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Though at the present time it is in effect a sub-office of the Local
Government Board, it cannot, he contends, be looked upon as sufficiently
co-ordinated with that department, indeed, it never can be an adequate
part of the public health system of the country until it is an essential
part of a ministry of public health, which would unite the three existing
and inco-ordinate branches of public health work—namely, the
Local Government branch, Public Health and Poor Law, the Board
of Education branch and the Home Office (factories, etc.) branch.
One very essential reform and one which has frequently been advocated,
is the placing of the registration of deaths under the control of medical
officers of health. This reform would be quite easy of accomplishment,
for it would only be necessary to place the local registrars of deaths
on the staffs of the medical officers of health, and as vacancies fell in,
appointing the latter superintendent registrars. In this way there would
be an expert official, who would be able to straighten out obscure entries
on certificates at the very outset, and thus lessen the work at a later
date of the central department, which in recent years especially has done
a large amount of good through making enquiries of medical practitioners
whose certificates have been capable of a double interpretation.
Sickness Statistics.
Whilst allowing death statistics their full value I consider it is a
fallacy always to regard the death-rate as the best possible index of the
health of a community. Much more useful information could sometimes
be obtained as to the health of a borough by the registration of sickness
apart from death. There is, of course, a great deal of preventible
sickness of insufficient severity to destroy life. This is greatest among
children, where the after-effects are often very serious. There is also
much adult non-fatal sickness, which, by loss of wage-earning power,
and by the loss of employment, and by the loss of the enjoyment of
life, is of the greatest importance. Much ill-health due to insanitary
environment, therefore, does not show itself upon the mortality statistics.
Nevertheless, there has been a great improvement in Public Health in
the last few years, and many more deaths and much more sickness
would have taken place but for the following agencies:—(1) Sanitary
science. (2) Advance in medical and surgical knowledge. (3) Improvement
in economic position. As to which of these factors has had the
greater influence, each will be acclaimed the cause alike by the sanitarian,
the practitioner of medicine, and the politician, and in each case the
claim will be false if the whole credit is claimed. Admitting all this,
we nevertheless claim that sanitary science has herein justified every
farthing spent upon its pursuit. There is only one asset of real value