assembly that the registration of deaths could not be accomplished by simply requiring deaths to be certified by physicians and returned at once to local registrars. In vain we pleaded that it is absolutely necessary to require a burial permit to be issued in every instance before it became lawful to inter or otherwise dispose of the dead body. The legislators thought that they knew how mortality returns ought to be collected, and they gave us a law without the burial-permit provision. Under that law we collected monthly returns for two years. The returns cost more and were worth less than those of any year since 1900, when the legislature repaired the error of 1898 by incorporating in the law a burial-permit requirement. The objection to burial permits came in Maryland, as is the case always, from country members, who thought that this requirement might bring hardship upon some isolated family invaded by death at a time when severe weather or other uncontrollable circumstance might make compliance with the law very difficult or impossible. It was said that in a sparsely-settled country there is no need of immediate registration on the spot and at the time of death. Perhaps such views have not been advanced, or else have little influence, in Pennsylvania, but if I were obliged to controvert this argument I should turn at once to the sanitary history of Pennsylvania for illustrations of the fact that the safety of health in towns and cities is intimately dependent upon the health of neighboring rural districts, and that unmarked illness in a lonely cabin or camp is too often the creeping spark which kindles an urban epidemic. I should recall the tragic story of typhoid fever at Plymouth in 1885, when the careless disposal of excreta at an isolated house on a distant hillside let loose a frightful energy to ravage the town. Such illustrations have been furnished by many parts of this country. It is a very common error in public-health work to consider sanitary problems as of interest only in their immediate environment. Of several destructive errors possible in the formulation of a registration law none is so certainly fatal as the omission of a burial-permit requirement. The records must include every death, no matter where it occurs. To do less than this is to omit a substantial debit item from the public accounts, it is to deny protection to certain private interests of those. who survive, and it is to withhold from your health authorities, both State and local, a sort of information which is absolutely necessary to give their work definite direction and measurable effect.

The bill now before your assembly is in all respects an admirable measure. So far as mortality registration is concerned it is as good as any I have seen. The provisions for registration of births seem to me better than are found in any law now in force in this country. Sometimes it is dangerous to make a statement of this

sort. When the consent to new measures is somewhat reluctant, legislators take alarm if it is suggested that the proposed laws are better than those of other States. Legislatures, as a rule, prefer to feel their way in dealing with new subjects or subjects upon which they are not fully informed. Unless the vote which you expect is very sound, it will be better not to spread abroad the suggestion that Pennsylvania is about to become a leading exemplar of modern registration methods. There will be great satisfaction in Washington, and you will receive congratulations from every registration office in the country if this bill passés the Pennsylvania. assembly with its essential provisions unimpaired.

Perfectly satisfactory registration of both births and deaths is not now accomplished by any State in this Union. Great progress has been made in collecting information concerning the causes of loss of population, but the sources of population-repair have not been successfully studied. This neglected phase of vital statistics has of late become deeply impressed upon the national government-insomuch that Congress two years ago passed a resolution addressed to the governors of all the States asking for the collection of full and complete data concerning the natural increase of population. We have discovered that our growth through immigration presents problems so vital that we dare not cease scrutinizing, in turn, every individual of the thousands thronging our shores. But in the natural increment of population by birth there are problems just as serious, though we are in no position as yet to consider them. If the registration of births and deaths were useful only in hygienic relations, the records would still be worth their cost, but it is in their relation to material progress that vital statistics are now being recognized. Indeed, the sanitary relations of vital statistics are merely incidental. Registration was first undertaken in England in the thirties, not by sanitarians, but by political economists, and for economic reasons. That registration opened up a vista of preventive medicine that was a surprise-so much of a surprise that, when the death-rates of great cities had been cut down from 40 to 20, the hygienic importance of registration obscured its original economic purpose. We are now coming back toward the earlier view. We shall never take the work of registration away from sanitarians, for they have shown particular aptitude in making the data serviceable. But the political economist has renewed his interest in vital statistics. The wealth of nations is in the vital energy of the people. The business of government is not summarized in statements of foreign and domestic trade, of corn, cattle, coal, cotton, oil, tobacco, iron, lumber, beef, and the infinite catalogue of material products, but must include detailed data concerning the living factors of national prosperity. Nor is it enough to know simply that so much life is expended, and that the

life-capital is by such and such figures recruited in a year's work. A few days ago a Russian newspaper suggested that the tangled affairs of Russia should be handed over to American receivers, as the Americans display extraordinary ability in the management of great enterprises. Now, the United States and Russia are in some respects alike. Each has experienced in the past half-century very marvelous growth of population; each has impressed other civilized nations as a formidable power; both of them, our own country and Russia, are quite ignorant as to the composition and vital history of their populations. In these respects they are alike. In . mastery of the details of business the United States is no doubt superior to Russia, but in population both have grown rich without. knowing, or trying to know, the sources of their wealth. Germany and England, however, compelled by circumstances, are fully informed on the composition and character of population, on its loss. and renewal, and on its adaptability to all pursuits. Japan, having studied carefully every phase of political science in all parts of the world, has seized upon every valuable idea and applied it with such skill and energy that she has amazed the world by withstanding the strain of a war which at its onset seemed on Japan's part suicidal. If American brains should be employed in the service of Russia at this time, it is certain that the business of Russia would be conformed to American methods, and precise information would be required on education, agriculture, mining, manufactures, capital, and labor; but the bald statement that the people of Russia are so many millions would be found of no service whatever. Months ago mere millions of population ceased to be what the insurance men call "a good talking point." Where are these people? Of what sort are they? How are they distributed as to locality, age, race, sex, occupation, education? What are the detailed relations of death to locality, age, sex, occupation, disease, war? How are the numbers recruited? What stocks are thriving? What stocks declining? Is the balance of migration favorable or no? What parts of the national business are conducted on a winning, and what on a losing basis? The vital energy of nations must be adjusted intelligently, and not at random, to the world's work, and in peace, no less than in war, the strength of nations depends upon the intelligent adaptation of men and means to aims and ends.

If the bill now pending in your legislature becomes a law without impairment of its provisions, it will be a matter of congratulation not alone for Pennsylvania, but for Maryland and for every other State. It will be a long step toward that efficiency of political organization which we must perfect in every State before our country can be in fact strong and sane, with the strength and soundness of mastery over her magnificent resources.

REVIEW IN MEDICINE.

Under the Supervision of Thomas R. Brown, M.D., Baltimore.

THE BACTERIOLOGY OF ARTICULAR RHEUMATISM.

Beattie (British Medical Journal, December 3, 1904) gives the results of his investigations, carried on in the pathological laboratory of Edinburgh University, in regard to the micrococcus rheumaticus. As is well known, this micro-organism was first described in 1903 by Beaton and Walker in considerable detail, and according to them was the bacterium which is the causal factor in acute articular rheumatism.

Beattie in his experiments used two different strains of microorganisms-one obtained from the synovial membrane of a girl with acute rheumatism and recovered from the vegetations of an endocarditis experimentally produced in a rabbit, the other from a culture sent by Dr. Paine. The microscopical and cultural characters of the two were practically identical, the only difference noted being that the coagulation of milk was more rapid in the case of the latter micro-organism. The characteristics of the micro-organism are as follows: It is a small micrococcus occurring in the tissues and cultures in pairs or in short chains, the latter being more marked in growth in milk bouillon. It is smaller than the ordinary streptococcus, and incapable in any medium of producing the long chains so characteristic of the latter bacterium. Many of the organisms are rather oval in shape, and resemble the pneumococcus more than the streptococcus. No capsule could be demonstrated. Degeneration forms are met with fairly regularly, but by no means so frequently as in the case of the streptococcus. The micro-organism stains readily with all the aniline dyes and is not decolorized by Gram's method of staining.

Beattie gives in detail the cultural peculiarities and characteristics of the bacterium, which, however, need not be gone into here. The most interesting results were those obtained by the experimental inoculation of animals with this micro-organism, Beattie's results being absolutely confirmatory of those obtained by Paine, Poynton, and others. Intravenous injections in animals produced endocarditis, polyarthritis, and chorea, the polyarthritis usually developing in about three days after the inoculation. With subcutaneous injections, even in large doses, no suppuration was produced in Beattie's experiments.

As to the question of whether or no this micro-organism shall be classed as a streptococcus (although if we use the term in its generic sense no fault can be found with it), nevertheless Beattie

insists that with most people streptococcus has a specific meaning, and as the results obtained by inoculation of the organism described in this article are specifically different from those obtained with the streptococcus, Beattie insists that a specific name had better be used, such as the micrococcus rheumaticus, as proposed by Beaton and Walker. Beattie also especially mentions certain points in the cultural characters and vitality of the micro-organism which absolutely distinguishes it from the streptococcus. Beattie in his conclusions does not claim that because this organism produces endocarditis it is the causal organism of this disease, but he does claim that it can be isolated from cases of typical acute rheumatism; that it can be grown outside the body, there showing characters in some respects specific; that in inoculation in animals it produces a combination of lesions which are similar to those of acute rheumatism in the human subject, sometimes especially affecting the joints, sometimes the heart, sometimes producing chorea, sometimes producing a combination of these conditions, and that from these lesions the organism can be recovered in pure culture. On these grounds Beattie regards the micrococcus rheumaticus as a special organism, causal in acute rheumatism.

THE APPARANT INCREASE OF PNEUMONIA.

Fulton (Journal of the American Medical Association, January 14, 1905), discusses in a most thorough and scientific manner the question of the incidence of pneumonia during the last five or six decades. The value of this communication is especially great because of the generally prevailing notion among physicians and laymen that this disease is constantly on the increase, which view, as Fulton rightly says, rests on no other evidence than the apparent mortality rates and ratios. Fulton first gives a careful history of the mortality registration in this country, especially as regards pneumonia, illustrating his remarks with charts and with statistics. These show in a graphic way the mortality from pneumonia in various States of the Union, divided, as regards individuals affected, up to five years of age, from 5 to 65 years, and over 65 years. After discussing at some length the factors which prevailed to make the reports of pneumonia less frequent in the earlier than in the latter decades, notably the symptoms which mask pneumonia in childhood and in old age, Fulton takes up seriatim the statistics in various cities in this country, and from his careful and thorough digestion of this enormous amount of material concludes that there is no proof that lobar pneumonia has grown more prevalent or more fatal at any period of life, with the possible exception of pneumonia in children under five years of age. Fulton's conclusions in regard to this extremely important subject are worthy of being given in full, and are as follows:

"I. The returned mortality of the United States for ages between 15 and 60 during the past 20 years shows a diminishing mortality from the class of respiratory diseases commonly returned as