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practitioner, or as being the invention or discoveryof a doctor when this is untrue will be forbidden.Methods of this kind have in the past swelled the

"huge dividends" of patent medicine vendors, andraised their profits to millions of pounds. Punch, in apoem based upon the pill-manufacturer’s complaint,which we began by quoting, puts the matter thus :-

Meanwhile you’ll understand that r, for one,, Refuse to buy your wares and eat them just for fun,"which is the common-sense view.

Certificates under the National Health Insurance Acts.The Minister of Health, acting upon the report of the

Inquiry Committee of the London Insurance Committee,has ordered that £ 50 be withheld from the Exchequergrant to the committee, to be recovered under Article 33of the Regulations from a medical practitioner on theLondon panele This heavy fine is inflicted in thefollowing circumstances. The practitioner had givencertificates in the usual form; stating that he hadexamined the patient on the dates named in them inrespect of a patient whom he had not in fact visitedfor some time. He was aware that the patient hadreturned to his home from an infirmary in October,1919, and gave the certificates up to January, 1920,when the patient died. It was not disputed that thepatient was during this period incapable of work,’or thatin the practitioner’s opinion he could never be otherwise.The penalty is a heavy one, but it must be rememberedthat it was in the power of the Minister to remove thepractitioner from the panel, and that to furnish acertificate at variance with the facts is not only abreach of the regulations, but is wholly unjustifiablein principle. A medical certificate of incapacity whichstates that a patient has been seen by the certifier isevidence from a trusted witness that he is alive andentitled to sickness benefit. A man may be certainlyand inevitably dying, but the fact of his being beyondquestion alive is important, and if fraud is rare anddifficult to perpetrate it is not impossible or incon-ceivable. One of the allegations made against our

admittedly faulty system of death registration is thatit does not effectively prevent burial without the presen-tation of the prescribed certificate, and that a certificateobtained for one person can thus be kept and used foranother whose death has not been registered. Suchfraud may be neither frequent nor easy, but in so far asit can occur, it would render possible the payment ofsickness benefit in respect of a person who w as dead.That no fraud should have been perpetrated or dreamtof by anyone in a particular case does not detract fromthe importance of certificates relating to sickness ordeath being absolutely accurate and trustworthy.

A Coroner on Expert Anæsthesia.An inquest held lately upon the body of a young

wbman who died under chloroform was the occasionfor interesting comment on the part of the coroner.The medical features of the case were not, so far asthe scanty details available show, unusual and merelyenforce the well-known lesson that anaesthetics have

special danger in the presence of acute cellulitis of theneck. In the case in question the an2esthetic wasadministered by a casualty officer, and the coronerstated that owing to the dangerous nature of opera-tion for cellulitis of the neck it would have beenbetter if one of the visiting anaesthetists could havebeen; in charge. This is a counsel of perfection.It is an unfortunate but unavoidable anomaly ofhospital practice at present that many of the mostdangerous and difficult subjects for anaesthesia fall intothe hands of the less experienced administrators. Theyare subjects for emergency operation and have to betreated when the expert anaesthetists are away fromthe hospital. It can hardly be otherwise unless there isalways at the hospital a resident anaesthetist, as there isat many hospitals a resident surgeon. Most of the greathospitals now do possess a resident anaesthetist, andoften he is a man of wide experience compared withthat of the other residents. Further progress mayensure the constant presence in large hospitals of ananaesthetist whose standing is on a par with that of theresident surgeon or physician.

URBAN VITAL STATISTICS.

(Week ended August 21st, 1920.)English and Welsh Towns.—In the 96 English and Welsh

towns, with an aggregate civil population estimated atnearly 18 million persons, the annual rate of mortality,which had been 9’9, 9’6, and 9-4 in the three precedingweeks, rose to 9’9 per 1000. In London, with a populationof nearly 4 million persons, the annual death-rate was9-8, or 1-3 per 1000 above that recorded in the previousweek, while among the remaining towns the rates rangedfrom 3’9 in Hornsey, 4’0 in Swindon, and 4-3 in Ealing to15-4 in South Shields, 15-7 in West Bromwich, and 16-0in Burnley. The principal epidemic diseases caused204 deaths, which corresponded to an annual rate of0-6 per 1000, and comprised 129 from infantile diarrhoea,35 from diphtheria, 17 from whooping-cough, 16 frommeasles, 5 from scarlet fever, and 2 from enteric fever.Measles caused a death-rate of 1-6 in Wolverhampton,but the [mortality from the remaining epidemic diseasesshowed no marked excess in any of the large towns.There were 2150 cases of scarlet fever and 1362 ofdiphtheria under treatment in the Metropolitan AsylumsHospitals and the London Fever Hospital, against 2106

and 1413 respectively at the end of the previous week. Thecauses of 27 of the 3394 deaths in the 96 towns wereuncertified, of which 8 were registered in Birmingham,4 in Liverpool, and 3 in South Shields.Scotch Towns.-In the 16 largest Scotch towns, with an

aggregate population estimated at nearly 2½ million persons,the annual rate of mortality, which had been 11-2, 11-1, and12-3 in the three preceding weeks, fell to 10’8 per 1000.The 235 deaths in Glasgow corresponded to an annualrate of 11-0 per 1000, and included 11 from infantile diarrhoeaand 1 each from scarlet fever and whooping-cough. The 75deaths in Edinburgh were equal to a rate of 11-5 per 1000,and included 3 from scarlet fever and 2 from diphtheria.Irish Towns.-The 106 deaths in Dublin corresponded to an

annual rate of 13-3, or 0’2 per 1000 above that recorded in theprevious week, and included 5 from infantile diarrhoea and1 from whooping-cough. The 68 deaths in Belfast wereequal to a rate of 8-6 per 1000, and included 4 from infantilediarrhcea and 1 from whooping-cough.

(Week ended August 28th, 1920.)English and Welsh Towns.—In the 96 English and Welsh

towns, with an aggregate civil population estimated atnearly 18 million persons, the annual rate of mortality, whichhad been 9’6, 9-4, and 9’9 in the three preceding weeks, wasagain 9’9 per 1000. In London, with a population of nearly4 million persons, the annual death-rate was 9’7, against9’8 per 1000 in the previous week, while among the remainingtowns the rates ranged from 3’7 in Edmonton, 3’9 inHornsey, and 4-9 in York, to 16’8 in South Shields, 17’2 inStockton-on-Tees, and 17’5 in West Hartlepool. The principalepidemic diseases caused 237 deaths, which correspondedto an annual rate of 0’7 per 1000, and comprised 150 frominfantile diarrhoea, 34 from diphtheria, 23 from measles,20 from whooping-cough, 9 from scarlet fever, and 1 fromenteric fever. The deaths from infantile diarrhœa, whichhad been 87,93, and 129 in the three preceding weeks, furtherrose to 150, and included 38 in London, 13 in Liverpool, 9 inBirmingham, and 8 each in Sheffield and Hull. There were2266 cases of scarlet fever-and 1391 of diphtheria under treat-ment in the Metropolitan Asylums Hospitals and the LondonFever Hospital, against 2150 and 1362 respectively at the endof the previous week. The causes of 34 of the 3395 deathsin the 96 towns were uncertified, of which 8 were registeredin Birmingham and 3 in Liverpool.Scotch Towns.-In the 16 largest Scotch towns, with an

aggregate population estimated at nearly 2½ million persons,the annual rate of mortality, which had been ll’l, 12’3, and10’8 in the three preceding weeks, rose to 11’1 per 1000. The270 deaths iri Glasgow corresponded to an annual rate of12-7 per 1000, and included 16 from infantile diarrhoea, 6 fromsmall-pox, 2 from enteric fever, and 1 each from measles,scarlet fever, and whooping-cough. The 77 deaths inEdinburgh were equal to- a rate of 11-8 per 1000, andincluded 2 from infantile diarrhoea and 1 from diphtheria.

Irish Towns.-The 122 deaths in Dublin corresponded to anannual rate of 15-3, or 2-0 per 1000 above that recorded in theprevious week, and included 4 from infantile diarrhoea, 2each from whooping-cough and diphtheria, and 1 fromenteric fever. The 105 deaths in Belfast were equal to a rateof 13’3 per 1000, and included 8 from infantile diarrhoea and 1each from scarlet fever and diphtheria.

THE Medaille de la Reconnaissance Frangaise(argent) has been conferred by the President of the French’,Republic on Mrs. Bedford Fenwick, honorary superintendentof the French Flag Nursing Corps.