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CERTIFICATES OF STILL-BIRTH.

IT is somewhat remarkable that medical practitioners arenot furnished with printed forms of certificates of still-birth. Previously to the amended Itegistration Act of 1874such certificates were not legally requisite, and it wasoptional to give or withhold them. But in the Act justmentioned new clauses were introduced dealing with theburial of the bodies of still-births, and it was there enactedthat no infant’s body should be buried as that of a still-borninfant unless there was handed in to the official in chargeof the burial ground a medical certificate of still-birth fromthe practitioner who had been in attendance at the birth, froma medical practitioner who had examined the body, a burialorder from the coroner if an inquest had been held, or adeclaration from one of certain persons specified in the Actas competent to make such that the child was still-born.A very large proportion of all the bodies now buried asthose of still-births have been delivered by medical prac-titioners, who are called upon to certify to the still-birth,and the certificate thus furnished is a very important andvaluable document to all concerned. It is valuable to the

parents of the child, since it spares them much annoyance-possibly saves them from an inquest; it is important to thecemetery officials, since it is a guarantee that there has beenno unfair play, and that the body may be safely buried. Asthese certificates are not required for registration purposes, it isnot incumbent on the Registrar-General to provide printedforms. Nor can it be said to be the duty of cemeteryofficials to provide them. It is another illustration of every-body’s business being nobody’s business. To many practi-tioners who have a large obstetric practice, and to the residentsurgeons of lying-in charities and workhouses, such formswould be a great convenience, saving time, and enabling thecertifier to give all the requisite information in a compactform. Perhaps the deficiency may be sooner or later

supplied by the Local Government Board or the Home Office.Meantime, it might be worth the while of some enterprisingmedical publisher to issue some forms with counterfoils,and we would suggest the following one as a specimen :-

I hereby certify tha,t I delivered ——————, the wife of ,residing at , of a stillborn - infant,on the - day of -, 189 .

Signature Med. Qualifications

" BRADYCARDIA," OR SLOW ACTION OF THEHEART.

THE cases hitherto recorded of "slow heart" and the

inferences derived from them are not altogether satis-

factory, as many errors have arisen owing to the pulsehaving been only taken at the wrist and not compared withthe apex beat. E. RiegeP has made observations on 1047patients whose hearts beat less than sixty times per minute.Such a condition he terms " bradycardia." He divides hiscases into two large groups : 1. Physiological bradycardia.By this Riegel understands a slowing of the heart’s action,caused by, or in connexion with, some physiological con-dition. Under this head would come the "slow heart" "

occurring in puerperal states, also that which is found incases of starvation, and finally the bradycardia which issometimes observed as a constitutional peculiarity. Riegelhere remarks that many of the cases of this kind whichhave been reported are greatly open to question, as some ofthem were obviously due to some pathological cause.

2. Pathological bradycardia. There are several varietiesunder this head : (a) The slowing of the pulse noticed inconvalescence from a febrile affection. More than a

quarter of the whole number of cases were of this

1 Centralblatt für die Medicinischen Wissenschaften, 1890, No. 34.

kind. They were most commonly observed after recoveryfrom croupous pneumonia ; then, in order of frequency,after typhoid, erysipelas, and acute rheumatism. Traubeattributed this phenomenon to a state of general ex.

haustion. (b) Bradycardia in diseases of the digestive tract.In this division were 379 cases. It was most frequentlynoticed in affections of the stomach (ulcer, carcinoma, anddilatation). Such a result might have been inferred fromphysiological experiments ; for in animals an increase ofarterial tension with diminution in frequency of the pulsetakes place when the stomach is submitted to electric,mechanical, or thermic excitation, and is caused by a reflexaction of the vagus. The slow pulse of icterus probablydepends on the paralysing action on the cardiac ganglia bythe bile acids in the blood. When occurring in cases of

peritonitis, the bradycardia is probably of the nature ofthose cases described in the first division. 3. Bradycardiain diseases of the respiratory organs. In this class were 87cases. Some of them were during convalesence from

pleurisy; others after haemoptysis, or after the withdrawalof a large pleural exudation. 4. Bradycardia in cases

of disorders of the circulatory organs (47 cases). This

phenomenon appeared in fatty degeneration of the heartand when the coronary arteries were ossified, but it wasnever found as a constant symptom of any one diseaseof the heart ; it more often occurred when the heartwas flabby and insufficiently nourished. 5. Slow heartin diseases of the urinary organs ( 64 cases). Acute

nephritis was the most common disease in which it wasfound; the slowing of the pulse was always accom.

panied by increase of arterial tension, and was oftenthe earliest sign of the retention in the blood of the

urinary constituents, thus denoting the commencementof uraemia. 6. Bradycardia as a result of poisoning.Riegel noticed it in three cases of lead poisoning andin five cases of chronic alcoholism. 7. A pulse under60 per minute was noticed in 27 cases of anæmia and

chlorosis, in 1 case of extreme ansemia after lead poisoning,and in 3 cases of diabetes. 8. Bradycardia in diseases ofthe nervous system (93 cases). In many of these cases itwas thought to be due to reflex vagus action. In someinstances of disease of the central nervous system it wasprobably caused by direct vagus action ; in others

Riegel ascribed the symptom to disturbances of the circula-tion and blood-pressure in the brain ; and in the remainingnumber of cases no definite action could be distinguished.9. Bradycardia in other diseases. Under this head were17 cases of extreme fatigue and exhaustion, 1 case of sun-

stroke, 12 cases of skin diseases, and 17 of painful affections ofthe muscles.

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HEALTH IN RELATION TO WORK.

THE text of the lecture lately delivered at Brighton beforethe Sanitary Institute by Dr. B. W. Richardson, on the sub-ject of Health in relation to Work, has not yet appeared, butthe abstract of it has given the public journals sufficientexercise for comment, and, curiously enough, for commentthat, on the whole, indicates an almost unanimous expres-sion of acceptance favourable in kind. The cause of thisis not far to seek ; the lecture, simple in its method anddecisive in its meaning, was free of all political partisan-ship. It was intended as a lecture of applied science,and applied medical science, to a great and pressingsocial question. In response to the vote of thanksmoved to him by Sir Alexander Christison, and secondedby Mr. Law, C.E., the lecturer said : "If the ministersof health, the professors of medical science and art,do not understand the powers of the human bodyin regard to the mental and physical work which it cansafely perform, who do know ? " And the question discussed

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throughout-the key-note—was, "Can a, computation hemade as to the full strain which the human body and mind willbear without risk to health ? Has our knowledge advancedto the point when we can say to the legislator, to the

employer, and to the employed, so much per day can bemeasured out as compatible with health and natural

vitality, and no more ?" " Eight hours’ work out of the

twenty-four hours was, he urged, a fair standard ; notan absolute standard, because work varies in quality,but a good average. When mere phyeical work wasconsidered, Dr. Richardson held that twice the amountof involuntary work of the heart of a working adult

man-i.e., about 250 foot tons per day-was a fair maxi-mum ; but when to physical work mental strain was

superadded, as in the case of the engine-driver, then muchless physical work and shorter hours of labour were required.This was a new thought in the study of the labour question,and led to another which has rather startled some hearers.In speaking of recreation as a means of health, Dr.Richardson condemned the Bank Holiday on account of "itscrush, its shortness, its head’over heels character, and itsentire dependence on the weather for pleasure or for pain."The working man, he contended, ought to have his holiday,like other persons, wben he required it for his health’s sake,or for his relief from the cares and worry of life. It wasa doctor’s argument, and, addressed to those most con-cerned-the working classes,-might have been misinter-preted. Fortunately, it appeared to be thoroughly understoodby all, and on the part of many working men has beenaccepted with an approval which employers will not beslow to second. Bank Holiday as an interruption to busi-ness is as inconvenient to the community at large as it isinsufficient to those for whose benefit it was speciallydesired; and we trust that those ministers who have theduty of framing legislative measures will be inclined tofollow the ministers of health in trying to revise forthe general good the periods of recleation demanded

by the necessities of this too busy generation of workingmen of all grades and callings.

TREATMENT OF CHOLERA.

THE chief medical officer of the Spanish army has pub- Ilished in the Revista de Sanidad Militar an article on

cholera, in which he indicates the treatment that is, in hisopinion, most satisfactory. When cholera is epidemic allcases of diarrhoea ought to be attended to, and treated bymeans of large doses of subnitrate of bismuch. He woulda1so give 30 grs. or more of subacetate of lead in 4 oz.

of distilled or boiled water as an enema after each looseevacuation. In cholera no food should be given, but plentyof acidulated water (without sugar) and ice. Enemas ofseltzer water and champagne are useful. Soup, milk, jelly,and toast-water are worse than useless as long as thekidneys do not act, as they only serve as culture liquids forthe pathogenic microbe in the intestines. Bismuth isuseful in helping the faeces to form more or less solid massestogether with the septic products of the small intestine,and so retarding absorption in the large intestine. If the

stage of asphyxia or general infection comes on he advisesrecourse, if possible, to oxygen inhalations. Failingthese, or as additional methods of medication, rectaletherisation and a dose of antipyrin, administered eitherhypodermically or per rectum, may be tried. Other means,such as rubbing, hot-water bottles, hypodermic injectionsof ether, alcohol, caffeine-or of morphia when there is

vomiting,-though useful, must be considered entirelysubordinate to those first mentioned, of which the writerregards the inhalation of oxygen as the most valuable. Inorder to treat the kidney affection, which is so frequently

the cause of death, warm baths and poultices must beused, and when cerebral symptoms develop ice should beapplied to the head, and leeches to the mastoid processes.

COUNTY COUNCILS AND THEIR HEALTHREPORTS.

DR. GEORGE REID, medical officer of health to theStaffordshire County Council, has submitted to the Councila report which possesses distinct value, both for theinformation which it so usefully summarises for localpurposes and as a type of the material which such a reportmay properly embody. The county contains fifty-sevensanitary districts, of which thirty-five are urban and

twenty-two rural. From a statistical point of view thesedistricts are dealt with separately and collectively, and incertain instances, where conditions of disease can be COE-veniently contrasted, comparison is made between the ratesfrom certain special mortalities. In this way, for example,the influence of moisture on phthisis and the general effectof overcrowded and insanitary houses are set out, carebeing taken to refer to the material which has beensubmitted by local health officers in their several reports,and which has served for the comparisons made. At thesame time, a caution is very properly issued as to basingtoo much on mere death-rates in the case of small or

comparatively small populations, and especially when shortperiods are in question. The condition of the countyand of its component sanitary areas, as regards suchmatters as the pollution of streams, water-supply, drainage,prevalence of zymotic diseases, &c., is also set out, and in atabular form the information on a number of these points,and on the existence within the districts of means of isola.tion, is conveniently contrasted. Preventive measures are

suggested, and some record is given of sanitary work thathas been inaugurated or carried out. If year by year a.volume is issued similar to the one which Dr. Reid has pre-pared for 1889, the series will soon constitute a valuableaddition to the scientific literature of the county. In

striking contrast with the Staffordshire report is a briefone signed by the chairman of the General Purposes Com-mittee of the Somerset County Council. It compilescertain statistics as to births and deaths, taken from theseveral annual reports of the medical officers of health, andin a few brief words it refers to some views expressed bythese officers; and then follow a few short paragraphs onimpure water, imperfect drains, what are termed " malarialgases," and insanitary dwellings. Having done this, it isstated that unless necessary improvements in respect ofthese matters are carried out, it may become the duty ofthe Council to cause representations to be made to theLocal Government Board under Section 19 of the Act of1888. We imagine, however, that the central authoritywould want information of a very different sort to that putforth in this report before they would take any action onthe initiative of the County Council. Any action takenon reports dealing with medical administration should be-based on information so compiled as to show that it hasbeen the subject of skilled medical judgment.

NURSING AGENCIES.

THE best and most popular nursing agencies are, andprobably always will be, the great hospitals at which thenurses are trained ; but for private agencies there is un-doubted scope, and a private or cooperative agency has,from the nurse’s point of view, the marked advantageover most hospitals that it permits the nurse to receivefor her own benefit a much larger proportion of her

earnings. It is, on the other band, not easy for a privateagency to give equal guarantees of efficiency and character