89

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 19’3 and 20’3 per 1000 in the precedingtwo weeks, declined again to 19.5 in the week endingJuly 2nd; this rate exceeded by 1’4 the mean rate duringthe same week in the twenty-eight large English towns.The rates in the Scotch towns last week ranged from 14 (jand 16’9 in Aberdeen and Edinburgh, to 23 3 in Greenockand 28.2 in Paisley. The 487 deaths in the eight townslast week showed a decrease of 20 from the number in theprevious week, and included 43 which were referred towhooping-cough, 18 to diarrhoea, 7 to scarlet fever, 7 todiphtheria, 6 to measles, 3 to "fever" (typhus, enteric, orsimple), and one to small-pox; in all, 8" deaths resultedfrom these principal zymotic diseases, against 90 and 71 inthe preceding two weeks. These 85 deaths were equal to anannual rate ot 34 per 1000, which was 0’7 above the mean ratefrom the same diseases in the twenty-eight English towns.The fatal cases of whooping-cough, which had been 48 and38 in the preceding two weeks, rose again last week to 43, ofwhich 16 occurred in Glasgow, 9 in Edinburgh, 9 in Dundee,and 4 in Greenock. The 18 deaths attributed to diarrhœa, ofwhich 7 were returned in Glasgow and 3 in Dundee, showedan increase upon the numbers in recent weeks, and were2 above tne number in the corresponding week of last year.The 7 fatal cases of scarlet fever showed a further declinefrom recant weekly numbers; they included 2 in Dundee.Of the 7 deaths from diphtheria, showing an increase uponthe low numbers in the previous two weeks, 4 occurred inGlasgow and 2 in Edinburgh. All the 6 fatal cases ofmeasles were returned in Glasgow; and the death fromsmall-pox occurred in Aberdeen. The delths referred to

, acute diseases of the respiratory organs in the eight towns,which had been 109, 7G, and 72 in the preceJing three

° weeks, rose again last week to 80, and were 3 a,bove thenumber returned in the corresponding week of last year.The causes of 85, or more than 17 per cent., of the deathsregistered in the eight towns during the week were notcertified.

___

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equalto 26.7 and 27.6 per 1030 in the preceding two weeks,further rose to 29’4 in the week ending July 2ad. Duringthe thirteen weeks ending on Saturday last the death-ratein the city averaged 28-7 per 1000, the mean rate duringthe same period being but 18’0 in London and 19 4 in Edin-burgh. The 199 deaths in Dublin last week showed afurther increase of 12 upon the numbers returned in thepreceding two weeks; they included 0 which were re-ferred to measles, 5 to diarrhœa, 3 to whooping-cough,2 to "fever" (typhus, enteric, or simple), and not oneeither to small-pox, scarlet fever, or diphtheria. Thus thedeaths resulting from these principal zymotic diseases,which had been 32 and 28 in the preceding two weeks,rose last week to 40, and exceeded the number in any pre-

- vious week of this year ; they were equal to an annual rateof 5’9 per 1000, the rates from the same diseases being28 in London and 2-8 in Edinburgh. The fatal cases

of measles, which had increased in the preceding eightweeks from 6 to 21, further rose last week to 30, andexceeded the number in any previous week of thisyear. The deaths from diarrhœa, whooping-cough,and "fever also showed an increase upon the numbers inthe previous week. The deaths of infants had declined,whereas those of elderly persons somewhat exceeded thenumber in the previous week. Six inquest cases and5 deaths from violence were registered; and 61, or nearly athird, of the deaths occurred in public institutions. Thecauses of 24, or more than 12 per cent., of the deaths registeredduring the week were not certified.

TASMANIAN MORTALITY STATISTICS.

The Government statistician for the colony of Tasmania(Mr. Robert M. Johnston) has recently issued his return ofthe vital and meteorological statistics for the year 1886. Vitalstatistics relating to our Australian colonies, especially theirmortality statistics, are full of interest for comparison withthose of England and Wales. Their interest and value would,however, be far greater if we could be assured of the approxi-mate accuracy of the civil registration of births, deaths, andmarriages in our several colonies. Tasmania has the repu-tation of being one of the healthiest of our healthy Austral-

asian colonies, and the statistics of the return just to handfully corroborate this impression. This colony, with anarea of rather more than 26,000 Pquare miles, had last yearan estimated population of only 135,501 persons. Therecorded birth-rate of thin population was etjual to 342 per1000, ranging from 368 in the chief urban districts (tfobiirbTown and Launceston) to 32 7 in the country district a. It maybe noted that the birth-rate in the colony steadily increasedfrom 30.2 in 1877 to 35 7 in 1881, since which it has some-what declined again. It would be useful to know whetherthese differences may be attributed to varying accuracy ofregistration or to variations in the proportions of women atthe child-bearing ages. The death-rate in the colony in;1880 was so low as 146 per 1000, showing a further declinefrom the rates in recent years. In the absence of officialinformation on the point, it i-t fair to assume that the regis-tration of deaths in recent years is at any rate fully asaccurate as in past years. It is, therefore, very satisfactoryto note that while the mean death-rate in the nraf fiveyears on record (1856-G2) was 17’2 per 1000, it did notexceed 15’7 in the last five years (1882-8C). The returnbefore us contains a singular defect (probably due to over-sight.) in its statistics bearing upon the mortality in1886 in various parts of the colony. The death-rate inthe year per 1000 of the mean population is givenas 5’30 in Ilobart Town, 3’33 in Launceston, and 5 95 in thewhole of the country districts, while in the whole colony,as before stated, it is said to be 14.58. It would appearthat by an oversight the rates given for the subdivisions ofthe colony are the proportions of deaths in each district tothe whole population of the colony; there figures being, ofcourse, valueless as a test of comparative mortality. It

appears from the facts given in the table that the true death-rate per 1000 of the population of IIobart was 235, andthat of Launceston 23 8; these are too high for rates incolonial towns, which should be free from the unhealthyareas which raise the death-ratps of cities in the OldWorld. The death-rate in the Tasmanian country dis-tricts in 183G would appear to have been as low as 9’-t;this low rate may probably be partly due to defec-tive registration in sparsely populated districts. It isunsatisfactory to find that "fever," principally enteric ortyphoid, is more fatal in Tasmania than in England andWales. The deaths in 1836 included 47 from this cause, ofwhich 25 occurred in Launceston, 9 in Hobart Town, andonly 13 in the rest of the colony. The mortality from theother principal zymotic diseases was decidedly below theEnglish average. Infant mortality from all causes, measured

, by the proportion of deaths under one year to registered’ births, was 105 per 1000, comparing most favourably with

the rate of infant mortality in England and Wales; it, should, however, be noted that, while in the country dis-’ tricts the proportion was only 73 per 1000, it was more than

twice as high (152 per 1000) in Hobart Town and Launceston,, the chief urban districts. It is evident from thee flgure3-

that the sanitary condition of the principal Tasmanian towns’

is not what it might be and ought to be.

THE SERVICES.

WAR OFFICE.—Army Medical Staff : Surgeon-GeneralJohn O’Nial, C.B., has been granted retired pay (datedJune 14th, 1887).INDIA OFFICE.—The Queen has approved of the following

promotions made by the Governments in India :-Surgeon-Major William Roe Hooper (dated March 31st, 1887), andSurgeon-Major John Richardson (dated April 29th, 1887),of the Bengal Medical Establishment, and Surgeon-MajorA. Nickson Ilojel (dated April lst, 1887) ; Surgeon-MajorPeter Stephenson Turnbull, M.D. (dated April 1st, 1887),.and Surgeon-Major II. Cook, M.D. (dated April 2nd, 1887),of the Bombay Medical Establishment, to be BrigadeSurgeons. This cancels the promotion of Surgeon-MajorIlojel, from April 2nd, 1887, notified in our columns onMay 21st, 1887.

ADMIRALTY.—The following appointments have beenmade:—Surgeon Penrose J. Barcroft, to the Tfalabar (datedJuly 2nd, 1887), and Surgeon William R. White, to the Duke’of Wellington, additional (dated July 2nd, 1887).ROYAL NAVAL ANTILLERY VOLUNEERS (Bristol Brigade).

Charles A. Wigan, M,D,, M.R.C.S., to be Surgeon (datedJuly 4th, 1887).

90

ARTILLERY VOLUNTEERS.—1st Gloucestershire : J. Lidder-dale, Gent., to be Acting Surgeon (dated July 2nd, 1887).-3rd Volunteer (Kent) Brigade, Cinque Ports Division, RoyalArtillery: John Irvine Boswell, M.B., to be Acting Surgeon(dated July 2nd, 1887).-Richard Joseph Bryden, Gent., tobe Acting Surgeon (dated July 2nd, 1887).RIFLE VOLUNTEERS.—1st Volunteer Battalion, the Duke

of Cornwall’s Light Infantry : Surgeon R. C. M. Pooley, M.D.,is granted the honorary rank of Surgeon-Major (datedJuly 2nd, 1887); Thomas Baxter Carlyon, Gent., to be ActingSurgeon (dated July 2nd, 1887).—1st Dorsetshire: ActingSurgeon W. A. E. Hay, to be Surgeon (dated July 2nd, 1887).—1st Dumbartonshire: William Drysdale, Gent., to be ActingSurgeon (dated July 2nd, 1887).—1st Volunteer Battalion,the Essex Regiment: St. Clair Brockway Shadwell, Gent.,to be Acting Surgeon (dated July 2nd, 1887).-4th VolunteerBattalion, the South Wales Borderers: Surgeon and Hono-rary Surgeon-Major Robert Smythe resigns his commission;also is permitted to retain his rank, and to continue towear the uniform of the Battalion on his retirement (datedJuly 2nd, 1887).—3rd Volunteer Battalion, the Duke ofWellington’s (West Riding Regiment) : Lieutenant J. F.Arlidge is appointed Acting Surgeon (dated July 2nd, 1887).THE VOLUNTEER MEDICAL STAFF CORPS.—The London

Division: Philip Henry Whiston, Gent., to be Surgeon (datedJuly 2nd, 1887).

_____________

Correspondence.THE POSITION OF MEDICINE IN THE STATE.

To the Editors of THE LANCET.

I’ Audi alteram partem."

SIRS,—Now that the Jubilee week has come and gone,and the list of those deemed worthy of honour is open toour study, it seems a fit time for the medical profession to ’take stock of the estimate formed of it by the ruling coteriein the State. " Honour a physician with the honour dueunto him" has come down to us from nearly 3000 years agoas embodying wisdom, and now in this marked year of ourera we have an opportunity of testing how far these ancientopinions on the healing art are recognised under our so-calledadvanced civilisation. I take the list of honours as a fairindex for guidance. The occasion was a special one, andfurnished an opportunity for making up any leeway. The

profession has not been passed by either as sufficientlyweighted with awards or as unworthy of recognition, butduly considered and value assessed; and though the healingart is noble, second to none, and in the opinion of some self-sufficing, yet like other callings some of our members haveaccepted gifts from the "fountain of all honour," sinkingtheir professional title in that applicable to the rank be-stowed ; and hence our profession, as to the nation’s estimateof it, is fairly gauged by the distributions awarded itsmembers. All professions, judging by acts, accept thehonour as something above, and added to, that derived fromthemselves. What, then, does an analysis of the list revealas bearing on our present subject ?Excluding promotions in the navy and army and those

nursing sisters decorated with the Royal Red Cross, thereare about 272 individuals deemed worthy of recognition,and among them we number twelve, six belonging to thecivil segment and six to the services, a ratio of 4’4 per cent.Taking the navy and army as expressive of a calling thevery opposite to the healing art, we find a ratio of 40 percent., the medical departments among them reaching onlyto five. We have no place among the six peers and thirteenbaronets; and among the knights commencing with PryceJones, Esq., and terminating with mayors of different towns,we have three out of thirty-three. Of the civil division ofthe Order of the Bath, its highest grade passing us by, weget two out of twelve K.C.B.’s, none out of thirty-one C.B.’s;and in its military division, giving us a similar omission inthe highest grade, we have three out of forty R.C.B.’s, andthree out of sixty C.B.’s. The Order of St. Michael andSt. George, among sixteen colonials, give us one-an M.D. ofOttawa. Hence the healing art is deemed honourable bythe State at a percentage of 4, one-tenth of the value of thefighting force; it is not worthy to take a place in the

highest grade of any order in existence in our country; itslevel is with the trades; and former experience repeats thepresent. The medical profession has no high-paid andtitled appointments as the church and law, and hence,acting on the principle advanced in the army, that the com-batants are entitled to honours in a higher ratio thanmedical officers on account of the smallness of the pecuniaryremuneration, we should have an excess as compared toothers, and this makes the invidiousness of our presentposition more pronounced. Thus this Jubilee year finds uslowly rated and lowly graded in the bestowal of distinctions;it finds no small number of our military members smarting(rightly or wrongly) under a sense of degradation and un-fairness ; it finds several in our lower ranks who in thestruggle for existence are working for a pittance barely, ifat all, above the artisan class. Surely there is foodhere for reflection and occasion for reasonable discontent,irritation, and a desire at least (to use your own words)for redress of what is felt to be a grievance," if nothingmore.

Does the cause of offence lie in our calling, in our-

selves, or in the power that honours? The first maybe dismissed, though it must be said that it places thesufferer only under an obligation; its influence is per-sonal rather than general; it is not obtrusive; it makesno appeal to the emotions of the mass as an army doesin a victory gained, or as politics in a great liberatingmeasure passed; in its public work it is preventive andsilent in working, unseen by the many, not demonstrative;and hence its value and influence are easily overlooked inthis busy world and thrust aside. Again, its members arenot recruited from the upper strata, from the moneyed or

influential ranks-rather from the medium or lower middleclass as a rule. They come under the category of self-mademen ; they have little time or desire or means for socialmatters; they do not come much under the cognisance ofthose capable of influencing the inner circle surroundingthe throne except as units. Nor are they potent politically.Their main power resides in the position their specialeducation gives them in the world of intelligence, and theirinfluence is probably best seen in those who carry theirmedical education into other spheres of work than in thosewho practise the healing art. Again, in the distribution ofhonours, it would appear, judging by the results, not to bebased solely on professional work, the selection, the outcameof a responsible body having the necessary knowledge. Inthe civil section several have been distinguished by Royaltyafter services personally rendered; and in the militarysection seniority has generally determined the result, andthe awarder has been the military, not the professionalhead. Hence it would seem that our calling is not one toprominently thrust itself under the nation’s recognition; itsmembers, as a rule, lack the social or political influence toimpress the fountain from which honours flow, and thesystem of awarding leaves much to be desired. These. points,however, furnish no excuse for the poor distinction that themedical profession has hitherto enjoyed. Surely the Stateshould have no favouritism in professions or callings, all (ifhonourable) should stand on the same basis, and awards inratio to numbers should be mainly based on selection madeby the respective heads acting in council.

1 presume that the profession regard the present condi-tion as one far from congratulatory. We want to extendour influence socially and politically; we want to raise thestandard of our profession, increasing its value and powerin the State. Most of us tend to undermine our power bythe ease with which we gratuitously give our professionalservices. We want our ranks recruited more, if possible,from the upper middle stratum, and especially to guardagainst the numerical swamping of the profession by theentrance of more than can be properly provided for. Thisis unquestionably a great rock ahead, increasing competitionand the struggle for existence not probably affecting thosein the first rank or those of middle age, but vitally touchingthose about, or in the future, to enter, and increasing thenumbers earning a miserable pittance, degrading in ten-dency, besides reducing the influence of the profession as awhole, and allowing the State to fill its posts with men at alower rate. It is certainly the best for all that this severecompetition for work and its pay should be prevented, thatentries should not be double the vacancies as at present;and to this end it would seem well that the Colleges shoulduse their authority, and by raising the required standardincrease the difficulties, so diminishing the number passed