984

merely on the information given by the relatives andwe have had evidence that many certificates havebeen carelessly or even recklessly given. It is no faultof the law if premature burials do not take place. Thepresent law of death certification offers every oppor-tunity for premature burial and every facility for theconcealment of crime."These vigorous statements justified the Federationof Medical and Allied Services in preparing a Billto change the law. In 1923 Sir FRANCIS FREMANTLE

presented the Bill in the House of Commons. It

required two certificates-a medical certificate ofthe fact of death and a certificate of the cause ofdeath-before death could be registered, and itinsisted that the fact of death must be certified

by a registered medical practitioner who hadviewed and examined the dead body, and wassatisfied that life was extinct. There is no need toelaborate the fact that mistake may easily be madeover the apparent manifestations of death. Thelate Sir FREDERICK TREVES published his recollec-tions of cases of this kind ; Sir GEORGE GREENWOODenumerated other cases in his pamphlet on theLaw of Death Certification. When Parliament

discussed the Federation’s proposals, the spokes-man of the Ministry of Health observed that, ifthere were a complete medical inspection in everycase as some people desired, it would mean heavyexpense, and " would set up a universal and

compulsory requirement for a very small chanceindeed." The Federation’s Bill was replaced byan official measure which became law in 1926.11The new Act contained no requirement as toexamination of the body after death, although inthe course of the debate someone quoted the

Registrar-General as having declared that " only40 per cent. of the people buried in this countryare certified on medical evidence actually to bedead." A fresh change in the law will come onthe day when some sensational case stirs publicopinion. The incident at Bootle was a genuinemistake with no serious consequences. As thecoroner observed, it would have been otherwiseif there had been any suspicion of foul play or anyevidence of heavy insurance.

1 See THE LANCET, 1926, ii., 1295.

ANNOTATIONS

PRESIDENTS AND PROPHECIES

WHEN, on Friday last, Oct. 20th, Dr. CharlesPorter, M.O.H. for the borough of St. Marylebone,delivered an address before the Society of MedicalOfficers of Health on his installation as president,he introduced a new responsibility for himself andhis successors in the important post by an inquisitioninto how far the things predicted in the expansivenessof such deliveries came afterwards to materialise.Dr. Porter was able to find in the earlier orationsmuch wisdom, and where his researches were notthus rewarded he made no detailed references. Butthe fact that, save in one or two instances, theforecasts of the presidents of the Society, since itsfoundation nearly 80 years ago, have not been muchor exactly borne out has a great implication, and onethat is at bottom a proof of the pace at which sanitaryscience has developed. As growth was rapid andprolific so it became impossible to foresee ramifica-tions. The failure to prophesy thus showed a

prophetic instinct, the instinct that unpredictablethings were at hand. The case of the first president,Sir John Simon, is different. He occupied the chairfor several years and whether he delivered a setaddress at the beginning of each session or no isuncertain ; our excellent contemporary Public Healthwas not founded as the journal of the Society until1888, before which date no precise records are forth-coming. But what Simon may have said can bededuced from what he did, and he was in thefavourable position for a prophet of being largelyable to bring about the things which he foresawwould conduce to the realisation of his views. Welearn from Dr. Porter that between the foundationof the Society in 1856 and the first issue of PublicHealth there were 15 presidential addresses delivered,and Dr. S. R. Lovett, who was president in 1894,gave in a retrospective resume the titles of these,from which one sees the extreme improbability thataccurate prophecies could be made. The funda-mental alterations in. scientific, economic, and socialactivities that were beginning to occur some 80 yearsago, and which have multiplied and gathered forceever since, must have constantly interfered with

accurate forecasting. It is clear that deliveriesupon such themes as the Cause of Disease, the

Sanitary Condition of Communities, or the ScientificWork of the M.O.H., could contain only vagueguesses, while new phases of pathology were becomingmanifested daily in an environment which was rapidlyrevolutionising itself. Among the great sanitarianswho were able in certain directions to look accuratelyinto the future, a place must be found for ShirleyMurphy, president in 1891-92, who foresaw the benefitsto health that would follow proper inspection ofanimal food-supplies while indicating the measures

needed for that end. Dr. Spottiswoode Cameron,also, who was president in 1902, was successful asa seer, his views in respect to housing and slumclearance having in certain directions been alreadyadopted. And Sir John Robertson, president in 1916,said in October of that fearful year that the causeof public health would be hastened and not retardedby the war, an outlook which has proved amplycorrect. Dr. Porter’s comments on the words ofhis predecessors brings out one striking thing: none

of the fine and experienced workers in public healthwho were presidents of the Society in the earlier

days ever seemed to contemplate the striking diminu-tions in the commoner infections that we now enjoyand that they were working to bring about; not oneof them would have dared to suggest the possibilityof such figures as our present vital statistics furnish.

THE DIAGNOSIS OF UNDULANT FEVER

UNDULANT fever, which many years ago was referredto by Nicolle as the " disease of the future," is nowbeing regarded as the disease of the present. Notonly in this country-where, according to Dalrymple.Champneys, actual records of about 190 cases havebeen obtained, and where, according to G. S. Wilson,serological evidence suggests an incidence of about500 cases a year-but also in other parts of Europeand in the United States of America it continues tocause the liveliest concern. Diagnosis is usuallymade on the basis of the agglutination reaction, atitre of 1/100 or over in a pyrexial patient who isnot in continual contact with infected animals, and