than’’ natural causes," the medical attendant is required, instead3f certifying the death in the usual way, to informthe coroner and also to notify the registrar of his

having so done. On receiving this information, and beforeholding an inquest, the coroner is required to communicatewith the public certifier of deaths, who must attend theinquest, and, if satisfied of the fact of death, must furnishthe coroner with a verification certificate which will beforwarded by that officer to the registrar, together with hisown certificate, for registration in the ordinary course.

Concerning the question of "stillbirths," the compulsoryregistration of which was strongly recommended in the:eport of Sir Walter Foster’s committee, the only referencecontained in the present Bill is to the following effect :-For the purpose of the provisions of the Births and Deaths Registra-

tion Acts, 1836 to 1901, and of this Act, relating to the registration ofieaths and to burials, any stillborn child which has issued forth fromts mother after the expiration of the twenty-eighth week of pregnancy;hall be deemed to have been born alive and to have died after birth,and not to be a stillborn child, and these provisions shall applyaccordingly.For the appointment of public certifiers of deaths pro-

vision is made in the Bill, the only condition of appointmentbeing that the officer should be a registered medical practi-tioner, and that he should be appointed by the local boardof guardians, presumably with the consent of the centralauthority as regards duties, remuneration, and dismissal fromoffice. It seems strange that almost synchronously with thepublication of the recommendations of the Poor-law Com-missioners for the universal supersession of Poor-lawguardians as the local authorities for purposes of "publicassistance " a Bill should be presented to Parliamentsuggesting an enormous increase in the functions andresponsibilities of these much-abused functionaries, whom

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the framers of the present Bill would apparently desire toinvest with a new lease of life.We have already intimated that, in our judgment,

this Bill is badly drawn. - Indeed, we can hardly believethat, abounding as it does with manifestly impracticablerequirements, it can have obtained in its presentstage the approval of the registration authorities atSomerset House. In particular, we note that thetime for complete registration of a death is so greatlyextended by the Bill that the burial of a body wouldfrequently be unduly delayed. In addition to whichthe preliminaries to registration appear to be far too

complicated for execution by the average type of registrar,whilst the duties imposed on the relatives of the deceased,naturally depressed by bereavement, are unnecessarilyvexatious if not impossible of fulfilment. Again, in a

measure the avowed object of which is to provide for thesafety of the community in this respect, we should havethought that definite arrangements would have been includedfor the registration of stillborn children. But, with theexception of the indirect reference to the subject of still-births previously alluded to, the Bill is silent on the point.Having said so much by way of unfavourable criticism of

Mr. Greenwood’s Bill, we gladly accord our approval to twoof its chief recommendations, both of which seem to us justand reasonable, but which, we fear, will hardly escape oppo-sition by certain economists of the House of Commons. Thefirst recommendation provides for the appointment of a

public certifier of death in each district of England ; the

other, for the payment of medical attendants for theircertificates and for the greatly increased responsibilities theywould incur in the event of legislation on the proposed lines.We think that in the present temper of the House either ofthese provisions would saffice to wreck this or any othermeasure of the kind unless strongly supported by theGovernment. It is certain that, on the one hand, thecost of maintaining a corps of "public medical certifiers

"

would undoubtedly be considerable, but, on the otherhand,by this means alone can the hardly less cost of holding un-necessary inquests as at present be saved to the community.That our national system of registration, which was estab-lished in 1837, should now need amendment will occasion nosurprise. But before venturing on any piecemeal tinkeringwith a system under which enormous improvements havebeen effected in the course of the last 70 years, it is essentialthat the whole system of registration of births and deathsshould be reviewed, with the advice of persons familiar withthe merits of the existing machinery as well as its defects.It would appear almost inevitable that the Acts themselveswould need practical reconstruction so as, inter alia, to pro-vide for the registration of stillbirths and for the acquirementof fuller data respecting both mortality and natality, inorder that amongst other important questions the relation ofa declining birth-rate and a stationary infantile mortalitymay be traced to the physical and social conditions of thepeople.

THE REPORT OF THE AMBULANCECOMMITTEE.

IN December, 1906, Sir Kenelm Digby, G.C.B., K. C., theEarl of Stamford, and Sir William Collins were appointed bythe Home Secretary to form a committte "to inquire as tothe provision made for dealing with cases of accident andsudden illness occurring in streets and public places withinthe metropolis, and to report whether any, and if so what,improvements in ambulance provision are necessary or

desirable, and how they could be best effected with dueregard to efficiency and economy." The incidents which ledup to the appointment of the committee are explained in thememorandum appended by Sir William Collins to the reportwhich he signs jointly with his colleagues, although he holdsviews differing from them affecting important matters of detail.In 1906 the London County Council sought to include in itsGeneral Powers Bill clauses enabling it to establish andmaintain or to contribute to the establishment and main-tenance of an ambulance service for street accidents inLondon. The House of Commons committee passed theseclauses, but the House of Lords committee, though satisfiedwith the medical evidence as to the need of a good

ambulance service, struck them out on the grounds thatthe financial aspects of the Council’s scheme were notmade clear in a manner satisfactory to the committee. Itwas stated, moreover, by Lord Camperdown, the chairman ofthe committee, in the debate which took place on the thirdreading of the Bill in the House of Lords that the HomeOffice was opposed to the Council’s scheme. A conferenceat which the Council, the Home Office, and the policeshould be represented was then proposed, but the outcome ofthe discussion seems to have been the appointment of thecommittee which has now issued its report. This appearstwo and a half years after the rejection of the Council’sclauses in Parliament and eight years after an inquiry by theCouncil the result of which those clauses embodied, so thatit cannot be denied that regrettable delay has taken place,to which the attention of Parliament may usefully becalled.The report in which the committee appointed by Mr.

Gladstone explains its views is an interesting but incon-clusive document, for unfortunately the committee is notunanimous as to the important question of the selection ofa central body to which the duty of organising the ambu-lance service of London should be assigned. The report,or rather the portion of it for which Sir Kenelm Digbyand Lord Stamford must be regarded as responsible, wouldenlarge the scope of the duties of the MetropolitanAsylums Board so as to include in them the provision ofambulances for accidents and cases of non-infectious illness

demanding them, and the working of them with the aid andcooperation of the police. It will be seen that at the incep-tion of its task the committee was not assisted by the termsof its reference, which we cannot help thinking must havebeen drawn up without due consideration. Strictly speak-ing, it was limited to the consideration of the ambu-lance service to be provided for ’’ street cases" " (aconvenient term adopted by the committee) in the

metropolis. Accidents and illnesses occurring in streetsand public places obviously do not include those whichtake place on private premises, such as factories, docks, andrailway stations, and the provision of an ambulance servicewhich would omit the care of these would be absurd. The

metropolis is presumably definable as the County of London,but the hospitals to which ambulances transport the sick andinjured do not draw their patients from so limited an area,and the scope of the inquiry necessarily included the con-sideration of the services of the metropolitan police inconnexion with the transport of street cases," services whichare not denied when cause for them arises on privateproperty. Now the metropolitan police exercise theirduties over an area six times as large as thatruled by the London County Council and over which,moreover, a rate is levied for the maintenance ofthis important body. Questions, therefore, as to the train-ing and employment of the police with a view to their

rendering first aid and assisting in the conveyance of injuredpersons to hospitals could not be discussed either in theirpractical or financial aspects without reference to conditionsoutside the "metropolis." The fact that the use of anambulance is not likely to be confined to street cases hasbeen referred to, but besides these and accidents on privatepremises there is the demand for means of transport whicharises when the poor patient lying ill at home has tobe taken to a hospital. Is he to be left for his’relatives to convey him in a cab, or cart, or barrow,all of which have been found by the committee tobe the inadequate and sometimes injurious vehicles in

general use when emergencies arise ? However, the com-mittee has interpreted its duties in a liberal spirit, and,while recognising the limits imposed by the authorityappointing it, has made inquiries and suggestions which gobeyond them. Its difficulties, however, have not endedthere, for it has had considerable divergence of opinionamong witnesses to deal with, notably upon a point of greatimportance in the organisation of an ambulance service-namely, the nature and extent of the service to be renderedby those accompanying the vehicle in order to assist in

bringing the case to the hospital.When we come to consider in detail the topics discussed

by the committee we observe that it found in existence thefollowing services : that of the Metropolitan Asylums Board,which without legal sanction deals to some extent with non-infectious cases, and by arrangement with the Commissoner