in its way, as important as the death rate. Sir George Newman, who speaks with unchallengeable authority on this question, has said that

the young child has to bear a heavy burden of environmental neglect, associated with bad housing, poverty and absence of hygienic supervision. As a result, the school medical service is faced with the hard issue that, out of an infant population born healthy, 35 to 40 per cent. of the children who are admitted to school at five years of age bear with them physical defects which could have been either prevented or cured. This is, indeed, a bad start on the journey of life.

Here is waste with a vengeance !

This waste continues throughout the school life of the child population.

Routine medical inspection [reports the Chief Medical Officer of the Board of Education] finds that about 40 per cent. of the children have a greater or less degree of physical defect. . . . We must not forget that these are maladies found at school. There are, in addition, the infectious diseases, which, unfortunately, often leave behind, and especially if neglected or untreated, a good deal of disablement and the seeds of further disease.

Here we have the indisputable fact that two out of every five boys and girls leaving school to embark on their wage-earning careers suffer from some physical defect or disability, though we know that at least four out of every five children are born healthy. The tragic story works itself out during the years of employment. The total volume of sickness, disease, and disablement in the community has never been measured. Even the figures which are available regarding National Health Insurance hardly tell the full story even so far as it concerns 'insured persons,' but

the total number of weeks represented by the sickness and disablement payments in 1923 may be estimated at about six and three-quarter million weeks' sickness and six million weeks' disablement for men, and at four and a quarter million weeks' sickness and three and a half million weeks' disablement for women. These figures, which do not include the first three days of incapacity for which sickness benefit is not payable, give a total of twenty and a half million weeks lost in 1923 through sickness, or a period of 394,230 years. That is to say, in England and Wales there was lost to the nation in the year, among the insured population only, and excluding the loss due to sickness for which sickness or disablement benefit is not payable, the equivalent of the work of 394,230 persons. Moreover, it must be remembered that it is not only the working equivalent of 394,230 persons that was lost, but also the labour and expense involved in their care during their incapacitation.

It is difficult to measure exactly what these words of the Chief Medical Officer of the Ministry of Health really mean. The loss of time due to sickness amongst insured persons in England and Wales in 1923 was equivalent to a third of the unemployment in Great Britain due to the severe trade depression last year. The

number of days for which sickness benefit was paid in England and Wales was double the number of days lost through strikes and lock-outs in the whole of Great Britain and Northern Ireland in 1923, and two and a half times as much as the time lost last year through industrial disputes involving stoppages of work.

Lieut.-Colonel Fremantle, M.P., consulting medical officer of health for the county of Herts, has estimated the total direct material loss in England and Wales due to sickness and disability at a minimum of 150,000,000l. a year, and this by no means represents the total drain upon the well-being of the community.

But let us retrace our steps and return to the question of the toll of death. Nine out of every hundred deaths are due to some form of tuberculosis. In 1923 over 40,000 people died from tubercular disease. It is a comfort to know that, though tuberculosis still continues to be one of the formidable problems of national health, the number of cases and the number of deaths steadily decline. Tuberculosis is not an ineradicable disease. It could be stamped out as typhus has been stamped out in this country. Its ravages have already been checked, and more determined action in the way of rooting out the conditions in which tuberculosis thrives would lead to its virtual elimination.

Cancer stands on a somewhat different footing. It accounts for 109 deaths out of every thousand. Every tenth person dies of malignant cancer. This dreadful disease in 1923 carried away as many people as live in the town of Burton-on-Trent. It is a source of untold suffering to its victims long before death releases them from pain. A good deal of investigation is going on at the present time, but would the income tax payer grudge a penny on the income tax for one year in order to provide a capital fund of 5,000,000l. to fight cancer and get rid of a large measure of the waste of life, health, and happiness which it involves ?

Then consider a third important cause of death which illustrates how apparently minor ailments may ultimately lead to serious results. The deaths of 128 people out of every thousand are ascribed to diseases of the heart. In 1923 no fewer than 56,886 people died from some form of heart disease-equivalent to the total population of the city of Oxford. These diseases may arise from different causes; but they are often rheumatic in their origin. A recent inquiry into rheumatic diseases goes to show that about one-seventh of the total sick benefit, or over 1,800,000l. a year, is paid to insured workers under the National Health Insurance Act, and 3,141,000 weeks of work are lost annually on account of these diseases (excluding benefit paid or work lost on account of organic diseases of the heart). It was found that in the cases of acute rheumatism nearly 50 per cent. of patients showed signs of recent or old endocarditis. Moreover, nearly

50 per cent. of the sufferers with acute rheumatism had either enlarged or septic tonsils, and only 2 per cent. of the patients with acute rheumatism had had their tonsils removed. Dental sepsis is also a cause of rheumatic ailments. The annual report of the Chief Medical Officer of the Board of Education for 1922 states that Dr. Beddard has attributed 90 per cent. of the cases of rheumatoid arthritis to infection arising from the teeth, and Sir W. Wilcox estimates 72 per cent. of fibrositis and arthritis to be due to the same source.' The report continues: 'the danger of dental disease begins in childhood, and it is admitted that dental sepsis is widespread among school children.' 'The school medical reports from all parts of the country,' we are informed, 'tell the same story-widespread dental decay and consequent ill-health-but, in varying degree, direct and prompt benefit follows inspection and treatment.' The reports, again, show that one out of every twenty children suffer from enlarged tonsils or adenoids to a degree which calls for surgical treatment, while a further 5 per cent. require to be kept under observation, though not necessarily requiring surgical treatment.

It is clear that if we could secure that all children had healthy mouths and throats, we should cut off a large slice of the subsequent disease, disability, and premature death which now burden the nation. There is no need to pursue the subject by telling the sad story of unnecessary suffering and death from other diseases. The main point, which is amply proved, is that an enormous and incalculable mass of suffering, a large number of premature deaths, and a heavy drain upon the health, strength, and efficiency of the people as a whole result from the prevalence of preventable diseases. The vitality of the nation is lowered, its productive capacity impaired, its resources depleted by the cost of the wreckage, and its doctors engaged on the task of curing what might largely never have arisen, because the country has not fully realised the waste which is going on in its midst.

This is not the opportunity to explain in detail how the waste can be ended. But it is worth while to point out that the material cost which would be entailed could not compare with the human and material cost which the continuance of the human waste involves. A healthy people is a business proposition, and in some directions the material cost of achieving health would be insignificant compared with the results. An example will suffice. Suppose the pall of smoke which overhangs our towns could be abolished, as it might be, and that sunlight were let into the towns as abundantly as it falls upon the countryside and seaside resorts. The results in health would be immeasurable. Towns would be enormously cleaner, and the cost of unnecessary dirt, unnecessary artificial lighting, and unnecessary doctors' bills would be elimi

nated. Or suppose the nation spent a million or two a year in securing skilled attention to the teeth of the child population. It would be repaid a hundredfold in less loss of working time, insurance benefit, doctors' bills, hospital expenditure, and poor relief.

The truth is that the nation, impoverished by the war and by the consequences of the war, faced with years of difficulty and struggle, cannot afford the loss of human power and quality to which we submit through the ravages of preventable disease. It is not that we cannot afford to safeguard and promote the health of the people. The simple fact is that we cannot afford the terrible price which a C3 population imposes on itself and on posterity.

ARTHUR GREENWOOD.

1925

PALESTINE AND LORD BALFOUR: A REPLY

THE recent inauguration of the Hebrew University in Jerusalem by Lord Balfour has been selected by Mr. H. St. J. B. Philby as the text for an intemperate philippic, in the last number of this Review, against the author of the Balfour Declaration and the British policy in Palestine resulting therefrom. The ceremony that has aroused his ire took place on Mount Scopus, one of the most wonderful and inspiring sites in the Holy Land, and formed the culmination of the zealous and assiduous labours of the last seven years and the fulfilment of an idea that was first propounded over forty years ago. It was attended by the official representatives of eight Governments and of over two score universities and learned academies in all parts of the world, who all gave voice to their congratulations and good wishes at the creation of a modern seat of learning in the Holy City. It was witnessed by a concourse of 10,000 people, who were thrilled not only by the impressive spectacle they were privileged to behold, but also by the thought of what it would ultimately mean to Palestine, to the Jewish people, and to humanity at large. It was reported— in many cases at length-in all the leading newspapers of the globe, and it was celebrated by countless public gatherings at which laudatory addresses were delivered by representatives not only of the Jewish, but also of the Christian, community. It was an event that captured the imagination of the world, for it suggested even to the dullest mind the dawning of a new era, in which the Jewish genius would have the opportunity of extending the bounds of knowledge and stimulating the progress of civilisation from the very land in which it gave birth to the greatest spiritual product of the human mind-the Bible.

Such was the event that has provoked Mr. Philby to join the little band of anti-Zionist writers and fulminate against the work of restoration that is now being accomplished in Palestine. He scoffs at the ceremony performed by Lord Balfour and says that it was superfluous, on the ground that the Institute of Jewish Studies, which, he alleges, is commonly regarded as the University, was opened last December. But that Institute is only one of several faculties that compose the University, and various depart