this country are not registered) are registered, but a large number of births escape registration either from negligence, shame of illegitimacy, or for the purpose of avoiding vaccination.

Fallacies as to Causes of Death.-In many parts of the country a large proportion, in the mining districts of Wales and Durham as high as 10 to 14 per cent. of the causes of death are entered by the registrar on the evidence of the friends, or are suggested by himself in the absence of any medical certificate. Thus the apparent prevalence of 'consumption' in Wales is partly due to all lingering diseases being so-called by the ignorant people. Even medical certificates are very often inaccurate, either from faulty diagnosis or from the patients having been attended by unqualified assistants, or, as is not unfrequently the case in rural districts, seen by the medical man only once before death.

Sum of ages at death

Number of deaths.

Sum of ages at census Number of persons living. Number of population Number of deaths in a year. age

=

Probable duration of life, or expectation at birth at which a number, say a million born, is reduced to onehalf.

This is not the same as the mean age at death, for in two communities I in 40 may die annually, i.e. 25 per 1,000, but in one the deaths may be mostly those of infants, the adults reaching a good old age, in the other few may attain a great age but the infant mortality may be low.

Natural increase excess of births over deaths. Fallacy of Duration of Life.-The rule given for finding the mean duration of life holds good only of the rare case of a stationary population, i.e. one in which the births just balance the deaths. Thus, with our present mean birth-rate of 35 per 1,000, Dr. Richardson's Utopian death-rate of 4 or 5 per 1,000 in Hygeiopolis would imply a mean duration of life of 65 years and not as would at first sight appear of 200 or 250 years.

The probable duration of life or expectation is obtained from life-tables which profess to show how many of a million born die every year, until all are extinct. They should be made by watching a generation throughout its existence, but they would then be out of date, since the conditions under which these persons passed their later years might be more or less favourable than those of their youth. Actually and probably they are made more correctly by observing for a period of ten or twenty years the ages of all persons at death, and assuming the results to be applicable to the whole lifetime of each. Some, of course, were born, and passed many years under better or worse conditions, and the same will be the case with the rising generation; but the error is greatly reduced, and life-tables frequently checked and corrected are the best guides to the health of a community.

For life assurance an error in the tables giving a duration under the truth is an advantage, but the aim of the sanitarian is to falsify all tables.

Dr. Rumsey proposed as a test of healthiness what he called lines of vitality and of mortality, or the mean ages of the living and the dying. In healthy communities the line of mortality is the

higher; in unhealthy, that of vitality. Thus he found in Herefordshire the vitality 28 years, mortality 38, but in Liverpool vitality=25, and mortality 17-i.e. in the former people lived longer, in the latter they died early. But immigration disturbs such calculations; even in the rural parts of Surrey 24 per cent. of the population were immigrants.

Birth-rates and Death-rates.-The health of a people lowers the death-rate; prosperity raises the birth-rate, unless voluntary and artificial checks are imposed; but a high birth-rate, may also be due to early and improvident marriages.

Increased length of life implies a decrease of the death-rate, but not necessarily an increase of the population, which depends on the excess of births over the deaths. With a decreased death-rate there will be a larger proportion of adults if the decreased death-rate be mainly among children, or of the aged if among adults.

The death-rate is dependent on the sanitary condition of a community, and is thus under legislative control.

The birth-rate depends greatly on voluntary marriage and the fertility of females-i.e. on the action of individuals rather than on that of the State. It is strikingly connected with the demand for labour, with emigration, and with any need for men to fill the vacancies caused by death. Thus, after wars and pestilences a population increases rapidly, young men filling the places of the deceased and marrying thereon. Rising industries, in like manner, lead to numerous marriages and propagation. The birthrate depends on the constitution of the population, chiefly as affected by employments; the death-rate on its constitution as regards ages and sanitary conditions.

A large proportion of aged persons by no means implies longevity, but depends on the proportion of children to adults-i.e. on the size of families. Thus there is a larger percentage of persons over sixty years in France than in England, not because life is longer there, but because fewer children follow each marriage; and the natural increase of the population is consequently less. The teeming populations of Liverpool and Manchester, amid insanitary surroundings and unfavourable social conditions, have the highest birth-rate; but also the highest deathrate, and are only maintained or increased by immigration.

The death-rate varies almost directly as the density of the population-not, that is to say, in consequence of mere aggregation, but from the social and moral conditions causing and caused by overcrowding, poverty, and vice. A high degree of aggregation is in itself quite compatible with a low death-rate, as in the improved industrial dwellings where one thousand persons or more are comfortably housed on an acre.

Fallacies concerning the Relations of the Birthrate and Death-rate. It is often said that a high birth-rate involves a high death-rate, the latter constituting a sort of natural check on the former. Of course infancy is more tender than manhood, and where there is a large infant population there will necessarily be more deaths than where children are few. But if the high birth-rate be the natural and direct result of prosperity and of high wages, as in industries where only adult males are employed or in flourishing colonies, the birth-rate will greatly exceed the death-rate, the sanitary conditions being good.

But if, on the other hand, the high birth-rate be the result of general illegitimacy, of improvident marriages, &c., the consequences will be a proportionately high death-rate and a teeming but shortlived population.

Estimation of Infant and Child Mortality.-It is usual to calculate the deaths of infants, &c., on the total deaths at all ages, or on the number of persons living. But since the proportion of children to adults in any population can be known only at the time of the census, and is very different in different places, all such estimates are useless, and for purposes of comparison most fallacious.

The infant mortality should always be calculated on the infant population, and so with any particular period of life for which the data are to be had. The infant population in any given year is the mean of the births in that and the preceding year.

The conclusions to be drawn from the infant mortality in any community are among the most important duties devolving on the sanitary reformer, but so long as the infant death-rate is calculated as it is by the vast majority of medical officers, &c., nothing but confusion can follow. The number of children under five years may be approximately obtained by the following method, which is, we believe, original. Add together the total births of the five previous years, and deduct from the sum the number of deaths under one year of age in the first of these years, under two in the second, and so on. The remainder will be the number now living under five. Errors arising from emigration and immigration may generally be left to correct one another.

Infant Mortality from all causes per 1,000 Births.

England London

Liverpool

1881

same increase of the adult and diminution of the infant mortality was observed during the Lancashire cotton famine when the mothers were no longer at work in the mills.

When improper feeding is the chief factor, a large proportion of the deaths are due to diarrhoea and other diseases of the digestive organs, convulsions, &c., and relatively fewer to other causes of a less preventable kind.

Fallacious Inferences from Neglect of the Factor of Age-Since of the 20 deaths per 1,000 living in this country 8 on an average are those of children under 5 years, 8 of persons between 5 and 65 years, and 4 of still older persons, or 40, 40, and 20 per cent. respectively of the deaths are contributed by these age classes; and since infancy and childhood are more susceptible to insanitary influences, it is obvious that the general mortality will be greatly affected by the relative proportion of children and adults. Indeed, Dr. Rumsey showed that the difference of 10.5 per 1,000 in the death-rates of Dr. Farre's 60 healthiest and 30 unhealthiest districts was thus explained to the extent of 8 per 1,000, depending on the number of children and the greater or less mortality among them.

We may here refer to a notion which has fascinated some minds fond of paradox, and which we may call the fallacy of the substitution of diseases. It has been said that the reduction of one cause of death leads to an increase of others. In one sense this is true, since everyone must die at some time from some cause or other; but the success of sanitary measures is seen in the reduction of deaths from preventable causes. But the fallacy referred to consists in ignoring the influence of mean age on the prevalent diseases. Thus of 1,000 persons dying from all causes in 1861 to 1871, there died of:

1871-85

148

130

Manchester

Salford

Leicester

Birmingham.. Portsmouth

The question of infant mortality is closely connected with that of infant feeding, and these extraordinary differences are mainly if not wholly explicable in this way. In the Faroe Islands and in Norway infants are invariably breast-fed, while in Iceland and among the working-classes in Bavaria they are as constantly brought up on sopped bread and farinaceous foods. It is a fact full of instruction that when during the sufferings and starvation caused by the siege of Paris the general mortality of the population was doubled, that of the infants was reduced by 40 per cent. simply from the mothers being compelled to suckle their babies, and the

These are diseases respectively of early, middle, and advanced life. It is not that there was less phthisis or cancer in Liverpool, but so many persons died in youth that fewer attained the age at which they became liable to those diseases. Thus, an increase in the deaths from diseases incident to advanced life may really indicate a general prolongation of life from improvement in the public health.

THE ATKINS FILTER AND ENGINEERING COMPANY, LIMITED, have received an order from Her Majesty's War Office for 40,032 lbs. of their specially prepared Granulated Charcoal, to be used in the Atkins's' Filters recently supplied by them for use in the Military Barracks and Hospitals, &c.

WE are glad to note that the City Engineer of Liverpool, Clement Dunscombe, Esq., M.A, M. Inst. C. E., has been awarded by the Jury Commission at the International Health Exhibition a Gold Medal for his designs for Artisans' and Labourers' Dwellings, and the Corporation of Liverpool have been awarded a Diploma of Honour for the exhibit. These designs embrace the Nash Grove Dwellings now being erected by the Corporation under Mr. Dunscombe's supervision, at a cost of £53,000, exclusive of the value of the site. Descriptions of these dwellings will be found in the SANITARY RECORD for Dec. 15, 1883, p. 291, and March 15, 1884, p. 437.

CC

CIATION.

By HENRY M. MAVOR.

It may be safely affirmed that in regard to general sanitation we are wise in our generation, but it must also be admitted that the present generation in the earlier years approached the subject somewhat tardily; and, furthermore, while recognising the many evils to be combated, the general public treated the danger somewhat disrespectfully, and took but few steps to ascertain causes when effects were only too palpable and fatal. In many cases of indisposition and sore throat or other pertinent | ailments, change of air' was and is rightly insisted on, but frequently in ignorance that the air' which naturally was not suitable' contained a considerable quantity of sewer gas. It was only in the event of severe illness or fatal results that the question of drainage was taken into consideration, and this is not to be greatly wondered at, as no general attention had been called to the subject, and, owing to this want of knowledge, it was a first experience from a householder's point of view, and as such was, as a rule, dearly purchased. The sanitary surveyor, or engineer, as we understand him now, was not in existence, and the warning voice was raised by the doctor. The cause being thus discovered, the inefficient services of the plumber or builder were called into requisition, and a general patching up of drains, with the addition of a trap here and there, mended matters more or less for a time, until the still present defects that were manifest were made manifest to the occupier. In a commercial age this want of knowledge of construction soon found the correlative supply, and being a fresh field for energy and ingenuity, there was no lack of competitors to undertake the work and meet the requirements in a practical and scientific manner. Still, the public attention or appreciation somewhat flagged, except under exceptional circumstances, and it is but comparatively recently that a sense of the great importance of the question seized upon the minds of the multitude, and for the past few years a growing disposition has been evinced to at any rate take an interest in and understand the rudiments of sanitation, so far as it pertains to the immediate surroundings of the people. This advancing interest led up to and has been greatly fostered by the well considered Exhibition at South Kensington, and the lessons to be there acquired have penetrated far and wide. Many of the mysteries which were supposed to surround this study have become gradually dispelled, and it is seen that common-sense principles are brought to bear upon ordinary physical facts, and the laws of nature are enlisted in the service and not set at defiance, as was formerly the case.

But if, on the other hand, we turn to see what our neighbours are doing we find a state of things which is pre-eminently unsatisfactory. The prevalence of cholera on the continent, with such terrible results, is a strong commentary upon the gross state of ignorance, and, one might also say, wilful negligence, of the commonest forms of precaution or cleanliness. Those who have had experience in foreign hotels or houses can bear out this statement, and the indifference with which such affairs in normal times are treated is a matter of surprise and horror, not unmingled with disgust,

sympathy. To see Naples and die' has now a terribly literal meaning. The following extract from a letter quoted in the Times emphasises the many sad reports: 'It may easily be imagined that a vast amount of filth has been accumulated century after century by an ever-increasing population. It is only necessary to cut brief trenches in old Naples to find a subsoil black and mephitic, because composed of organic débris in slow or active putrefaction. To this be added a most imperfect sewerage system, the walls of which are unprotected, without any fall, without a course of water, often placed under the level of the sea, and one can readily imagine again the putrid exhalations which arise, and which, filtering into the cisterns, poison the drinking water of the city. At present Naples is a disgrace to civilisation and humanity, and, what will come nearer to the feelings of Italians, it is a national danger.' When the disease has run its course, and the danger is past, will they, can they set their houses in order, and give reasonable sanitation to their city? It is of extreme doubt, if we judge by what has been done before.

In Paris the present condition is almost as serious; and the predisposing causes of infection are many. Typhoid fever is very rife, and the Seine is a distributing agent of disease, and to the defects of the city drainage may be added a supply of inferior water. We see, however, that it is proposed to institute a municipal sanitary service in Paris, which will take upon itself all the functions usually performed in England by vestries, district boards, commissioners of sewers, the Metropolitan Board of Works, and water-companies, as the management of the water-supply is to be included.

The Spaniards have barely sufficient water for drinking, therefore there is little for washing or drainage purposes. Not that they possess any ap preciable system of drainage; but this perhaps is well for them, for the hot dry air sufficiently deodorises and oxidises the products of sewage, and they escape some of the risks of contamination by

water.

In Germany but little encouragement comparatively is given to sanitation, although official sanc tion is given in high quarters to departmental efficiency. To see ourselves as others see us is always more or less amusing, if not instructive; and it will be amusing to many to hear a German professor's view of the International Health Exhibition. He reports to his 'Society' that, from a scientific point of view, it is pitiful, it being anything rather than its name implies.' The statement shows anything but a healthy exhibition of judgment, and its very absurdity carries its own refutation. We look in vain through all the foreign sections of the Exhibition for any real improvements in sanitary appliances or methods, and, beyond a few drawings in the French and Belgian Courts, we see no attempt to approach the subject in such a way as to require any serious attention. Perhaps this was all our German friend could find, and this might give rise to his remarkable want of perception. The literal meaning of approaching a subject without prejudice' is knowing nothing about it:' could the professor have been prejudiced or otherwise?

In America, where they have less to unlearn, they are keeping step with us, for, although we speak their language so badly,' they are not above exchanging views, nor are we above borrowing from

them, to mutual advantage. The business-like and go-a-head way in which they treat the subject, both in practice and theory, is characteristic, and their press agencies and other institutions for spreading technical knowledge are well considered.

Turning to the appreciation of the question at home, we find necessary attention called from time to time in the columns of the daily papers, and letters appear from all sorts and conditions of men, some with, and some without, a knowledge of what they are writing about; but, such as they are, they all tend to awaken, or, we might almost now say, extend the interest in work which has hitherto been, unfortunately, a dead letter with so many.

A well-known London architect, continuing the discussion in the Times, points out that there is in most cases, especially in London, absolutely no one whose interest it is to see that the buildings are in any respect stronger or better than the minimum which Acts of Parliament require, and there is no Act in force dealing with the drains and sanitary fittings within the house; though elsewhere many boards, acting as urban authorities under Mr. Cross's Act, have issued by-laws relating to these, and will be able, if only their inspectors are competent and honest, to prevent a great many defects which in London we suffer from. This last sentence means a great deal, and Dr. Alfred Carpenter, the chairman of the Council of the Sanitary Institute, replies and points out that it is not every local authority which has inspectors of nuisances and local surveyors competent to make the required reports, because the officers themselves are sometimes quite ignorant of the true principles of sanitary science. That which one officer recommends, another, without reason, condemns as utterly inadequate, useless, or worse than useless. If local authorities would insist upon their local surveyors and inspectors of nuisances having the diploma of the Sanitary Institute of Great Britain, they will be certain of appointing officers fully competent to make the inspections which are so necessary for the protection of the health of the inmates of all houses. The law requires that local authorities shall see to these matters, but it does not compel them to appoint competent officers. This result can only be brought about by public opinion, which may be evoked by the judicious action of the public press. Another point referred to is the difficulty which private persons have in deciding which are the best forms of sanitary apparatus and appliances to use, and we are afraid that the ordinary householder, unless he receives a competent opinion, will be more puzzled than ever when the various examples are placed before him. The conclusion of Dr. Carpenter's letter points a moral, and suggests a remedy. If persons in this difficulty will visit 74A Margaret Street, which is the home of the Sanitary Institute, as well as the "Parkes Museum," they may see for themselves the different kinds of apparatus in actual work. They will see the forms which have gained prizes and medals at different sanitary exhibitions, and which are sanitarily correct. The exhibition is open to the public free of charge. It is a curious comment upon the difficulties of sanitary work when we see two bodies like the Parkes Museum (which has been organised for the purpose of educating the people as to what are the best forms of sanitary apparatus) and the Sanitary Institute of Great Britain, whose raison d'être is the education of the lower grade of sanitary officials, languishing

for want of funds and popular support, while your columns teem with compliments which could not. arise if the public knew the advantages which would accrue to them from a further development of the two above-named institutions.'

Other letters contain complaints, and give examples of defective principles and construction, which are well known in professional circles, but probably have a touch of novelty to the writers and to the majority of the readers. Great stress is laid upon the fact of so many of these defects occurring in West-End houses; but as the whole system of house drainage is wrong, it is but natural that the wealthier portion of the community should take the first steps hence the individual cases of alteration which are becoming so numerous are merely indications of the march of progress.

The obvious, but none the less useful, remedy is advocated-that intending leaseholders or purchasers should, before transacting business, insist upon receiving a certificate or report from a qualified surveyor; and if it were done it would go far towards a satisfactory solution of the subject. The testing of drains is also adverted to, and an architect writes: For some years hardly a week has passed in which I have not had to test drains by having them filled with water; and I only recollect one case of drains standing that test, unless where they had been very recently laid under the superintendence of a good sanitary surveyor, or by builders who had been recently trained in the system now used by our most able men. No drains should be accepted as perfect until they will stand this test, and I have generally found good builders glad to have the test applied so that their work could be guaranteed.'

Appreciation of true principles is shown by the allusion to the excellent sanitary arrangements of the latest phase of London house-building—viz., Flats, which, being carried out under the supervision of skilled architects, as a rule leave nothing to be desired. A leading example of this class of work at Brighton was lately noticed (see SANITARY RECORD for September 15, page 102), where the building-owner obtained considerable professional attention by the thorough manner in which the scheme was carried out. Evidences of this kind are not wanting to prove that correct views are making headway rapidly, and the majority of publications recently issued show that the science may safely be left in the hands of its present exponents. Further signs of progress are evinced by the measures being taken to counteract the pollution of rivers, the abatement of smoke, the agitation as to the disused burial grounds, the destruction and disposal of refuse, the Adulteration Acts, the proved fallacy of quarantine, and kindred subjects-a long and formidable list. We may flatter ourselves that we are in advance of other nations in these respects, but our requirements are much greater; and although the evils have been recognised for a long time past, it has necessarily taken a long time to clear the way to institute methods of procedure to counteract the influences of a long period of neglect. It is not to be supposed that a short lifetime can atone for the deficiencies of centuries.

A contrast to this perhaps congratulatory picture may be found in the doleful utterances of Dr. Norman Chevers, the President of the Health Section of the Social Science Congress. This gentleman's experience is very great, and it is therefore

discouraging to hear his views, although the disheartening effects are considerably lessened when it is found that his propositions for reform are of such a comprehensive nature as to practically deny the admission of the word 'progress.' Nothing short of absolute perfection in a comparatively short time is admitted; and here again we are met by the difficulty of defining a limit to the period in which such a desirable state is to be brought about. No power of concentrating language would enable us to detail, within a space of twenty minutes, even a bare list of grave sanitary shortcomings which every stranger must perceive within a week after he sets foot on British chalk. Referring to the fallacy of placing dependence on death-rates, which, of course, depend greatly upon local circumstances, another grievous factor in the calculation is mentioned-viz., drink; and in this respect we fear the English nation cannot show a clean bill, or compare favourably with southern countries, although, with regard to those races of equal latitude with our own, it is doubtful if we differ much at pro rata with extent of population and the temptations and facilities thereby offered. The 'latrine on the lobby' is condemned, and the diphtheria-traps and plumbers' hunting-grounds' certainly do not compare favourably with the mediæval 'latrines,' the artistic construction of which received no scientific aid. But circumstances alter cases,' especially reduced circumstances,' as the cynic has stated; and the requirements of the inhabitants of a fortified castle are not those of the dwellers in cities and towns in which the insanitary evils are not only aggravated but induced by the reduced circumstances, or, in other words, the want of means for prevention or remediation. To place these necessary latrines in detached towers may be desirable, but the existing conditions will not allow of it; and to do so in all future works brings us again face to face with the item of expenditure, and to devote money and space to a portion of the building which is usually relegated to out-of-the-way corners is too sweeping a measure for general adoption. True it may be that forty years ago many of the great sanitary questions were nearly as advanced in men's minds as they are at this moment; but were they as advanced in material fact? Dr. Norman Chevers advocates the appointment of a Minister of Public Health, invested with great powers, against which all narrow self-interested opposition will be futile, and commanding large means (money again!). Then, and then only, will it be found that these great questions are to arrive at a practical solution; 'not as you are working now-struggling decade after decade for certain good ends, which you can only hope (probably in vain) to achieve by another and yet another of those already innumerable Acts of Parliament, despite which every crime against sanitation is still paramount throughout the realm.' Whatever may be our present rate of progress, it is hardly to be expected that an agreement to this can be found while human nature remains as it is.

Vested right and interest are too deeply ingrained and sanctioned to be readily displaced, and we must Ideal with the world as we find it. Benevolent absolutism' is not for an over-populated civilisation.

Two women were fined 10s. each and costs at the Gateshead Police Court, for exposing for sale a number of rabbits in a putrid state, and which Dr. Robinson, medical officer of health, stated were totally unfit for human food.

THE REGISTRAR-GENERAL'S LAST

QUARTERLY RETURN.

By J. HAMPDEN Shoveller.

THE Registrar-General has just issued his quarterly return of marriages, births, and deaths in England and Wales. The statistics relating to marriages are for the second quarter of the year, while those relating to births and deaths are for the three months ending September last. The marriage-rate showed a marked increase upon the rate recorded in the second quarter of last year; the birth-rate was below the average, while the death-rate, owing principally to the excessive fatality of summer diarrhoea, exceeded the average. The mean temperature during the quarter at the Royal Observatory, Greenwich, was 627, and was considerably above the average for the corresponding periods of 112 years. The rainfail amounted to 453 inches, which was nearly 3 inches below the average amount in the corresponding periods of 68 years.

During the second quarter of 1884 the marriages of 107,278 persons were registered in England and Wales, equal to an annual rate of 15.8 per 1,000 of the population, estimated by the Registrar-General to be rather more than twenty-seven millions of persons. This marriage-rate exactly corresponded with the average rate in the same quarter of the ten preceding years 1874-83, but exceeded by as much as 14 per 1,000 the rate recorded in the corresponding quarter of last year.

The births registered in England and Wales during the third quarter of this year were 225,454, corresponding to an annual rate of 330 per 1,000 of the estimated population. This birth-rate was ro per 1,000 below the average in the corresponding quarter of the ten preceding years 1874-83. In the several counties the birth-rates last quarter ranged from 267 in Herefordshire, 27.2 in Westmorland, and 27.8 in Sussex, to 37'4 in Monmouthshire, 38.3 in Nottinghamshire, and 40'5 in Durham. The 225,454 births registered in England and Wales during the quarter under notice exceeded the deaths by 90,776; this represents the natural increase of the population. It appears from returns issued by the Board of Trade that 87,522 emigrants embarked during last quarter from the various ports of the United Kingdom at which emigration officers are stationed. Excluding foreigners, and distributing rateably those whose nationality was undistinguished, the emigrants of British origin were 72,631, including 48,414 English, 6.339 Scotch, and 17,878 Irish. The proportion of emigrants last quarter to a million of the respective populations of the three divisions of the United Kingdom were 1,784 from England, 1,639 from Scotland, and 3,610 from Ireland. Compared with the corresponding quarter of 1883, the proportion of emigration last quarter showed a decline in each of the three divisions of the United Kingdom.

From returns published by the Local Government Board it appears that the average number of paupers relieved on the last day of each week in the quarter ending September last was 682,057, of whom 168,076 received indoor and 513,981 out-door relief. The proportion of the population in receipt of pauper relief showed a further decline from that recorded in the corresponding quarters of the two preceding years.

The deaths of 134,678 persons were registered in England and Wales during the third quarter of this