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rather those who dwelt on the higher ground who wereaffected. No very clear explanation of the circumstancesunder which the disease spread seemed to be forthcoming.Much the same may be said of a similar occurrence at Wick,in the district of East Preston.

Wolverhampton Urban District.—Dr. Malet draws atten-tion in his report for 1889 to the influence of isolation in theborough hospital as having materially reduced the scarletfever mortality in Wolverhampton, and it is certainly satis-factory to find it recorded that in cases where such isolationwas carried out no further attacks in the families concernedtook place after the removal to hospital. Unfortunately,the hospital which has such a record is stated to be used forscarlet fever only, a circumstance which seems to implythat the institution does not properly admit of the isolationat one and the same time of cases of more than one disease.Happily such diseases as enteric fever and diphtheria werenot very prevalent during the year. The general death-rate was low for Wolverhampton--namely, 16’9 per 1000,and the zymotic rate was also low, but the deaths amongstchildren were above the average. The sanitary circum-stances of the town are referred to in a general way, whichseems to indicate negligence and default, but that part ofthe report hardly conveys information sufficiently explicitto be understood by outsiders.

Newcastle-upon-Tyne Urban District.-The mortality re-turns for 1889 do not bear favourable comparison with thoseof 1888, and one-third of the increase which has taken placeis attributed to zymotic ailments ; the general death-ratebeing 25’0 and the zymotic rate 3’0 pr 1000. Amongstthe cases of infectious diseases heard of during the year therewere of scarlet fever 601, enteric fever 136, diphtheria 96,and typhus 7 ; and both these cases and the vital statisticsbased on them and other causes of death are dis-cussed at some length by Mr. Henry Armstrong.Amongst the preventive measures adopted, removal tothe excellent new isolation hospital played a prominentpart ; and in the case of some diseasea, such as typhus,nearly all attacked were so removed. But even with theexcellent organisation existing in this northern city thepercentage of removals to hospital of all the cases of in-fectious fevers heard of did not reach more than 15’6. Thegeneral work of the Health Department is set out at somelength, and it is evident that considerable importance isattached to the question of the association of diseases inthe lower animals with the health of man, the inspectionand supervision of dairies, cowsheds, milkshops, and

slaughter-houses receiving much attention. During theyear house accommodation was newly provided for 9C3families, in 217 self-contained houses and 3i3 houses of twoflats each ; and perusal of the defects, which were notedwhen the plans were first submitted to the corporation,shows that increasing attention is being given to this im-portant subject of the wholesome housing of the workingclasses.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 3898 birthsand 5186 deaths were registered during the week endingDec. 27th. The annual rate of mortality in these towns,which had been 21’3 and 21-5 per 1000 in the precedingtwo weeks, further rose to 27’8 last week. The rate was26’3 in London and 29.1 in the twenty-seven provincial towns.During the past thirteen weeks of the current quarterthe death-rate in the twenty-eight towns averaged 21’6per 1000, and exceeded by 0’6 the mean rate in thecorresponding periods of the ten years 1880-89. The lowestrates in these towns last week were 15’2 in Brighton, 16’6in Hull, 20’7 in Derby, and 21-8 in Plymouth; the

highest rates were 34-9 in Liverpool, 41-3 in Halifax,43’6 in Manchester, and 44.6 in Preston. The deathsreferred to the principal zymotic diseases, which hadincreased from 430 to 511 in the preceding four weeks,declined again last week to 472; they included 199 frommeasles, 90 from whooping-cough, 55 from diphtheria, 51from scarlet fever, 39 from " fever" (principally enteric),38 from diarrhcea, and not one from small-pox. No daathsfrom these diseases were recorded in Plymouth, Wolver-hampton, Derby, and Hull; while they caused the highestdeath-rates in Sheffield, Bolton, Bristol, and Preston. Thegreatest mortality from measles occurred in Birkenbead,Manchester, Salford, Bolton, Bristol, and Preston; from

scarlet fever in Preston, Sunderland, and IT alifax; andfrom whooping-cougit in Norwich, Cardiff, and Sunderland. The mortality from "fever" showed no markedexcess in any of the twenty-eight towns. The 55deaths from diphtheria included 31 in London, 5 inManchester, 5 in Portsmouth, 2 in Norwich, and 2 in

Birmingham. No death from small-pox was registeredin any of the twenty-eight towns ; and no small-poxpatients were under treatment in the Metropolitan Asylum.Hospitals or in the Highgate Small-pox Hospital on

Saturday last. The number of scarlet fever patients inthe Metropolitan Asylum Hospitals and in the LondonFever Hospital at the end of last week was 1685, againstnumbers declining from 2122 to 1752 on the precedingseven Saturdays; the patients admitted during the weekwere 78, against 125 and 108 in the previous two weeks.The deaths referred to diseases of the respiratory organs.in London, which had increased in the preceding three-weeks from 444 to 753, further rose last week to 806, andexceeded the corrected average by 296. The causes of 14(-or 2’8 per cent., of the deaths in the twenty-eight townswere not certified either by a registered medical practi-tioner or by a coroner. All the causes of death were dulycertified in Leicester and Derby. The largest proportions’of uncertified deaths were recorded in Salford, Shenield,Huddersfield, and Liverpool.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns;.which had been 20’1 and 20’9 per 1000 in the precedingtwo weeks, further rose to 24’6 during the week ending.Dec. 27th, but was 3-2 per 1000 below the rate that prevailedduring the same period in the twenty-eight large Englishtowns. The rates in the eight Scotch towns ranged from16.6 in Leith and 19’4 in Aberdeen to 28’7 in Paisley and29’1 in Glasgow. The 637 deaths in the eight Scotchtowns showed an increase of 71 upon the number in thepreceding week, and included 22 which were referred towhooping-cough, 19 to measles, 9 to diphtheria, 8 to

diarrhcea, 7 to "fever," 5 to scarlet fever, and not one tosmall-pox. In all, 70 deaths resulted from these principalzymotic diseases, against 46 and 54 in the preceding two.weeks. These 70 deaths were equal to an annual rateof 2’7 per 1000, which was 0.4 above the can rate lastweek from the same diseases in the twenty-eight Englishtowns. The fatal cases of whooping-cough, which had been16 and 12 in the preceding two weeks, rose again lastweek to 22, of which 13 occurred in Glasgow and 5 in Edin- burgh. The deaths from measles, which had been 12 and11 in the preceding two weeks, rose again to 19 last week,and included 8 in Glasgow and 8 in Greenock. The 9fatal cases of diphtheria showed a slight further increaseupon those recorded in recent weeks, and included 4 inGlasgow. The deaths referred to "fever," which had been 2and 6 in the preceding two weeks, further rose last weekto 7, of which 4 occurred in Edinburgh and 2 in Glasgow.The 5 fatal cases of scarlet fever included 3 in Glasgowand 2 in Aberdeen. The deaths referred to diseases of therespiratory organs in the eight towns, which had been137 and 139 in the preceding two weeks, further roselast week to 182, but were 7 below the number in thecorresponding week of last year. The causes of 69, or nearly11 per cent., of the deaths in the eight towns last weekwere not certified.

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HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 25-6 and 28.2per 1000 in the preceding two weeks, further rose to 31.3during the week ending Dec. 27th, and exceeded the raterecorded in any week since February last. During the past.thirteen weeks of the current quarter the death-rate in thecity averaged 24’3 per 1000, the rate for the same periodbeing 20.6 in London and 18-6 in Edinburgh. The 212deaths in Dublin showed an increase of 21 upon thenumber in the preceding week, and included 6 whichwere referred to different forms of "fever," 4 to whooping-cough, one to diarrhoea, and not one either to small-pox,measles, scarlet fever, or diphtheria. Thus the deaths from theprincipal zymotic diseases, which had declined in the preced--ing four weeks from 17 to 9, were 10 last week; they wereequal to an annual rate of 1 -6 per 1000. the rate from the samediseases being 2-3 in London and in Edinburgh. The deathsreferred to " fever," which had been 5 and 4 in the previoustwo weeks, rose again last week to 6. The fatal cases of

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whooping-cougb, which had been 4 and 1 in the preceding-two weeks, rose again to 4 last week. The 212 deaths inthe city included 33 of infants under one year of age, and59 of persons aged upwards of sixty years ; the deaths bothof infants and of elderly persons exceeded the number re-- corded in the preceding week. Four inquest cases and.3 deaths from violence were registered; and 70, or nearly-a third, of the deaths occurred in public institutions.The causes of 21, or nearly 10 per cent., of the deathsin the city were not certified.

THE SERVICES.

ARMY MEDICAL STAFF. - Brigade Surgeon Edward’Corrigan Markey, C.B., to be Deputy Surgeon-General,ranking as Colonel, vice J. Landale, M.D., retired (datedDee.lOth,1890); Surgeon-Major John Maturin, F.R.C.S.I.,Tanking as Lieutenant- Colonel, to be Brigade Surgeon, viceE. C. Markey, C.B. (dated Dec. 10th, 1890); Surgeon-MajorHamilton George Gardner, M.B., retires from the Service,receiving a gratuity (dated Dec. 24th, 1890).NAVAL MEDICAL SERVICE.-The following appointments

have been made at the Admiralty:—Deputy Inepector-’General Alexander Turnbull to Hong.Kong Hospital (datedDec.- 20th 1890); Surgeons John Lowney and Henry F.Illiewicz to the Du7.-e of Wellington, additional for disposal(dated Dec. 29th, 1890).

Correspondence.

THE MIDWIVES’ REGISTRATION BILL.

°‘ Audi alteram partem."

To the Eclitors of THE LANCET.SIRS,—As this Bill is now before Parliament and may possi-

bly become law in some shape or other, and as the subject it’deals with is important, I venture to trespass on your space,the more so as, having had great experience in the trainingof midwives, I can speak with some confidence on the’subjectThe Bill, in my opinion, is not alone objectionable in

many of its details, but is radically wrong as being foundedon a false principle. Its title indicates this, and the framers’evidently think that "registration is all that is neededto improve the present class of midwives, whereas the

, "education" of these women should be first thought of,and registration, if it comes at all, should not come intooperation immediately, or indeed till after the lapse of atleast some years. What would have been thought if Parlia-ment had passed the Medical Registration Act before’medical schools or licensing bodies had been establishedand in full working order, so that all who desired to prac-tise had an opportunity of obtaining the necessary educa-tion and qualifications to fit them for so doing ? Yet this iswhat the advocates of the Bill under consideration wantnow to do.No one can more sincerely desire that the education of

midwives should be improved than I do, but I protestagainst their being registered at all until it is shown thatmeans exist for educating them, that their education beconducted under the supervision of properly qualifiedmedical men, and that when this has been completed theybe examined by persons in whom both the public and theprofession have confidence. The Bill under considerationdoes not in reality provide for any one of these essentials. Itis, as its title states, simply a " Registration Bill," with thisaddition, that the General Council, or, failing it, the Privy’Council, shall make rules for the admission to examinationand course of study to be pursued previously &c. ; but notone word as to when, for how long, how, or by whom thesewomen are to be educated, while the proposed examinationis certain to be most unsatisfactory.

If the Bill become law it is evident that a large numberof women will at once seek to be educated as midwives. Towhom are they to apply for this purpose ? What qualifiedstaff of teachers exists? If facilities for their education donot exist, it is manifest that either—(&agr;) it will be impos-sible for them to pass the examination, assuming it to be of

a standard sufficient to prove that they possess the necessary" knowledge and skill" which the Act is assumed to require ;(b) or that the examination will become a mere form, if not afarce ; or (c) that the number of women passing it will beso few that the number of midwives who become registeredwill be altogether inadequate to supply the demand. Myown opinion is that the second of these alternatives willprove to be the actual result, and that the Act will havethe eft’ect of actually inflicting an injury on the public, forthe women who at present act as midwives are known tobe uneducated, and possess no title to pose as beingeducated, whereas those who become registered will producetheir certificates of registration, and will pose as qualifiedpractitioners in midwifery ; while all the time they will be inno way superior to their predecessors save in this: that theymay have picked up a few medical terms, by the use ofwhich they may further impose on the illiterate pooramongst whom they will chiefly practise.But let it be assumed that the difficulties as to education

and examination are got over, and that a sufficient numberof educated or partly educated women are annually put on;the register, it will be admitted out of the thousands of mid-wives on it a good many will be guilty, or at leastbeaccused ofbeing guilty, of "drunkenness," "incompetence," "infamousor disgraceful conduct," or of some of the causes for whichtheir names are to be erased from the register. The PrivyCouncil are " to make regulations" " for providing" for theerasing of the names of those convicted of being guilty.But by whom are the charges to be investigated, where are-they to be heard, and by whom is the cost to be defrayed?A magistrate or county court judge would manifestly beunfitted to investigate the purely professional matterswhich would crop up in all and be the chief ground for thecharge in the majority of the cases. Of necessity thereshould be some form of medical court or courts: not theGeneral Medical Council; it would not undertake the office.The court should be composed of, or at least in the chiefdegree consist of, medical men of experience and repute,who must be adequately paid for their services. It must beeasy of access, for it would be unjust to compel a midwifeto lose time and incur expense in travelling long distances.The members of this court would have a most irksome anddifficult task to perform, and the expense attending itwould be proportionally great; but unless they dischargetheir duties efficiently a number of most unworthyand dangerous midwives would be allowed to practise,not alone with the authority given them by holdingthe certificate of registration, but also with almostabsolute impunity, for the Bill contains this extraordi-nary provision, that "no private person, except withthe consent of the Attorney - General or of a CountyCouncil," may prosecute a registered midwife. Imagine thecase of some poor labourer whose wife has died from theincompetency or in conqequence of drunkenness of a mid-wife. How could he apply to the Attorney-General or havehis voice heard in the County Council ? No such protectionis extended to registered medical men. Why should it beto midwives ? ’?Next, how will the register be kept accurate ? The

Registrar of the General Medical Council will testify to thedifficulty in this respect in the case of medical practitioners,all educated men and comparatively few in number. Whatwill be the case of these nearly illiterate women, who willbe likely to change their residences frequently, and howwill personation be prevented ?But perhaps the greatest objection to the proposed

system of registration of midwives is this, "that everywoman who at the passing of the Act is 6o.’:« fide acting asa midwife shall be registered, provided she claims to be sowithin eighteen months. She may be a drunkard, she maybe grossly ignorant, may have carried infection from houseto house, regardless of the deaths which have followed in herwake, yet she is at once to be placed on the register, andher certificate of registration will be by the public acceptedas a qualification to practise, and she will, moreover, prac-tise with the impunity which the provisions of the Bill willconfer. It will be said that to exclude these women wouldbe unfair, as amongst them will be some fitted to act asmidwives. But why inflict an injury on the public forthe sake of a few deserving ones, espacially when regis-tration is at best a very doubtful advantage, and underexisting circumstances a positive evil? This leads me to thequestion, Is registration of midwives necessary at all? Ihave endeavoured to show that it is doubtful if it will lead’