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mittee of yours see the red light and do something atlast. Married quarters would solve your problem, evenif it did mean more building. A really solid staff shortageis the only thing, in my experience, to shift a lay com-mittee-which is probably why so many dull old hos-pitals have such pleasant new nurses’ homes.

Let’s face it Jack, junior staff have a pretty bad timeof it. Not so bad as in our day perhaps; but the increasein salary has scarcely kept up with the cost of living, andthe hours, even now, are often atrocious. They don’tusually know their rights (have your administratorsshown the juniors the Ministry circular on Standards ofAccommodation H.M.58/68-have they? I bet!), andwhen they do they are too insecure and scared to make afuss. And not without reason, for it may be professionaldeath to become known as a " trouble-maker ". I wonderif your medical committee has a junior staff representativeyet? This proposal has been approved by quite exaltedbodies-although often the behaviour of consultants at

this function is far too disturbed to exhibit before juniorgaze. However, a junior’s presence is to be encouraged,if only to make his seniors act like gentlemen. One ofour splendid representative bodies, not a hundred milesfrom Tavistock Square, is at present trying to compose asort of Guide Michelin to hospitals in the N.H.S., andgood luck to it. The trouble seems to be that the ques-tionary is not getting through to the very chaps thatshould be filling it in: our region held a meeting notlong ago and none of the junior staff there had heard ofit. It’s a modest affair concerned with matters of solidfact-none of the 5-star business yet-but I hope thenext edition will be more enterprising. Good luck to itanyway; it is contributing, if meagrely, to the Millennium.

So a Happy Christmas to you Jack-and to your staff.Spare a thought for them as you carve the turkey in thebosom of your family on Christmas day, on Christmasday, on Christmas day in the morning.

Your old and affectionate friend,RICHARD COBBLEIGH.

Public Health

The Registrar-General’s CommentaryIN his commentary on the statistics for England and

Wales for 1957 the Registrar General remarks that thehome population has been increasing by an average of180,000 a year, in round numbers, since 1951, and inthe twelve months mid-1956 to mid-1957 it increased by240,000 to an estimated 44,907,000.The " natural increase " (the excess of births over deaths)

was 226,000 in 1956-57-a year of high birth-rate and lowmortality. About 106 boys are born for every 100 girls, butthe death-rates for males are higher than those for females atall ages; so at ages 0-4 there were 1053 males per 1000 females,at ages 30-34 the numbers were about equal, at ages 60-64there were 770 males per 1000 females, and at ages 75 andover there were nearly twice as many women as men.Births.-The 723,381 live births in 1957 were the largest

number since 1949, and the birth-rate of 16-1 per 1000 popu-lation was the highest since 1950. This increase continued theupward trend which began in the late spring of 1955. (The1958 rate was higher still, at 16-4.)Marriages.-There were 346,903 marriages in 1957-6000

fewer than in 1956. The decrease was due to the smallernumber of unmarried persons of marriageable age in thepopulation. The marriage-rate-15-4 persons marrying per1000 total population-was slightly lower than in 1956. Thetendency to younger marriage is reflected in the proportion ofgrooms and brides who are under 21. For men it rose from

34% in 1938 to 8-7% in 1956 and to 96% in 1957; for womenfrom 16-4% in 1938 to 32-2% and 33-6% in 1956 and 1957.Deaths.-There were 514,870 deaths registered in 1957, the

death-rate for both sexes being slightly lower than in 1956.Infant mortality and stillbirths.-The infant-mortality rate

was 23-1 per 1000 live births in 1957, and was the lowestrecorded in England and Wales (the 1958 rate was lower still,at 22-5). More than 60% of the deaths occurred in the firstweek of life, but the rate for these deaths in the first week(14-1) was also the lowest recorded in this country. Thestillbirth-rate of 22-5 per 1000 total live and still births wasslightly lower than in 1956. Immaturity continued to be thechief cause of infant mortality.

Tuberculosis.-There were 4784 deaths from tuberculosis in1957-11 % less than in 1956. Deaths from respiratory1. The Registrar General’s Statistical Review for England and Wales, 1957,

Part III, Commentary. H.M. Stationery Office. 1959. Pp. 299.16s. 6d.

tuberculosis fell by 12 %, but for the first time for many yearsthere was a small rise in the number of deaths from the non-

respiratory form-from 522 in 1956 to 535 in 1957. Therewere no deaths from respiratory tuberculosis of boys aged5-9 or of girls aged 10-14. Notification-rates continued todecrease, being 82 per 100,000 population for males and 49for females. Mass miniature radiography units made 3,514,600examinations in 1957; the number of cases found by theseunits was 22% of all cases of respiratory tuberculosis notified.The highest incidence of cases was again found among personsreferred to the units by general practitioners.Cancer.-Deaths assigned to cancer in 1957 numbered

94,017 (50,056 male and 43,961 female), the highest numbersyet recorded. The largest increase in cancer mortality in bothsexes since 1936-39 has been from cancer of the lung. Cancerof the lung accounted for the highest proportion (nearly athird) of all male deaths from cancer in 1957 and for about6% of all female deaths from cancer.

Diseases of the circulatory system.-In 1957 there were

188,630 deaths assigned to diseases of the circulatory systemand a further 73,669 to vascular lesions of the central nervoussystem, which together accounted for 51 % of all deaths.

Accidental and violent deaths.-There was a decrease in 1957in the number of deaths due to accidents and violence, whichnumbered 21,561 compared with 21,870 in 1956.

Registration of Food PremisesIn his annual report for 1958, Dr. J. H. Briscoe-Smith,

medical officer of health for St. Marylebone, describes a sharpoutbreak of food-poisoning, involving two schools, in which62 pupils and staff were affected. The cases were spread overseventeen local-authority areas; and, apart from verbal notifica-tion of the original case, only 3 cases were notified. Had thisoutbreak resulted from consumption of food in a restaurantit might have remained undetected or, at best, investigationmight have linked the 4 notified cases."... the control of detected cases of food-poisoning and their

contacts, though essential, is much less likely to be effective than adirect attack on the source of the infection by the close supervisionof every place where food is produced, prepared, handled or eaten toensure that every precaution is taken against its contamination.... *The registration of all food premises is long overdue and it is a sadcommentary on the present state of the law that while one shopkeeperselling packaged ice-cream from a refrigerator is required to registerwith the local authority, his next door neighbour selling frozen foodsis not required to do so. Many of these foods such as made up meatand fish dishes, some of which may be prepared as far afield as Italy,are, if not stored properly, potentially at least as dangerous as ice-cream and are much more liable to contamination duringmanufacture." .