sickness statistics of the community, so far as they can be made available.

Foreign Systems of Notification of Sickness.

We may conveniently consider here foreign methods of notification and registration of sickness. A recent investigation into the etiology and relative prevalence of rheumatic fever in various parts of the world has made me familiar with the available sources of information in many countries; and by personal inquiries in German and Scandinavian towns I have been able to acquire additional information from the responsible medical officers.

Belgium. In accordance with a royal decree of the 31st March, 1818, all doctors in Belgium are required to bring to the knowledge of the burgomaster, or of the Bureau d'Hygiène, all cases of infectious disease which appear in their districts. A similar instruction, but with more rigorous regulations, was issued by the municipal authority of Brussels on the 18th November, 1824. In 1874 an arrangement was made by which information as to the cases notified is interchanged weekly between the authorities of Brussels and its suburbs."

Germany.-Notification of infectious diseases has been in force in some parts of Germany, as at Hamburg, since the year 1818, but the general compulsory notification of such diseases is more recent. Suspected as well as pronounced cases must be notified. A statement of the notifications in each district is sent weekly to the Kais. Gesundheitsamt, or Imperial Health Office. The weekly reports issued from this office give the number of cases of enteric fever, measles, scarlet-fever, diphtheria, and puerperal fever notified during the preceding week in thirty-one cities and districts of the empire. Similarly in the excellent weekly returns of morbidity and mortality issued by the municipal authority of Berlin (Veröffentlichungen des Statistischen Amts der Stadt Berlin), a tabular statement of the cases of infectious disease notified in Berlin is given. These are summarised in the monthly and annual reports of the same department, so that there is no difficulty in following the course of any of the notified infectious diseases in the city or in any of its thirteen divisions.

The following is the schedule which must be filled up by the

"Milroy Lectures on the Natural History of Rheumatic Fever," 1895. Palmberg's "Treatise on Public Health." English translation, p. 253.

Heute

The regulations as to notification issued by the Medicinal Collegium of Hamburg are very stringent. Sec. 1 states: Doctors must report to the Medicinal Bureau all the cases of the following infectious diseases occurring in their practice :

Cases of disease under the heading A must be notified within twenty-four hours of the doctor's knowledge of them, and under the heading B must be notified weekly.

:

In addition to the general notification of infectious diseases in Germany, admirable hospital statistics are kept in most German towns, and particularly in those of Prussia, which come nearer than any hitherto described to a national system of registration of disease. These hospital statistics have been kept since the year 1877 Professor Guttstadt, to whose kindness I am much indebted for valuable information, being responsible to the Königl. Stat. Bureau for their reception, tabulation, and publication. They are published on a uniform basis for all the great Prussian towns, and they relate for each town to general diseases (including infectious diseases), diseases of the eye, parturition, lunacy, idiocy, and old age. Both State and private hospitals are included in the reports. From the annual reports issued from the office of the Königl. Stat. Bureau in Berlin we can learn the total proportion of hospital cases in each State and town, and the proportion shared by different groups of diseases. In further tables are given the number of hospital cases of each individual infectious disease, and of a large number of constitutional diseases, fifty-two diseases altogether; then of a large number of local diseases, making the total headings for diseases or groups of diseases 144 in number. Then the same 144 diseases are stated according to sex and number of fatal cases in the thirty-six districts (Regierungsbezirke) of Prussia. A careful distinction is drawn between persons and cases of sickness, the number of the former entering all the Prussian hospitals during the three years 1889-91 being 410,152, the number of the latter 437,368. The average number of days of illness in hospital of each patient is given for

the hospitals in each of the fourteen provinces and thirty-six districts. The average for the whole State was 33.8 in 1889, 334 in 1890, and 339 in 1891. In other tables are given the age, distribution, and the monthly incidence of the hospital cases for the whole State, separately stated for thirty-three infections and constitutional diseases. These statistics will, as years go on, be invaluable for demographical investigations. Already they possess a very high value to the communities to which they relate. They constitute a mine of information for epidemiological and general medical purposes.

The following is the (anglicised) return which has to be made weekly by the resident medical officer of each hospital. The return is compulsory, and no fee is paid for this or any other notification in Germany.

Number of Cases admitted and now in the Hospital.

The hospital statistics of some of the chief cities of the German empire are made available for use week by week by returns published in the weekly "Veröffentlichungen des Kaiserlichen Ge"sundheitsamts." In this are published the number of admissions into the hospitals of Berlin, Breslau, Frankfort on the Main, Magdeburg, München, Leipzig, and Hamburg, suffering from

the number of deaths under each head being also given.

For Berlin even more elaborate sickness statistics are published. It is part of the function of the Statistisches Amt (Bureau of Statistics) of the city of Berlin, which was established in the year 1872, to collect and tabulate inter alia the statistics of disease among the poor and in the establishments of the relief boards; also the sickness and mortality experience in the associations of working men, as well as the statistics of infectious diseases based on compulsory notification. Anyone consulting the "Statistisches "Jahrbuch der Stadt Berlin," so ably compiled by Herr R. Böckh, the Director of Statistics for Berlin, must admit that the “Annual "Summary" of the English Registrar-General, so far as it relates to London, admirable though it is so far as it extends, is a scant and imperfect record of the vital statistics of the greatest city of the world. The statistics in the "Jahrbuch" give, in addition to the fullest records about the causes and distribution of mortality, particulars as to the number in receipt of relief in each district of the city; the number in receipt of medical care; the number, age, and sex of patients in each of the public and private hospitals of Berlin, the family condition and occupation of patients in the hospitals and asylums respectively; the number of patients in the general hospitals, classified according to disease; and a large mass of other particulars.

Denmark. The immediate notification of the chief infectious diseases by the medical attendant is obligatory throughout Denmark; and in addition every medical practitioner is obliged to report weekly to the district medical officer, on special forms supplied to him, every case of "epidemic disease" coming under his