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years 1893-1902 infantile mortality averaged 152 per a

1000 births. Of 24 countries or colonies furnishing the u

necessary data there were seven-viz., Italy, Chili, Ceylon, c

Prussia, Jamaica, Hungary, and Russia-where the average r

birth-rates ranged from 34.3 to 48-6 per 1000 of the 1

population and the average infantile mortality ranged from 170 to no less than 333 per 1000 births. On the other 1hand, in Scotland and in Norway, with comparatively highbirth-rates of about 30 per 1000, the average rates of in-

fantile mortality were as low as 127 and 94 respectively ineach 10U0 births. Of the 28 countries furnishing returnsFrance has the lowest average birth-rate, while the averagerate of infantile mortality in that country amounted to 158

per 1000 births. In 13 of the 16 countries contributingadditional statistics for the year 1903 infantile mortalitywas below the average of the previous ten years-theexceptions being Chili, Jamaica, and Queensland.The question of the falling birth-rate in this country as

well as in other parts of the British Empire has been

prominently brought to the notice of the public by therecent Royal Commission on the Decline of the Birth-ratein New South Wales and by the interesting and instructive

report of the Duke of DEVONSHIRE’S Inter-departmentalCommittee on Physical Deterioration. In connexion with

this subject it is necessary to repeat a statement which hasbeen many times advanced in these columns-namely, thatthe rate of mortality is affected in a serious and peculiarmanner by changes in the birth-rate. The first effect of a

continuous decline in the rate of birth is to loxer the rate

of mortality owing to the reduced proportion in the popula-tion of very young children, among whom the death-rate

is always very high. In subsequent years the death-rate, asmeasured by total population, will be increased owing to thesmaller numbers of survivors reaching those ages which are

subject to lower death-rates ; and this effect will last so longas the survivors of those born before the birth-rate beganto decline form an abnormally large proportion of the

population.With regard to the proportion of deaths among the

population that remain uncertified either by medical menor by coroners the Registrar-General remarks that the per-centage of uncertified to total deaths in the year 1903

was the lowest on record. With reference to this subject,however, particular attention is directed in the reportto the still abnormally high percentage recorded in the

counties of Carnarvon and Hereford, as well as in the

boroughs of Gateshead, Warrington, South Shields, andSt. Helens, all of which held the same unenviable positionin the annual report for 1902. It is, however, a remarkablecoincidence that each of the above localities should have a

high proportion of uncertified deaths together with a corre-spondingly lom proportion of inquests. Analysis of the returnsshows that the percentage of inquests and uncertified deathsto the total deaths in England and Wales was respectively6’ and 1 ’ 7. In the above-mentioned counties and

boroughs, however, the proportion of inquests was low,ranging only from 3.6 to 5’5 per cent., whereas the

percentage of uncertified deaths was excessive, rangingfrom 4’ to 6’ 7. The Registrar-General, therefore, ex-

presses the hope, in which we fully concur, that the coronersof these districts will give their cordial support to the objectaimed at, by considering whether it might not be partially

ittainecl by holding inquests more frequently in the case ofmcertifled deaths which are referred to them. In the presentconnexion, however, and in justice to the coroners we

may mention an important fact which probably may be un-known to the Registrar-General-namely, that the decisionas to the number of inquests to be held in any particularplace does not always rest with the coroner who in recentyears has become in certain cases the officer of the local

authority. As the holding of inquests means a consider-able increment to the local expenditure it will readily beunderstood that these authorities will in some cases endeavour

to reduce that expenditure to the lowest practicable amount.Having devoted so much space to a consideration of the

important innovations in the Registrar-General’s presentreport we have no room left for noticing the question of

the death-rate, which is, after all, of most importance toour readers. To this subject, however, we purpose to returnhereafter ; meanwhile we congratulate Sir WILLIAM DUNBARon the fact that the death-rate of England and Wales in

the year 1903 was the lowest since the establishment of

civil registration.

School Legislation and theDemands of Hygiene.

OF all the social problems which demand solution at thepresent day none is more urgent than that implied in the

hygienic management of the children whom legislativeenactments compel to attend our elementary schools. Since

attendance is enforced rigorously by law, it is an obvious

duty of the State to insure that school life shall not be

fraught with danger to the health and the happiness of thescholars. There are reasons for thinking that a satisfactorystate of things is as yet far from realisation. Only too often

.

do we hear complaints from parents that school life involvesrisks of infection, with maladies of varying degrees of serious-

: ness, which no amount of care can avoid. Many medicalauthorities, upon good evidence, are inclined to associate the

great increase that has taken place in the prevalence of diph-i

theria with the herding together of children for purposes

_

of instruction. If it is difficult to acquit our school system

) of all responsibility for the propagation of epidemic diseases,yet so far no trustworthy statistical evidence has been

available for estimating the extent of its evil influence.

A very interesting attempt to remedy this defect of evidence

a has recently been made by Dr. MYER COPLANS, the medical

inspector of the schools which are under the GloucestershireEducation Committee, whose report to a subcommittee of

e this board will, we believe, shortly be published. Dr.

a CoPLANs examined medically 6652 children in the schools

of the Stroud district with a view to ascertain the

.s effects of school life in spreading infectious diseases

or evoking other ailments and the results of his inquiry

y tend to acquit the school system of so great a share in

cl the propagation of scarlet fever, measles, and diphtheriaas is sometimes assigned to it. We hope that this con-

ie clusion will be justified on further inquiry, but the

question is very difficult to decide. The comparativeprevalence of infectious maladies among children too young

rs for attendance at school and among those of school

ct ages affords, for example, no sound test, for we have

ly to bear in mind that children not yet old enough to

654

go to school associate at home with those who do

attend and that if a single child of a family contracts,say, scarlet fever at school he will probably be a source ofinfection to his younger brothers and sisters. Hence the

fact of children suffering from such maladies before theyreach school age does not acquit the school of responsibilityfor spreading the disease. The original source of infectionin the case of many infants may have arisen thus. The

comparative susceptibility of children at different ages alsocomplicates the question, for if infants are more liable to

suffer than older children, then the number of sufferers athome will tend to rise disproportionately when infectionis introduced into any district. Only a comparison of thefigures for each class extending over a long period of

time could supply trustworthy grounds for arriving at a con-clusion.

The Dundee Social Union lately has directed the prepara-tion of a series of reports upon the physical condition of a

large number of children attending six Dundee schools-

four under the control of the Dundee school board and two

voluntary schools. The reports have been made upon 1000children taken upon no selective plan from the registers ofthe schools and have been collated by Miss MARY L. WALKERand Miss MONA WILSON, with the valuable assistance of

Dr. CHARLES TEMPLEMAN, medical officer of health of

Dundee, who has furnished an introduction. The report onthe general medical examination of the boys was made byDr. ALEXANDER P. Low and of the girls by Dr. EMILY C.THOMSON, while Dr. G. TAYLOR GUILD reported on the ears,throats, and noses of the children, and Dr. E. F. MACLEODNEAVE and Dr. W. E. FOGGIE on their eyes. The results are

exceedingly interesting and show, as Miss WALKER and MissWILSON say in their general preface, that an enormous

amount of actual suffering among children is unnecessaryor preventable, though the causes of the various evils being many the remedies must also be many. Taking pediculosis as an example of an obviously and easily preventable maladywe find that of 1000 Dundee children the number, not onlyof those who were verminous but of extremely bad caseswhere the heads and the bodies of the children were in a

foul state, was large. As a numerical statement under

the heading of " cleanliness of body 177 of the 1000

were classified as "bad," a tabulation which indicates

the presence of vermin. Let us pass now to the more

important subjects of physical development and definite

bodily lesions. Some average measurements of Dundee

children were submitted to the Inter-Departmental Com-mittee on Physical Deterioration as evidence of re-

tarded development and these figures have since been

confirmed by the larger number of observations

made at the instance of the Dundee Social Union.

In these last-mentioned observations the average weightsand heights of children from five to 13 years of age

attending the elementary schools are compared with the

weights and heights furnished by Mr. FRANCIS GALTON tothe Anthropometric Committee of the British Association in1881 and with figures given by that committee in 1883. At

a secondary school in Dundee-the Harris Academy-480children were also weighed and measured in order that acomparison might be made between children attending theelementary schools and children living in the same localityunder better home conditions. At all ages from five to

13 years the height of the boys attending the Dundee ele.

mentary schools compares unfavourably with Mr. GALTON’Sfigures, while the average weight of b)ys of 13 years is aboutnine pounds less than Mr. GALTON’s estimate and the

average weight of girls of 12 years attending the elementaryschools is more than nine pounds below the average of the

girls attending the Harris Academy. The children in the

Dundee elementary schools were, at all ages from which acomparison could be made, distinctly below those at theHarris Academy in both weight and height.

Of the diseases of special organs and regions described inthe reports compiled for, and published by, the Dundee

Social Union we can only mention those affecting the heart,the eyes, and the teeth. Heart diseases were found in the

large proportion of 7’ 47 per cent. of the children ; amongthe boys these included 30 instances of valvular defect, theseveral forms being mitral stenosis, mitral incompetence,pulmonary systolic murmur, and slight impurity of the first

sound in the mitral area. With respect to vision it was

found that only 52.2 per cent. of the children could see toread the standard types at the proper distance. This did not

necessarily mean that their refraction was normal, for, as amatter of fact, only 26 per cent. showed normal refractionand the remainder must have been straining their accommo"dation in order to read the types. The examination of the

teeth led to the general result that caries of the teeth wasvery prevalent, hardly any of the children being free from it.Attention has been drawn lately to the insufficient food uponwhich many of the children of the poor have to subsist andto the impossibility of ill-nourished brains assimilating a dueamount of mental pabulum. The food may in other instancesbe sufficient and the child yet may be unable to thrive upon

, it owing to defect in those much-neglected organs the. teeth. An inquiry carried out by Mr. E. RICE MORGAN1. into the state of the teeth of children in the Swansea

: educational area showed that of 295 children of both sexes

only 11 had mouths free from dental defects, while on an

average each child had more than three decayed teeth.

; Such figures need no comment. If we cannot, as HORACE

says, permanently expel nature with a pitchfork, we mayyet perhaps repel physical degeneration with a tooth-brush.

) The result of reading these various interesting reports is

; to learn how much preventable disease is present among thechildren of the poor; while the depression produced by this

, knowledge is tempered by the feeling that never before have, so many wise and charitable efforts been directed towards- the problems of school hygiene as are now at work.

The Colonies and CancerResearch.

A GOVERNMENT Blue-book of some 96 pages dealing withthe subject of cancer research has just been published andpresented to both Houses of Parliament. It contains the

correspondence between the Colonial Office and the governorsor high commissioners of the various colonies with the

object of acquiring information as to the incidence of

malignant disease and its causes, together with materialboth from man and animals for the Cancer Research

1 Swansea Education Committee. Quarterly Report upon theSchools in the Upper Division of the County Borough of Swansea,by E. Rice Morgan, medical officer. Dec. 28th, 1904.