the past two generations. Unfortunately there is no State record of the prevalence of illness, as there is of its fatality, but some returns obtained from the leading Friendly Societies are sufficient to demonstrate the fact.

The Hearts of Oak Benefit Society has an adult membership of over 300,000. In 1901 the annual average amount of sickness experienced per member was 1.63 days. By 1910 this average had steadily risen to 2.37 days. The National Deposit Friendly Society has a membership of over 200,000. In 1900 the annual average amount of sickness per member was 2·92 days. In 1911 it had increased to 3.34 days. The Manchester Unity of Oddfellows is the largest friendly society in existence, having a membership of nearly 900,000. In 1886 the average payment per member for sick benefit was 178. 24d. By the year 1910 this sum had steadily increased to 11. Os. 4 d.

It is, of course, a fact that illness is more prevalent during the later years of life; and it may be thought that this increase is merely due to the survival of an increasing number of the population to a more advanced and more vulnerable age. That this is not the case, and that there has been a steady increase in the average amount of sickness at all ages, is shown by the following table (showing the changes in thirty years, 1866-97) taken from the Report of the Actuaries appointed in connexion with the National Insurance Act of 1911.

The statistics quoted refer to a more or less selected group, since all members of Friendly Societies have to

pass a medical examination before admission; but there is no reason for thinking that there has been any material change in the class of persons joining these societies, and the figures can only be regarded as indicating an increased liability to sickness on the part of an industrious, thrifty and very extensive section of the community. It is estimated that amongst the workers of the country as a whole the amount of illness is 10 per cent. higher than in this select class.

A study of the causes of death in young infants also points in the same direction. As is well known, since the year 1900 there has been a marked decline in the infant mortality rate. Thus in 1900 out of every 1000 children born 154 died within a year, while in 1909 the number of such deaths was only 109. This decline is clearly due to advances in preventive medicine and to the greater attention which is now being concentrated upon the requirements of child life; and it would be fallacious to look upon it as indicating any improvement in the inherent vitality of the children now being born. On the contrary, the returns of the Registrar-General show that the proportion of deaths resulting from innate defects of constitution is as high to-day as it was thirtyfive years ago. Making due allowances for differences of nomenclature, by considering all such cases together under the general heading of 'immaturity,' we find that out of every 1000 children born to-day there are practically as many who die from this cause as there were in 1873. And the proportion is by no means insignificant; it is now nearly two-fifths of the total number of deaths. But it is certain that many delicate children are reared to-day who would formerly have perished; if, therefore, we find that there are still as many deaths from this cause, it necessarily follows that the number brought into the world must be greater, and that there is an increase of degeneracy. The continued high death-rate from 'immaturity' is capable of no other explanation.

The medical inspection of school-children, which is now compulsory in the case of all scholars in public elementary schools, has not been in force long enough to yield comparative data. Nevertheless it cannot be regarded as otherwise than extremely unsatisfactory

that, according to the last report of the Chief Medical Officer to the Board of Education [Cd 5925, p. 256],

'Out of the six million children registered in the books of the public elementary schools of England and Wales, about 10 per cent. suffer from a serious defect in vision; from 3 to 5 per cent. suffer from defective hearing; 1 to 3 per cent. have suppurating ears; 6 to 8 per cent. have adenoids or enlarged tonsils of sufficient degree to obstruct the nose or throat, and thus to require surgical treatment; about 40 per cent. suffer from extensive and injurious decay of the teeth; about 30 to 40 per cent. have unclean heads or bodies; about 1 per cent. suffer from ringworm, 1 per cent. from tuberculosis in readily recognisable form; from 1 to 2 per cent. are afflicted with heart disease; and a considerable percentage of children are suffering from a greater or less degree of malnutrition.'

Leaving the question of their physical health, let us now turn to the mental condition of the people of England. This is a matter of the utmost significance, because not only is it the inevitable tendency of civilisation to impose increasing demands upon the capacity and endurance of the nervous system, but everything points to the fact that it is in the direction of mental development that the future progress of the race must take place. It is therefore hardly possible to overestimate the importance to a nation of the mental vigour of its citizens.

I think it is the experience of most physicians that diseases of the nervous system generally are on the increase; regarding this, however, there are no actual statistics, and the only available figures are those which relate to insanity. Until the last few years the increase in insanity, as shown by the annual reports of the Lunacy Commissioners, was truly alarming. Thus in 1859 the number of the certified insane was 36,762, while in 1911 this number was 133,157; in other words, while during this period of fifty-two years the population of England and Wales increased by 85.8 per cent., the certified insane increased by 262.2 per cent., or from 1 insane person in 536 normal to 1 in 275. In considering these reports, however, it has to be remembered that they do not relate to all insane persons, but only to such as are certified and under the jurisdiction of the Commissioners. There is not the slightest doubt that a far greater tendency to make use of the legal instrument of certification obtains

to-day than fifty years ago, although I do not think that there has been much change in this respect during the past ten years; there is equally no doubt that the decline in the rates of death and recovery of those who are certified has led to the accumulation of patients in asylums; and both these causes have contributed to swell the numbers of the official insane. Much of the apparent increase in insanity, therefore, is certainly fictitious; and it is difficult, indeed impossible, to make accurate corrections for these disturbing influences and to say definitely whether insanity is, or is not, really more prevalent. In their report for 1911 the Commissioners say, 'Such facts as are available tend to the conclusion that, if insanity is increasing at all, it is doing so very slowly.' But even if not increasing, it is certainly not diminishing; and the fact that there is to-day 1 insane person to every 275 normal cannot be regarded as otherwise than very disquieting.

But, as I have stated, the figures of the Lunacy Commissioners by no means include all those persons who are mentally affected. Beyond these there is an even more numerous class suffering from a still more serious condition, inasmuch as their incapacity is not possibly temporary, but is permanent and incurable. These are the feeble-minded. Until lately the number of this class was quite unknown, but the special enquiries instituted by the Royal Commission of 1904 now enable them to be estimated with approximate accuracy; and it is found that the country contains close on 150,000 persons suffering from such serious forms of mental defect as feeblemindedness, imbecility, and idiocy. If this number be added to the official insane just mentioned, there exist to-day at least 290,000 mentally affected persons in England and Wales. But beyond these again, there is a vast horde of persons discharged from asylums, whose mental condition is decidedly unsatisfactory; and there is an additional army of individuals who, although they have not yet been committed to asylums, are nevertheless of feeble and unstable mental constitution and may well be described as potential lunatics. On the whole the proportion of the mentally weak in the entire community must be well over one per cent.

Let us now turn to another condition in which inVol. 217.-No. 432.

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capacity for progress frequently shows itself, namely, Pauperism. With regard to the incidence of this, the Royal Commissioners on the Poor-Laws, in their report published in 1909 [Cd 4499, p. 20], say:

'Some satisfaction may be derived from the reduction of the ratio of pauperism to population since the early seventies; but it should not be allowed to obscure the facts that the amount of the decrease is rapidly diminishing, that from 1901-2 to 1905-6 there was a continuous increase in the ratio, and that the number of persons relieved has considerably increased during the cycle of the last ten years.'

The following table, taken from the Reports of the Local Government Board (Cd 5865; Part 1, p. 123), shows the average number of indoor and outdoor paupers (not including casuals and insane) for each year during the last decade, together with the ratio per thousand of estimated population. It may be remarked that the number of vagrants has increased in a considerably greater ratio.

At the present time there is one pauper to every fortyfive persons in England and Wales. And it is to be remembered that these figures relate to 'official' pauperism only. On March 31, 1910, there were in England and Wales 441,489 persons in receipt of old-age pensions to the aggregate value of close on 6,000,000l. a year. No doubt it would be wrong to regard the bulk of these as paupers; many would never have become chargeable to the PoorLaw; and the grant of a pension simply means less selfdenial and less expense to their relatives, who previously