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THE REGISTRAR-GENERAL'S LAST
with this exception the death-rate last quarter was
lower than that recorded in any spring quarter since QUARTERLY RETURN.
civil registration was established in 1837. This By J. HAMPDEN SHOVELLER.
low rate of mortality last quarter implies that
upwards of 16,000 persons survived the three The quarterly return of marriages, births, and months who would have died had the death-rate deaths in England and Wales has just been issued corresponded with the average rate in the same by the Registrar-General. The statistics relating to quarter of the forty-six preceding years. In the marriages are for the first quarter of this year, and various counties the death-rates ranged from 14:3 those relating to births and deaths are for the three in Sussex, 14.7 in Huntingdonshire, and 154 in months ending June last. The marriage-rate showed Berkshire, to 20:6 in Staffordshire, 21°8 in Lana considerable decline from that recorded in the cashire, and 22°1 in Cornwall. In the principal corresponding period of the previous year ; the birth- urban districts comprising the chief towns, and conrate and the death-rate were below the average. taining an estimated population of nearly sixteen The mean temperature during the quarter at the millions of persons, the death-rate last quarter Royal Observatory, Greenwich, was 52°5, and averaged 20'0 per 1,000 ; in the remaining and slightly exceeded the average for the corresponding chiefy rural population of about ten millions and periods of 113 years. The rainfall amounted to 4:31 three quarters of persons, the rate of mortality did inches, which was one inch and a half below the not exceed 17.3. These urban and rural rates were average amount.
respectively 13 and 147 per 1,000 below the average During the first quarter of 1884 the marriages of rates in the ten preceding corresponding quarters. 83,076 persons were registered in England and In twenty-eight of the largest English towns, Wales, equal to an annual rate of 12'3 per 1,000 of including London, and having an estimated poputhe population, estimated by the Registrar-General | lation of more than eight millions and three quarters to be rather more than twenty-seven millions of of persons, the death-rate during the quarter under persons. This marriage-rate was l'oper 1,000 notice was 20:8 per 1,000, and exceeded by 0:8 below that of the rate recorded in the first quarter of the general urban rate. While the death-rate in 1883, and 0'7 below the average rate in the corre- London did not exceed 1949, it averaged 21.6 in the sponding periods of the ten years 1874-83.
twenty-seven provincial towns, among which it The births of 231,149 children were registered in ranged from 16'1 in Brighton, 16.8 in Derby, and England and Wales during the second quarter of 17'2 in Bristol, to 24:9 in Wolverhampton, 25.5 in this year, equal to an annual rate of 34:2 per 1,000 of Manchester, and 25:6 in Oldham. The rates of the estimated population. This birth-rate was mortality at different ages in these towns varied lower than that recorded in the corresponding considerably; it may be noted that the death-rate quarter of any year since 1869. In the several among infants in the twenty-eight towns, measured counties the birth-rates ranged from 26:4 in Rut by the proportion of deaths under one year of age to landshire, 27.5 in Herefordshire, and 29:1 in the 1,000 births registered, ranged from 82 in Brighton, extra-metropolitan portion of Surrey, to 39*7 in to 175 in Oldhain; that among persons aged beNottinghamshire, and 417 in Durham. The 231,149 tween one and sixty years the rate of mortality did births registered in England and Wales during the not exceed 9'2 in Derby, whereas it was equal to second quarter of 1884 exceeded the deaths by 17'3 in Oldham; and that among persons aged 103,203 ; this represents the natural increase of the upwards of sixty years, the death-rate ranged from population. From the Board of Trade returns it 61:1 in Norwich to 99'2 in Bolton. appears that 120,102 emigrants embarked during last The 127,946 deaths in England and Wales last quarter from the various ports of the United King- quarter included 28,001 of infants under one year of dom at which emigration officers are stationed. age, 66,629 of children and adults aged between one Distributing those whose nationality was undis- and sixty years, and 33,316 of persons aged sixty tinguished, and excluding foreigners, the emigrants years and upwards. Infant mortality was equal to of British origin were 92,451, including 46,345 121 per 1,000 births, and was below the average of English, 7,854 Scotch, and 38,252 Irish. The pro- the ten preceding corresponding quarters. In the portions of British emigrants to a million of the twenty-eight great towns the proportion of infant respective populations of the three divisions of the mortality averaged 137 per 1,000 births; it did not United Kingdom were 1,708 from England, 2,031 exceed 131 in London, but averaged 142 in the from Scotland, and 7,723 from Ireland. Compared twenty-seven provincial towns, among which it with recent corresponding quarters, the proportion ranged from 82 and 92 in Brighton and Birkenhead, of emigration last quarter showed a decline in each to 16; in Preston and 175 in Oldham. Among of the three divisions of the United Kingdom. persons aged sixty years and upwards, the rate of
From returns published by the Local Government mortality last quarter in England and Wales was Board it appears that the average number of paupers below the average. relieved on the last day of each week in the quarter The deaths registered in England and Wales ending June last was 696,931, of whom 173,749 during the second quarter of this year included received indoor and 523,182 outdoor relief. The 3,603 which resulted from whooping-cough, 3,457 proportion of the population in receipt of pauper from measles, 2,620 from scarlet fever, 1,674 Irom relief showed a further decline from that recorded diarrhea, 1,491' from 'fever? (including typhus, in the corresponding periods of the two preceding enteric féver, simple and ill-defined forms of conyears.
tinued fever), 902 from diphtheria, and 652 from The deaths registered in England and Wales small-pox; in all, 14,399 deaths were referred to during the second quarter of this year were 127,946, these principal zymotic diseases, equal to an annual corresponding to an annual rate of 18:9 per 1,000 of rate of 2.13 per 1,000, against an average rate of the estimated population. In the second or spring 2.38 in the ten preceding corresponding quarters. quarter of 1881 the death-rate was so low as 18:6; In the twenty-eight great towns this zymotic rate
last quarter averaged 3:13 per 1,000, and ranged was below the average last quarter. The death-rate from 0.82 and oʻ92 in Brighton and in Derby, to from fever, which in the ten preceding June quarters 4:30 in Wolverhampton and 4:64 in Liverpool. In had averaged 0-33 per 1,000, did not exceed 0*22, fifty other towns this zymotic death-rate averaged and with the single exception of the second quarter 1.95 per 1,000, while in the remaining or rural of 1881, when it was also o‘22 per 1,000, was lower portion of the country it did not exceed 1.60. than in any quarter on record. The fever death
Whooping-cough was the most fatal zymotic rate in the twenty-eight towns did not average disease in England and Wales during the quarter more than o‘23; it was, however, 0.60 in Portsending June last. The 3,603 fatal cases of this mouth, and 0.62 in Blackburn. The fatality of disease were equal to an annual rate of 0.53 per diphtheria somewhat exceeded the average, though 1,000, which almost corresponded with the average it showed a marked decline from that which prerate 'in the ten preceding June quarters. The vailed in the first quarter of the year. The highest highest rates of mortality from whooping-cough in death-rates from this disease among the twenty-eight the twenty-eight towns were 129 in London, 1.62 in towns last quarter were reported in Portsmouth and Bolton, and 1'74 in Liverpool. Among the fifty Cardiff. of the 652 fatal cases of small-pox regisother towns the death-rate from this disease was tered in England and Wales during last quarter, 344 equal to 1'54 in Bury and 2:12 in Gateshead. The occurred in Greater London (excluding 87 of London 3,457 deaths attributed to measles were equal to a residents in hospitals situated outside Registration rate of 0.51 per 1,000, against an average rate of London), 50 in Liverpool, 20 in Sheffield, 15 in West 0944 in the ten preceding corresponding quarters ; Bromwich, 15 in Sunderland, 9 in Hull, 9 in Newthe measles death-rate in the twenty-eight towns castle-upon-Tyne, and 103 in other parts of the averaged o'94 per 1,000, but the rate was equal to country. 2.56 in Portsmouth, 3.40 in Oldham, and 3:43 in The causes of 116,661, or 91•2 per cent., of the total Wolverhampton. In the fifty other large towns the deaths in England and Wales last quarter were cerhighest rates of mortality from measles were 1.40 in tified by registered medical practitioners ; and 6,671, Bury and 2.75 in Macclesfield. The 2,620 deaths
or 5'2 per cent., by coroners in inquest cases. The from scarlet fever were equal to an annual rate of causes of the remaining 4,614, or 3.6 per cent., were 0-39 per 1,000, which was considerably below the not certified; this proportion showed a decline from average rate in the corresponding quarter of the ten those in recent quarters. The proportion of unpreceding years. In the twenty-eight large towns certified deaths in London was only 1'3 per cent., the highest scarlet fever rates were 1.42 in Cardiff, whereas in the rest of England and Wales it averaged and 1.67 in Sheffield ; among the fifty other towns 40. In the twenty-seven largest provincial towns the rate was equal to 1.73 in Gateshead, 1679 in the proportion of uncertified deaths averaged 3-4 per Ashton-under-Lyne, and 4:51 in Wigan. The rate cent., and showed the largest excess in Sheffield, of mortality from diarrhea in England and Wales' Hull, Halifax, and Oldham. Analysii of the Vital and Mortal Statistics of the Twenty-eight Great Towns, dealt with in the Registrar-Generals
Weekly Returns, for the Second Quarter of 1884.
119 102 118
MORTALITY STATISTICS OF HEALTHY tarians and statesmen, who have quoted them freely AND UNHEALTHY DISTRICTS OF
and appeared to consider them of some value as a LONDON.
ground for legislation. Mr. Gladstone and Sir Wm. By ERNEST HART.
Harcourt have in their places in Parliament em
ployed some of the statistics here set out, and I find The following tables have been worked out from the that they have been quoted at the recent conferences data of the Registrar-General's reports. They form at the International Health Exhibition. I have, on part of a statement which was made by me at a meeting request, furnished copies of the tables to various at the Mansion House on Dec. 11, 1883, on the dwell- correspondents, who have since communicated with ings of the poor, in moving the resolution for the esta- me, but finding that they are likely to be frequently blishment of the Mansion House Committee, which is discussed, and that their more extended publication now at work for the purpose of forming Sanitary Aid may possibly be of some public value, I think it well Committees in the various districts of London for the to print them here. I may add that it is my intenenforcement of existing legislation, and for the pro- tion from time to time to make a similar periodical motion of amendments of the law. Up to the pre- analysis of the mortality of the healthy and unhealthy sent time no statistics have, so far as I have been districts of London and publish the tables, and I able to find, been available for the purpose of deter- shall be very glad to receive any suggestion from mining the relative mortality of the various districts correspondents which may either further test the in London divided in such a manner as to show the value of this mode of tabulation, or add to the inforvariations expressive of the very different health mation which they are capable of affording. The conditions prevailing in rich and poor districts. death-rates in the accompanying tables have all been These figures were printed in a tabular form, and corrected by the rateable distribution of deaths distributed at the meeting, and have had therefore a occurring in public institutions; without some such limited circulation. They have since been much distribution the uncorrected death-rate of any locality inquired for, and have fallen into the hands of sani- 1 is comparatively worthless. Mortality Statistics of Healthy and Unhealthy Districts of London.
Death-rate. an Acre.
1 year 1881.
3,816,483 75,362 51
214 3.58 152 Mayfair
106 St. John, Paddington
1'37 Hampstead ..
2'10 Cavendish Square.
168 Hanover Square
137 Plumstead East
125 Plumstead West
2.89 Stoke Newington
2'19 20 Healthy Districts 478,458 30,028 16 15-3 1.94
122 20 Unhealthy Districts
307,911 1,753 176
171 St. Mary, St. George in the East
183 St. Giles, South
154 St. Nicholas, Deptford
194 City Road
146 Bethnal Green, Town
175 St. Olave, Southwark
305 Kent Road
182 St. Paul, St. George in the East
168 Leather Market
185 Old Street
152 Christchurch, Southwark
187 Waterloo Road, Second
273 St. Giles, North
178 St. James, Clerkenwell
165 Hackney Road (Bethnal Green)
169 St. Saviour, Southwark
166 St. John, St. George in the East
155 Waterloo Road, First
167 NOTE. — The average annual deaths in the unhealthy districts, 1880-1-2, were 7,968; if the healthy districts death-rate had prevailed in the unhealthy districts, the deaths would have been only 4,711, or 3,257 a year fewer than they actually were.
This loss of life, according to Dr. Fart's estimate of the minimum value of the population (men, women, and children) at 1591. a head, represents an annual money loss of 517.8631 . On the same authority there are two years disabling sickness to one death; and, on the assumption
that the men aged between 15 and 63 earn 11. a week and the women gs., the annual loss from sickness in these unhealthy districts may be estimated at 71,570l., making in all an average annual loss of 589,4331. caused by the excess of mortality in these twenty districts.
Taking the whole of London, the deaths would have been annually 23,407 less than they were had the healthy districts death-rate prevailed throughout the Metropolis , applying Dr. Farr's estimates of cost of death and sickness, the annual loss in London is estimated at 4,236,0541.
Average Average annual
Population. Death-rate, 1880-1-2.
11,987 Industrial Dwellings
18'4 or 22:8 corrected for institution deaths. 5,914
15'7 or 1994 Total
17'5 or 216
32 40 12
medical men may sometimes be—though we believe they rarely are-reluctant to attend cases where they think their remuneration is doubtful. If the
services are rendered on the requisition of the local AUGUST 15, 1884.
authority, a medical man may feel safe about getting his payment either from the patient or out of the rates,
and thus it is to be hoped that there will be no delay The Editor will be glad to receive, with a view to in attending to cases of dangerous disease, through
In the publication, announcements of meetings, reports of any doubt as to payment being secure.
not improbable case of cholera or any similar proceedings, and abstracts or originals of papers disease making its appearance in a ship which enters read before the members of any sanitary or kindred an English port, the charges for medical attendance association.
on board the vessel, together with any reasonable
expenses for the treatment of the sick, are made THE PROVISION OF
payable by the captain of the vessel on behalf of
the owners. MEDICAL ATTENDANCE IN CASE
These charges may be recovered sum
marily, so that there need be no delay in enforcing OF EPIDEMICS.
payment. A case occurred a few years ago which The spread of cholera in Europe, and the possi- went ultimately to the Court of Appeal, where it was bility of its introduction into this country, has decided that a local authority may make a valid conattracted attention to the means which we have tract to pay a medical man for attending to patients available for combatting that and other epidemic during an epidemic, without observing the formalities diseases. Sanitary arrangements are useful for pre- which are required by law for the ordinary contracts venting the outbreak of disease, but cases may of corporate bodies. A verbal order to attend, given occur when persons are attacked notwithstanding by a duly authorised member of a local authority, is every precaution, and medical assistance may a sufficient contract to render the authority liable to become necessary.
If members of the well-to-do pay for the medical man's services. As we have seen classes are attacked, they would probably call in such services may properly be paid for out of the their own doctor, and be attended in the same way, rates, irrespective of the question of the patient whatever was the disease from which they suffered; being a pauper, and the question as to who is ultiand pauper patients have the same right to medical mately liable to pay is one with which the medical attendance if they are victims of an epidemic as man at the time he is called in need not concern him. when they suffer from ordinary diseases. But in self. Parliament has rightly considered that in case case of epidemics it is specially important for the of epidernics is most important to have medical well-being of the community that medical assistance attendance promptly available for all who need it, should be promptly rendered to all who may need it, and has imposed on the local authorities the liability and it is well to point out the means by which such of providing such attendance, where it may be assistance ought to be provided.
needed, and has not imposed on them any restricUnder the provisions of the Public Health Act, tions which would delay or prevent the employment 1875, which for this purpose is applicable to the of a medical man where his services are needed. whole of England, the Local Government Board may make regulations, amongst other things, 'for The Local Government Board has appointed Mr. E. G. the provision of medical aid and accommodation, Ballard to be an inspector, and Mr. Adrian Blaikie, for promotion of cleansing, ventilation, and disin- D.Sc., to be a sub-inspector under the Alkali, &c., Works fection, and for guarding against the spread of Regulation Act, 1881. disease.' The local authority of the district within
SANITARY INSTITUTE OF GREAT BRITAIN. -At the which such regulations are in force is bound to anniversary meeting held at the Royal Institution, Albe: superintend and see to their execution, and to
marle Street, on Thursday, July 10, the Right Hon. Earl appoint and pay such medical or other officers and
Fortescue in the chair, an address was delivered by Dr. persons, and do and provide all such acts, matters, H. C. Bartlett, entitled 'Some of the Present Aspects of and things as may be necessary for mitigating any Practical Sanitation,' and the medals and certificates were such disease. The expense of carrying this out presented to the successful exhibitors at the exhibition must in the first instance be defrayed out of the held at Glasgow in September 1883. At the close of the rates, though in some cases the local authority may
address the chairman proposed a vote of thanks to Dr. be able to recover some part of it from the indi
Bartlett, which was seconded by R. B. Grantham, viduals on whose behalf it has been incurred. In
M.Inst.C.E., and a vote of thanks to the Right Hon. case of hospital accommodation, the Act expressly
Earl Fortescue for presiding, was moved by Dr. A. provides that expenses incurred by a local authority Carpenter, and seconded by Professor de Chaumont,
M.D., F.R.S. in maintaining a patient in a hospital shall be deemed a debt due from the patient to the local
Ven rilaTION OF Public BUILDINGS.-Messrs. Robert authority, and such expenses may be recovered in a
Boyle & Son, 64 Holborn Viaduct and Glasgow, have court of law. The charges for medical attendance recently applied their system of ventilation to the Head in ordinary cases can be recovered by a medical man
Quarters of the Honourable Artillery Company, Finsbury; from the person who has employed him to attend, County Hall, Menai Bridge ; Franciscan Convent, Bridg
Liberal Club, Sheffield ; Burton Club, Burton-on-Trent; as the law ordinarily implies a contract to pay by
water; New Lecture Hall, Newcastle-on-Tyne ; Bromley the person who calls him in. Such a contract may, and Beckenham Joint Hospital ; New Public Baths, however, in some cases be not proved, as recently a
Lewisham ; London and County Bank ; St. Austell gentleman, who had called in a medical man to aid Union ; Hull Workhouse, Hull'; New Workhouse, someone whom he saw suddenly taken ill in church, Wandsworth ; Richmond Union, Surrey ; Hanwell Police successfully maintained that he had made no con- Station ; New Police Station, Mitcham ; Her Majesty's tract to pay for the services then rendered. And | Prison, Leicester ; and Her Majesty's Prison, Manchester. THE LONDON WATER SUPPLY. hands of an eminent chemist, results which would
place it in his first class of waters, those, namely, of It is greatly to be deplored that the merits of the extraordinary organic purity,' it is time to consider controversy as to the London water companies, and how far we are justified in relying upon laboratory the liquid they supply, should be obscured by the inferences rather than upon the evidence of the political and professional antipathies and disagree- senses. Yet Messrs. Crookes, Odling, and Tidy, ments that now rage around the question. Granted who are paid by the London water companies to that the quality of the water is rendered infinitely make to the President of the Local Government worse than it might be by the carelessness of reports which he does not want, and refuses to domestic storage in cisterns, the inquiry whether recognise, would apparently have us believe that the the sewage-polluted Thames can be regarded as a Thames is still the same pellucid and silvern stream fit source for the potable water of some millions of whose merits the Elizabethan poets were wont to sing. people admits of but one answer. Yet we are in- These gentlemen report that during the first half vited by the water companies and their professional of 1884 they examined 1,071 samples drawn from advocates to believe that really and truly the the mains of the seven companies taking their supply diminution in volume of the water in the Thames, from the Thames and the Lea, and have been able and all the complaints that have been made about to register these many samples as being, without a its condition in the papers, do not affect in the least single exception, clear, bright, and efficiently filtered. its charms as a beverage ; and that, in point of fact, Judged by the eye, they had all of them the further Londoners are exceptionally lucky in having so claim to be described as being, even when in conadmirably pure a supply to drink.
siderable bulk, colourless. Subjected to more exact In view of the possible introduction of cholera examination in this particular, their degree of browninto London, and the desire expressed by the ish tint proved to be exceedingly low, so as in no metropolitan medical officers of health for the recti- case to preponderate over the proper blue tint of the fication of defects (if any) in the water supply of the water. The whole of the 1,071 samples were further metropolis, and particularly for watchfulness over examined for organic matter by the permanganate the reservoirs and mains of the water companies, a process, and for dissolved oxygen by the Schutzencommunication was recently addressed by Sir berger process, with similar satisfactory results. As Francis Bolton to each of the eight companies on regards the quantities of organic carbon, and conthe subject, specially asking whether they had any sequently of organic matter, present in the Thamesdefects to report, and whether they could suggest, in derived samples, the mean result for January, exaddition to their customary precautions for ensuring ceptionally low for this season of the year, was the purity of their water supplies, any improvements 118 part of organic carbon in 100,000 parts of water. or increased precautions capable of being taken The mean result for February was "140 part, for during the present summer. The replies received March 165 part, for April •139 part, for May '104 from the companies are reproduced in the last part, and for June 114 part of organic carbon in report of the water examiner, and will be read with 100,000 parts of the water ; while the highest result some curiosity and not a little scepticism. It was furnished by any single sample examined during the hardly to be expected that the companies would last two months was '129 part, equivalent to about foul their own nests by reporting defects in the a quarter of a grain of organic matter per gallon. fashion that Sir Francis Bolton ingenuously sup- The Report of the Royal Commission on Water posed. Accordingly, we find that with one voice Supply is quoted to show that a minute proportion they report their arrangements as the most perfect of organic matter, variable in amount with season, that could be devised, and as to improvements, is a normal constituent of river water, and it is argued these would be impossible. The companies are that there is no reason whatever to consider this severe, however, in their condemnation of house- proportion of natural organic matter as in any way holders of all classes in not looking after their prejudicial to health ; and that there is absolutely cisterns as they ought. A variety of pains and no chemical evidence to indicate that the small propenalties are suggested as fitting punishments for portion of organic matter present in the water supply those who do not keep their cisterns in a condition of London is different, either in quantity or kind, meet for the extraordinarily pure and lavish supply from the natural organic matter of the river, as met of water which the companies bountifully bestow. with, for instance, at Lechdale, 120 miles above the All the improvements, the vast filtering beds, the intake of the companies. Still, in view of the imconstant supply, the perennial analyses, the hydrants, portance which is attached, unwarrantably the reand the rest of it, are set at nought by the neglect of porters think, to the not inconsiderable variations the householder to clean out his cistern with due in the proportion of organic matter present in the regularity and frequency. No doubt domestic water London supply, the consolatory remark is added receptacles are very often sadly neglected, but is not that at periods of summer heat and drought like the this perpetual harping upon the carelessness of the present the natural agencies at work to keep down householder a little suspicious, with our knowledge the proportion of organic matter existing in the of the omissions and neglects of the companies ? water of the river are at their maximum of activity.
We should have thought that the revelations of 'It results in this way, that the water supply of the Medical Department of the Local Government | London is at its best just at those seasons, like the Board as to the fallacies of the results declared by present, when any failure in the quality of the supply water analysts ought by this time to have exploded might be considered likely to be of exceptionally any arguments based upon the largeness or small- serious import.' On reading this report one is ness in a given bottle of water of the decimal frac- tempted to repeat the inquiry, Can these things be?' tion of a grain of some particular chemical compound. When a sample of water, to which has been The Corporation of Newcastle have agreed to erect a added an appreciable quantity of the excreta from a refuse destructor of twelve cells at Byker Hill, at an patient suffering from typhoid fever, gives, in the estimated cost of 7,000l.