782

least of our correspondents, who says that the appeal oughtnot to have been made without the publication of a fullaccount of the case, and without disclosing the fact that themedical secretary of the Association had advised the

defendants not to allow the matter to come into court.The publication of the appeal in its present form seems tous to be unfair to Dr. D. T. Macleod. As the British Medical

Association is now applying for a charter, conferring uponit certain quasi-judicial powers in matters of ethics, it is theconcern of every medical man to see that the Associationexercises its present discretion in such matters adequatelyand equitably.

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MEDICAL MEN AND PATIENTS’ WILLS.

AN annotation under this heading which appeared in our- columns last week does Major Rawnsley, the plaintiff in ]

the case, a grave injustice if it can be considered in

any way to have impeached his honour. We had not theslightest intention of doing this, and must refer further to’this matter.

THE London County Council has resolved and ordered thatSection 55 of the Public Health (London) Act, 1891, withrespect to the notification of infectious disease, shall apply inthe administrative County of London for a further period of12 calendar months, as from and including March 13th, 1909,,to the disease known as cerebro-spinal fever (epidemic,cerebro-spinal meningitis). The Council has consideredwhether the term cerebro-spinal fever" includes, for thepurposes of notification, cases of posterior basal meningitisand on the advice of a committee appointed by the Presidentof the Royal College of Physicians of London has decidedthat, for notification purposes, the disease at present knownas posterior basal meningitis is included in the term

"cerebro-spinal fever." That term, however, is not to be

interpreted to include cases of meningitis due to tuber-

culosis, syphilis, middle-ear disease, or injury.

A REPORT has been presented to the Houses of Parliament’by the delegates of the Government to the recent Inter-

national Congress on Tuberculosis at Washington. The

signatories are Dr. Arthur Newsholme, medical officer of theLocal Government Board; Mr. J. P. MacDougall, C.B., vice-president of the Local Government Board of Scotland ; andMr. T. J. Stafford, C.B., medical commissioner of the LocalGovernment Board of Ireland. The report is considered in,detail in another column.

___

THE Prince and Princess of Wales, with Sir Frederick’Treves in attendance, paid a visit to the Royal College of- Surgeons on Wednesday, March 10th, where they werereceived by the President, Mr. Henry Morris; by the con-servator, Professor Arthur Keith ; and by the secretary, Mr.S. Forrest Cowell. The Royal visitors spent some two hoursin the College and were conducted over the Hunterian

Museum. _

THE annual meeting of the General Council of KingEdward’s Hospital Fund for London was held at MarlboroughHouse on Wednesday, March 10th, H.R.H. the Prince of

Wales, President of the Fund, being in the chair. Theaccounts and reports for the year 1908 were presented.and adopted.

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Surgeon-General George D. Bourke, C.B., has been

-appointed an honorary physician to the King, vice Surgeon-<General T. Tarrant, C.B., deceased.

THE ROYAL COMMISSION ON THE POOR-LAWS AND RELIEF OF DISTRESS.

III. 1

STATISTICAL SURVEY OF POOR-LAW PROBLEMS.IN THE LANCET of Feb. 27th we gave a brief summary of

the contents of Part II. of the Commissioners MajorityReport. which forms a statistical survey of Poor-law

problems in England and Wales and contains, therefore,material and arguments which both the Majority and theMinority Commissioners have taken into account in theirrecommendations. In the present article we proceed to acloser examination of this valuable survey.The object of the Majority Commissioners has been

to show by statistical methods (a) the dimensions of the

problems with which they have to deal; (b) the changes thathave modified these problems in the course of years; and(c) the extent to which existing administrative methods havesucceeded or in which they have failed. The subject-matterof Part II. has been subdivided under 36 heads, each ofwhich will be regarded as more or less important than therest, according to the judgment of individual readers. Wehave carefully perused the whole of the matter contained inthis part of the report, but for the purposes of the presentarticle considerations of space necessitate the limitation ofour comments to those particulars which seem to us of chiefinterest to the medical profession.With reference, in the first place, to the relative amount

of pauperism in England and Wales, we learn from thereport that the number of paupers (excluding the insane andthe casuals) relieved on any one day is approximately equalto the population of Liverpool, the mean number of sanepaupers other than casuals being equal to 22.1 1 per 1000 ofthe English population. But the number relieved on any oneday does not fully represent the number relieved within aspecified period, for the former number takes no account ofpersons who, though not in receipt of relief at the moment,may have been relieved at other periods of the year. Inorder to obtain a complete return it is necessary to enumeratethe persons who have passed through the portals of the Poor-law in any given year. A special return of this kind’made bythe Local Government Board shows that in the year 1907 thenumber of persons under the care of the guardians at sometime or another of that year approached one and three-quarter millions-a number equal to the aggregate populationof Liverpool, Manchester, and Birmingham, and greater by2 ’15 times than the number relieved on anyone day. Fromthis it appears that the true rate of English pauperism,in terms of total population, becomes 47 - 7 per 1000, against22’ 1 per 1000 as determined by the day counts alreadyreferred to.

Of the total number of paupers in England and Walesnearly half are women, the other half including men andchildren. The average duration of relief is longer amongwomen than among men, probably because the latter resortto the Poor-law more frequently than the former for thepurpose of tiding over periods of temporary unemployment,Among the causes of the higher rate of female pauperismthe principal is that of widowhood. The premature death ofthe husband may leave the wife with a young family andwithout ability to support them. The husband experiencesno such disability on the death of his wife, though he hasthe difficulty of providing for the care of his motherlesschildren.

Concerning the age distribution of pauperism among theadult English population the report contains interestingparticulars. During the years of adolescence and earlymanhood the proportion is the lowest, although even atthese ages it is very considerable. As age advances theproportion rapidly increases, until at ages 55-65 relief is

granted to 43 in each thousand of the population at the sameages. The incidence of pauperism among females is greaterthan among males at all stages of life. The excess increasesup to the age 35-45 and then diminishes until the age 55-60.It again increases up to the age 70-75 and thereafter subsidesgradually. As regards the methods of relief it appears thatthe recipients of outdoor relief outnumber those of indoor

1 Nos. I. and II. were published in THE LANCET of Feb. 27th (p. 638)and March 6th, 1909 (p. 706), respectively.