2
1228 civil labourers on first effecting a landing on an enemy’s soil. What might possibly meet the occasion would be a large and well-organised body for executive conservancy work in connexion with the Quartermaster-General’s department. RESERVE OF STORES. 16. The reserve medical stores kept on hand must obviously be calculated on the number of army corps or force main- tained on the home establishment as efficient, ready, and designed for the express purpose of offensive warfare. It is equally obvious that the most portable and compressed forms of medicine and drugs must largely enter into the list of preparations intended for field service, that the number and variety of these must be restricted to those of well- known and established reputation, and that medical officers and others must learn that bodies of troops operating in the field cannot be accompanied on service by a section of wholesale dispensing chemists and their drugs, and that what may be termed a " great run" on any particular drug when others would suffice equally well has to be carefully avoided. It is a question whether a certain amount of shipping trans- port could not be placed entirely at the disposal of the Director-General, so that medical stores, accompanied by’ a supercargo provided with lists of everything on board, could be sent out in the transports and hospital ships for field service use. LIGHTENING OF CLERICAL WORK IN THE FIELD. 17. The conduct of the business transactions connected with field service seems to us to be susceptible of improvement in the way of more directness of aim and simplification, and this might be effected by taking a leaf out of the method adopted in civil life, as at the various Coöpera- tive Stores, for example. With the view of instru0ting medical officers, the officers of the supply departments, and all concerned with the field medical arrangements, as well as with the object of decreasing the amount of clerical labour and of facilitating the conduct of business as far as practicable, a portable handbook or 7-MM of these arrangements should be published by authority and used as a general guide. This should be issued on the order for mobilisation and be considered as binding on all concerned during a campaign. It should not only succinctly set forth the different scales of hospital equipment provided, but the different sources of supply to which requisitions and applica- tions have to be addressed, together with condensed notes of a practical character. This was, we believe, done with practical advantage on the occasion of some of the Afghan campaigns. A pricis of field medical arrangements was published under the sanction, and with the authority, of the I military department of the Government of India. Every medical officer should be supplied with a copy of such a I portable handbook as we are referring to, with a carbon book for making short communications and requisitions on depart- ments, a small almanac-diary, and a medical certificate form-book, these should be all that are personally necessary for his use. Other documents and forms of returns could be kept at the field, stationary, arid general hospitals. With the agency of the carbon book a duplicate of any com- munication or requisition addressed to individuals would be preserved, and these, with the entries in the diary, would remain as a permanent recotd, so far as they went, of the medical transactions in the field and could be handed in as so many vouchers at the end of a campaign. All that related to more elaborately prepared documents and returns con- nected with the official medical transactions and history of the war should be relegated to the hospitals furnished with a more or less permanent staff of medical officers and pro- vided with the requisite clerical aid. TREATMENT OF CONVALESCENTS. 18. Among the subjects which might be usefully taken up for consideration at the present time, when a large i number of invalids have already returned, or are returning. from the war, is the question of the greater utilisation of military hospitals and barracks situated in favourable districts for convalescing soldiers requiring change of air and for such as need special hospital accommodation and treat- ment-the open-air treatment of pulmonary tuberculosis, for example. The sites occupied by some of the Government hospitals and buildings are so salubrious and good that it seems to be a pity to restrict the advantages to the sick, suffering for the most part from trifling ailments, drawn from the troops quartered in the neighbourhood. We have not yet heard of any movement in the army in the direction of the open-air treatment so successfully adopted in certain forms ot pulmonary disease. HOME MILITARY HOSPITALS. 19. The opportunity should be taken in the interest of the sick soldier to inquire into the subject of the management of home military hospitals, concerning which an article by Mr. W. Pagin Thornton of Canterbury was recently published in these columns.1 As Mr. Thornton’s paper professes to be largely based upon a statement ot facts and sets forth the results of a personal experience acquired in a military hospital it seems to us to be well deserving of attention at the present time. MEDICAL PRACTITIONERS AND UNQUALI- FIED (PHARMACEUTICAL) ASSISTANTS. A JOINT meeting of the Glasgow Southern Medical Society, the Glasgow and West of Scotland Branch of the British Medical Association, and the Glasgow Eastern Medical Society was held in Glasgow on April 17th, Dr. WILLIAM WATSON, President of the Glasgow Southern Medical Society, being in the chair. It was unanimously resolved that the following memorial should be forwarded to the General Medical Council :- That the memorialists are medical practitioners in Glasgow and the West of Scotland and have a right at common law, in virtue uf their degrees granted by the Scottish universities and of their diplomas granted by the three qualifying corporations of Scotland, to sell drugs and poisons, including the scheduled poisons under the Pharmacy Acts. That the liberty of selling drugs and poisons (except scheduled poisons) belongs to every British subject and the memorialists are under no disability in this respect merely because they are members of the medical profession. That the rights and privileges of the memorialists as medical practitioners to sell drugs and poisons, including the scheduled poisons, are expressly reserved by Parliament (32 & 33 Vict., cap. 117, section 1). That the memorialists have learned with surprise and alarm of a conviction of a registered medical practitioner on a charge in the following terms: "That he, being a registered medical practitioner, habitually employed as assistants for the sale of drugs and poisons persons who are not qualified to act as chemists or pharmaceutical assistants, and thereby causes such persons to commit breaches of the Pharmacy Acts." The conviction is said to have been that the registered medical practitioner in question was guilty of "infamous conduct in a pro- fessional respect." The memorialists are bound to assume that conduct of a grave and reprehensible character was proved to the satisfaction of the General Medical Council before such a conviction could take place, but of the facts proved and the arguments used they have no knowledge. That a general impression has gone abroad that the only evidence against the registered medical prac- titioner in question was evidence in support of the charge as quoted, and that on this charge he was convicted of infamous conduct it a professional respect. That this view of the matter is publicly stated and commented on in trade journals, such as the Pharmaceutical Journal of Dec. 8th, 1900, and the Chemist and Druggist of the same date, and no secret is made of the meaning of such a judgment-viz., altogether to deprive medical practitioners of the right to sell drugs and poisons. In the view of the memorialists this is an illegal and unwarrantable interference with the memorialists’ rights, and they do not believe that the General Medical Council intended to lay down any such general doctrine or to impose any such disability. That a difference of opinion formerly existed as to the true interpretation of section 15 of the Pharmacy Act, 1868, some holding that the person who eommits the offence under that section is the person who keeps open shop, to whom the poisons belong, and on whose behalf the sale is effected ; others holding that the only offender under that section is the actual salesman. The latter view has received judicial sanction both in England and in Scotland, with the result that the salesman and not the owner of the shop is the person liable. That if the judg- ment of the General Medical Council in the case of the registered medical practitioner above referred to is to be regarded as a general statement of their views as to the responsibility of medical prac- titioners, it amounts to a reversal of the decisions of the law courts when interpreting section 15 of the Pharmacy Act. 1868. It makes the owner of the shop liable for offences under that Act, whereas the law has decided that the salesman and not the owner is the person liable. That unoer section 15 of the Pharmacy Act, 1868, a certain statutory penalty is imposed upon persons infringing-viz., a fine of .E5; but the decision of the General Medical Council not only imposes a penalty upon persons not struck at by that section of the Act, but also imposes an entirely new penalty-viz., deprivation. Where Parliament has prescribed the penalty to be attached to any Act it is incompetent for the General Medical Council, or any other body except Parliament, to alter or increase the penalty. To subject registered medical prac- titioners to the risk of being struck off the Register because a salesman of theirs sells drugs or poisons is unauthorised by any Act of Parliament and is an unconstitutional assumption of statutory auth. rity on the part of the General Medical Council. That the memo- rialists are not concerned to defend any medical practitioner who authorises his assistants to sell scheduled poisons. They recognise that, as the law stands, the utmost care should be taken to prevent such sales by anyone not duly authorised. But even in such an 1 THE LANCET, March 30th, 1901, p. 958.

MEDICAL PRACTITIONERS AND UNQUALIFIED (PHARMACEUTICAL) ASSISTANTS

Embed Size (px)

Citation preview

Page 1: MEDICAL PRACTITIONERS AND UNQUALIFIED (PHARMACEUTICAL) ASSISTANTS

1228

civil labourers on first effecting a landing on an enemy’s soil.What might possibly meet the occasion would be a largeand well-organised body for executive conservancy work inconnexion with the Quartermaster-General’s department.

RESERVE OF STORES.16. The reserve medical stores kept on hand must obviously

be calculated on the number of army corps or force main-tained on the home establishment as efficient, ready, anddesigned for the express purpose of offensive warfare. It is

equally obvious that the most portable and compressedforms of medicine and drugs must largely enter into the listof preparations intended for field service, that the numberand variety of these must be restricted to those of well-known and established reputation, and that medical officersand others must learn that bodies of troops operating inthe field cannot be accompanied on service by a section ofwholesale dispensing chemists and their drugs, and that whatmay be termed a " great run" on any particular drug whenothers would suffice equally well has to be carefully avoided.It is a question whether a certain amount of shipping trans-port could not be placed entirely at the disposal of theDirector-General, so that medical stores, accompanied by’a supercargo provided with lists of everything on board,could be sent out in the transports and hospital ships forfield service use.

LIGHTENING OF CLERICAL WORK IN THE FIELD.

17. The conduct of the business transactions connected withfield service seems to us to be susceptible of improvementin the way of more directness of aim and simplification,and this might be effected by taking a leaf out of themethod adopted in civil life, as at the various Coöpera-tive Stores, for example. With the view of instru0tingmedical officers, the officers of the supply departments,and all concerned with the field medical arrangements,as well as with the object of decreasing the amount ofclerical labour and of facilitating the conduct of business asfar as practicable, a portable handbook or 7-MM of thesearrangements should be published by authority and usedas a general guide. This should be issued on the order formobilisation and be considered as binding on all concernedduring a campaign. It should not only succinctly set forththe different scales of hospital equipment provided, but thedifferent sources of supply to which requisitions and applica-tions have to be addressed, together with condensed notesof a practical character. This was, we believe, done withpractical advantage on the occasion of some of the Afghancampaigns. A pricis of field medical arrangements waspublished under the sanction, and with the authority, of the Imilitary department of the Government of India. Everymedical officer should be supplied with a copy of such a I

portable handbook as we are referring to, with a carbon bookfor making short communications and requisitions on depart-ments, a small almanac-diary, and a medical certificateform-book, these should be all that are personally necessaryfor his use. Other documents and forms of returns couldbe kept at the field, stationary, arid general hospitals.With the agency of the carbon book a duplicate of any com-munication or requisition addressed to individuals would bepreserved, and these, with the entries in the diary, wouldremain as a permanent recotd, so far as they went, of themedical transactions in the field and could be handed in as somany vouchers at the end of a campaign. All that relatedto more elaborately prepared documents and returns con-nected with the official medical transactions and history ofthe war should be relegated to the hospitals furnished with amore or less permanent staff of medical officers and pro-

vided with the requisite clerical aid.TREATMENT OF CONVALESCENTS.

18. Among the subjects which might be usefully takenup for consideration at the present time, when a large inumber of invalids have already returned, or are returning.from the war, is the question of the greater utilisation of

military hospitals and barracks situated in favourabledistricts for convalescing soldiers requiring change of air andfor such as need special hospital accommodation and treat-ment-the open-air treatment of pulmonary tuberculosis, forexample. The sites occupied by some of the Governmenthospitals and buildings are so salubrious and good that itseems to be a pity to restrict the advantages to the sick,suffering for the most part from trifling ailments, drawnfrom the troops quartered in the neighbourhood. We havenot yet heard of any movement in the army in the direction

of the open-air treatment so successfully adopted in certainforms ot pulmonary disease.

HOME MILITARY HOSPITALS.19. The opportunity should be taken in the interest of

the sick soldier to inquire into the subject of the

management of home military hospitals, concerning whichan article by Mr. W. Pagin Thornton of Canterburywas recently published in these columns.1 As Mr.Thornton’s paper professes to be largely based upon a

statement ot facts and sets forth the results of a personalexperience acquired in a military hospital it seems to usto be well deserving of attention at the present time.

MEDICAL PRACTITIONERS AND UNQUALI-FIED (PHARMACEUTICAL) ASSISTANTS.

A JOINT meeting of the Glasgow Southern Medical Society,the Glasgow and West of Scotland Branch of the BritishMedical Association, and the Glasgow Eastern Medical

Society was held in Glasgow on April 17th, Dr. WILLIAMWATSON, President of the Glasgow Southern Medical

Society, being in the chair.It was unanimously resolved that the following memorial

should be forwarded to the General Medical Council :-That the memorialists are medical practitioners in Glasgow and the

West of Scotland and have a right at common law, in virtue uf theirdegrees granted by the Scottish universities and of their diplomasgranted by the three qualifying corporations of Scotland, to sell drugsand poisons, including the scheduled poisons under the PharmacyActs. That the liberty of selling drugs and poisons (except scheduledpoisons) belongs to every British subject and the memorialists areunder no disability in this respect merely because they are members ofthe medical profession. That the rights and privileges of thememorialists as medical practitioners to sell drugs and poisons,including the scheduled poisons, are expressly reserved by Parliament(32 & 33 Vict., cap. 117, section 1). That the memorialists havelearned with surprise and alarm of a conviction of a registered medicalpractitioner on a charge in the following terms: "That he, being aregistered medical practitioner, habitually employed as assistants forthe sale of drugs and poisons persons who are not qualified to act as

chemists or pharmaceutical assistants, and thereby causes such personsto commit breaches of the Pharmacy Acts." The convictionis said to have been that the registered medical practitionerin question was guilty of "infamous conduct in a pro-fessional respect." The memorialists are bound to assume

that conduct of a grave and reprehensible character was provedto the satisfaction of the General Medical Council before such aconviction could take place, but of the facts proved and the argumentsused they have no knowledge. That a general impression has goneabroad that the only evidence against the registered medical prac-titioner in question was evidence in support of the charge as quoted,and that on this charge he was convicted of infamous conduct it aprofessional respect. That this view of the matter is publicly statedand commented on in trade journals, such as the PharmaceuticalJournal of Dec. 8th, 1900, and the Chemist and Druggist of the samedate, and no secret is made of the meaning of such a judgment-viz.,altogether to deprive medical practitioners of the right to sell drugsand poisons. In the view of the memorialists this is an illegal andunwarrantable interference with the memorialists’ rights, and they donot believe that the General Medical Council intended to lay down anysuch general doctrine or to impose any such disability. That adifference of opinion formerly existed as to the true interpretation ofsection 15 of the Pharmacy Act, 1868, some holding that the personwho eommits the offence under that section is the person who keepsopen shop, to whom the poisons belong, and on whose behalf the sale iseffected ; others holding that the only offender under that section isthe actual salesman. The latter view has received judicial sanctionboth in England and in Scotland, with the result that the salesmanand not the owner of the shop is the person liable. That if the judg-ment of the General Medical Council in the case of the registeredmedical practitioner above referred to is to be regarded as a generalstatement of their views as to the responsibility of medical prac-titioners, it amounts to a reversal of the decisions of the law courtswhen interpreting section 15 of the Pharmacy Act. 1868. It makes theowner of the shop liable for offences under that Act, whereas the lawhas decided that the salesman and not the owner is the person liable.That unoer section 15 of the Pharmacy Act, 1868, a certain statutorypenalty is imposed upon persons infringing-viz., a fine of .E5; but thedecision of the General Medical Council not only imposes a penaltyupon persons not struck at by that section of the Act, but also imposesan entirely new penalty-viz., deprivation. Where Parliament hasprescribed the penalty to be attached to any Act it is incompetent forthe General Medical Council, or any other body except Parliament, toalter or increase the penalty. To subject registered medical prac-titioners to the risk of being struck off the Register because asalesman of theirs sells drugs or poisons is unauthorised by any Actof Parliament and is an unconstitutional assumption of statutoryauth. rity on the part of the General Medical Council. That the memo-rialists are not concerned to defend any medical practitioner whoauthorises his assistants to sell scheduled poisons. They recognisethat, as the law stands, the utmost care should be taken to preventsuch sales by anyone not duly authorised. But even in such an

1 THE LANCET, March 30th, 1901, p. 958.

Page 2: MEDICAL PRACTITIONERS AND UNQUALIFIED (PHARMACEUTICAL) ASSISTANTS

1229

event they cannot but view with alarm the attempt now being made oto hold one person liable for a statutory offence committed by another 3and to visit such liability with so severe a penalty as is contemplated-viz., deprivation. If it be right, in the interest of the public, thatthis new and grave responsibility should be imposed on medical prac- ’Ttitioners, this can only be done by Parliament and after full comidera- t;tion of the interests involved. That in all the matters which havebeen already referred to the medical practitioners are in precisely the dpsame position as Members of the Pharmaceutical Society. They are dentitled to employ unqualified assistants but such assistants must not 1sell scheduled poisons. It is impossible to teach the business of

Cdispensing without employing unqualified assistants, and subject to Ithe common law responsibility of the shopkeeper for any blunderswhich the assistant may make and the statutory responsibility of thesalesman himself, there is no restriction upon the emplosment ofsuch assistants, whether apprentices or not. The memorialists cannotconceive that what is permissible on the part of a pharmaceuticalchemist can be "infamous conduct in a professional respect" on thepart of a medical practitioner. That in some quarters the decision of .

the General Medical Council has been interpreted to mean that where Ian unqualified assistant has been convicted under the Pharmaceutical EActs of selling a scheduled poison he should, in addition to the jpenalty imposed by Section 15 of the Act of 1868, be subjectedto the further penalty of instant dismissal at the hands of his employer; and that a failure on the part of an employer so to dismiss 7an offending assistant amounts to "infamous conduct in a professional ]respect." This view of the decision is open to the same objection as ihas been already urged-viz., that it adds a new and arbitrary penaltyto the penalty imposed by Act of Parliament. But it is open to the ’further objection that failure on the part of the employer to do whatno law requires, and what in many cases may be a very harsh act, is tobe treated as infamous conduct. Speaking generally, no omission ofthat kind can be properly so characterised. Infamous conduct mustconsist of some overt act, not any omission. But, apart from this, itcan never be infamous to omit to do what no law requires to bedone.

The memorialists, therefore, respectfully submit that this mattershould be reconsidered and that, whatever be the specialcircumstances justifying the decision in the case of the regis-tered medical practitioner above referred to, no generaldoctrine should be laid down to the effect that the employ-ment by a registered medical practitioner of an unqualifiedperson to sell drugs and poisons is "infamous conduct in aprofessional respect."

It was also agreed that the following gentlemen shouldbe appointed a deputation to support the memorial before theGeneral Medical Council-viz., Dr. John Lindsay Steven, Dr.Russell, Dr. C. E. Robertson, Dr. David Young, Dr. WilliamWatson, Dr. John Stewart, Dr. J. H. Nicoll, and Dr. JohnF. Orr.

___ _______

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 7385 births and 4159deaths were registered during the week ending April 20th.The annual rate of mortality in these towns, which had been19’2 per 1000 in each of the two preceding weeks, declinedto 184 per 1000 last week. In London the death-ratewas 17’5 per 1000, while it averaged 19-0 per 1000 in the32 large provincial towns. The lowest death-rates in thesetowns were 10 8 in Burnley, 11-2 in Halifax, 11-9 in WestHam, and 12’3 tin Cardiff ; the highest rates were 22-7 inManchester, 22 9 in Liverpool, 23-7 in Nottingham,and 25-4 inWolverhampton. The 4159 deaths in these towns included 346which were referred to the principal zymotic diseases, against380 and 397 in the two preceding weeks ; of these, 117 resultedfrom measles, 108 from whooping-cough, 39 from diphtheria,33 from diarrhceal diseases, 27 from "fever" (principallyenteric), 20 from scarlet fever, and two from small-pox.No death from any of these diseases was registered lastweek in Croydon, Plymouth, Huddersfield, or Halifax ; in theother towns they caused the lowest death-rates in Norwich,Birkenhead, Oldham, and Newcastle, and the highest ratesin Hull, Sunderland, and Gateshead. The greatest pro-portional mortality from measles occurred in Portsmouth,Liverpool, Bolton, Blackburn, Leeds, and Sunderland ; fromscarlet fever in Blackburn ; and from whooping-cough inBristol, Hull, and Sunderland. The mortality from " fever "and from diarrhoeal diseases showed no marked excess

in any of the large towns. The 39 deaths fromdiphtheria included 11 in London, four in Bristol, fourin Manchester, three in Leeds, and three in Sheffield.Two fatal cases of small-pox were recorded in Hull, butnot one in any other of the 33 large towns ; and no small-pox patients remained under treatment in any of theMetropolitan Asylums hospitals on Saturday, April 20th.The number of scarlet fever patients in these hospitalsand in the London Fever Hospital at the end of theweek was 1526, against 1568, 1572. and 1601 on the threepreceding Saturdays ; 150 new cases were admittedduring the week, against 167, 180, and 205 in thethree preceding weeks. The deaths referred to diseases

of the respiratory organs in London, which had been360 and 345 in the two preceding weeks, rose again lastweek to 374, but were slightly below the corrected average.The causes of 39, or 09 per cent., of the deaths inthe 33 towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in West Ham, Bristol, Bradford, Leeds, and16 other smaller towns ; the largest proportions of un-certified deaths were registered in Birmingham, Liverpool,Hull, and Gateshead.

-- ---

HEALTH OF SOOTOH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 24’1 and 23 per 1000 in the two preced-ing weeks, further declined to 23 0 per 1000 during the weekending April 20th, but showed an excess of 46 per 1000 overthe mean rate during the same period in the 33 largeEnglish towns. The rates in the eight Scotch towns

ranged from 18’5 in Perth and 20’5 in Aberdeen to 26-7. in Greenock and 28-3 in Dundee. The 722 deaths! in these towns included 56 from whooping-cough,B 23 from diarrhoea, 21 from measles, 10 from small-, pox, four from "fever." two from scarlet fever, and one

; from diphtheria. In all, 117 deaths resulted from these

b principal zymotic diseases last week, against 102 and 95.b in the two preceding weeks. These 117 deaths were3 equal to an annual rate of 37 per 1000, which was 22rabove the mean rate last week from the same diseases in1 the 33 large English towns. The fatal cases of whooping-’ cough, which had been 57 and 51 in the two preceding. weeks, rose again last week to 56, of which 37 occurred:i in Glasgow, 14 in Edinburgh, two in Dundee, and twoa in Paisley. The deaths from diarrhoea, which had been

eight and 13 in the two preceding weeks, further increasedd to 23 last week, and included 12 in Glasgow, five in Edinburgh,e and four in Dundee. The fatal cases of measles, which had. been 16 and 17 in the two preceding weeks, further rose lastn week to 21., of which eight were registered in Edinburgh, five inn Dondee, four in Leith, and two in Glasgow. The deaths from

small-pox, which had been 10, five, and six in the three pre-ceding weeks, rose again last week to 10, and were allrecorded in Glasgow, where two of the four deaths fromI fever" and the two fatal cases of scarlet fever were alsoregistered. The deaths referred to diseases of the respira-tory organs in these towns, which had increased from 126

.

to 155 in the four preceding weeks, declined again to 130>9 last week, and were slightly below the number in theb.. corresponding period of last year. The causes of 34, orm nearly 5 per cent., of the deaths in these eight towns lastsd week were not certified.

___

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 31’9 and 35’6per 1000 in the two preceding weeks, declined again to 35’4 -during the week ending April 20th. During the pastfour weeks the death-rate in the city has averaged 34’2 per1000, the rates during the same period being 18-0 in Londonand 23’1 in Edinburgh. The 235 deaths of personsbelonging to Dublin registered during the week undernotice were within one of the number in the precedingweek, and included 18 which were referred to the prin-cipal zymotic diseases, against 12 and 15 in the two pre-ceding weeks ; of these, nine resulted from whooping-cough,four from diarrhoea, three from " fever," and two fromscarlet fever. These 18 deaths were equal to an

annual rate of 2’7 per 1000, the zymotic death-rateduring the same period being 1-5 in London and4’7 in Edinburgh. The fatal cases of whooping-cough,which had been five and eight in the two preceding weeks,further increased last week to nine. The deaths fromdiarrhoea, which had been one and three in the two pre-ceding weeks, further rose to four last week. The fatal casesof "fever," which had been four and two in the twopreceding weeks, rose again to three last week. The

mortality from scarlet fever corresponded with that in thepreceding week. The 235 deaths in Dublin last weekincluded 34 of children under one year of age and 65 ofpersons aged upwards of 60 years; the deaths both ofinfants and of elderly persons showed a slight decline from,the numbers recorded in the preceding week. Twelve inquestcases and six deaths from violence were registered ; and 98,or more than two-fifths, of the deaths occurred in publicinstitutions. The causes of 11, or nearly 5 per cent., of the

! deaths in the city last week were not certified.