THE REGISTRAR-GENERAL'S LAST

QUARTERLY RETURN.

By J. HAMPDEN SHOVELLER.

THE quarterly return of marriages, births, and deaths in England and Wales has just been issued by the Registrar-General. The statistics relating to marriages are for the first quarter of this year, and those relating to births and deaths are for the three months ending June last. The marriage-rate showed a considerable decline from that recorded in the corresponding period of the previous year; the birthrate and the death-rate were below the average. The mean temperature during the quarter at the Royal Observatory, Greenwich, was 52°5, and slightly exceeded the average for the corresponding periods of 113 years. The rainfall amounted to 4.31 inches, which was one inch and a half below the average amount.

During the first quarter of 1884 the marriages of 83,076 persons were registered in England and Wales, equal to an annual rate of 12.3 per 1,000 of the population, estimated by the Registrar-General | to be rather more than twenty-seven millions of persons. This marriage-rate was 10 per 1,000 below that of the rate recorded in the first quarter of 1883, and 0.7 below the average rate in the corresponding periods of the ten years 1874-83.

The births of 231,149 children were registered in England and Wales during the second quarter of this year, equal to an annual rate of 34.2 per 1,000 of the estimated population. This birth-rate was lower than that recorded in the corresponding quarter of any year since 1869. In the several counties the birth-rates ranged from 264 in Rutlandshire, 27.5 in Herefordshire, and 291 in the extra-metropolitan portion of Surrey, to 39'7 in Nottinghamshire, and 417 in Durham. The 231,149 births registered in England and Wales during the second quarter of 1884 exceeded the deaths by 103,203; this represents the natural increase of the population. From the Board of Trade returns it appears that 120, 102 emigrants embarked during last quarter from the various ports of the United Kingdom at which emigration officers are stationed. Distributing those whose nationality was undistinguished, and excluding foreigners, the emigrants of British origin were 92,451, including 46,345 English, 7,854 Scotch, and 38,252 Irish. The proportions of British emigrants to a million of the respective populations of the three divisions of the United Kingdom were 1,708 from England, 2,031 from Scotland, and 7,723 from Ireland. Compared with recent corresponding quarters, 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 June last was 696,931, of whom 173,749 received indoor and 523,182 outdoor relief. The proportion of the population in receipt of pauper relief showed a further decline from that recorded in the corresponding periods of the two preceding

This

with this exception the death-rate last quarter was lower than that recorded in any spring quarter since civil registration was established in 1837. low rate of mortality last quarter implies that upwards of 16,000 persons survived the three months who would have died had the death-rate corresponded with the average rate in the same quarter of the forty-six preceding years. In the various counties the death-rates ranged from 14'3 in Sussex, 147 in Huntingdonshire, and 15.4 in Berkshire, to 206 in Staffordshire, 218 in Lancashire, and 221 in Cornwall. In the principal urban districts comprising the chief towns, and containing an estimated population of nearly sixteen millions of persons, the death-rate last quarter averaged 200 per 1,000; in the remaining and chiefly rural population of about ten millions and three quarters of persons, the rate of mortality did not exceed 17.3. These urban and rural rates were respectively 13 and 17 per 1,000 below the average rates in the ten preceding corresponding quarters.

In twenty-eight of the largest English towns, including London, and having an estimated population of more than eight millions and three quarters of persons, the death-rate during the quarter under notice was 20.8 per 1,000, and exceeded by 0.8 the general urban rate. While the death rate in London did not exceed 199, it averaged 21.6 in the twenty-seven provincial towns, among which it ranged from 16.1 in Brighton, 16.8 in Derby, and 17.2 in Bristol, to 249 in Wolverhampton, 25.5 in Manchester, and 256 in Oldham. The rates of mortality at different ages in these towns varied considerably; it may be noted that the death-rate among infants in the twenty-eight towns, measured by the proportion of deaths under one year of age to 1,000 births registered, ranged from 82 in Brighton, to 175 in Oldhaın; that among persons aged between one and sixty years the rate of mortality did not exceed 9.2 in Derby, whereas it was equal to 17.3 in Oldham; and that among persons aged upwards of sixty years, the death-rate ranged from 611 in Norwich to 99.2 in Bolton.

The 127,946 deaths in England and Wales last quarter included 28,001 of infants under one year of age, 66,629 of children and adults aged between one and sixty years, and 33,316 of persons aged sixty years and upwards. Infant mortality was equal to 121 per 1,000 births, and was below the average of the ten preceding corresponding quarters. In the twenty-eight great towns the proportion of infant mortality averaged 137 per 1,000 births; it did not exceed 131 in London, but averaged 142 in the twenty-seven provincial towns, among which it ranged from 82 and 92 in Brighton and Birkenhead, to 165 in Preston and 175 in Oldham. Among persons aged sixty years and upwards, the rate of mortality last quarter in England and Wales was below the average.

The deaths registered in England and Wales during the second quarter of this year included 3,603 which resulted from whooping-cough, 3,457 from measles, 2,620 from scarlet fever, 1,674 from diarrhoea, 1,491 from 'fever' (including typhus, enteric fever, simple and ill-defined forms of continued fever), 902 from diphtheria, and 652 from small-pox; in all, 14,399 deaths were referred to these principal zymotic diseases, equal to an annual rate of 2:13 per 1,000, against an average rate of 238 in the ten preceding corresponding quarters. In the twenty-eight great towns this zymotic rate

THE

medical men may sometimes be-though we believe they rarely are-reluctant to attend cases where

AUGUST 15, 1884.

The Editor will be glad to receive, with a view to publication, announcements of meetings, reports of proceedings, and abstracts or originals of papers read before the members of any sanitary or kindred association.

THE PROVISION OF MEDICAL ATTENDANCE IN CASE OF EPIDEMICS.

THE spread of cholera in Europe, and the possibility of its introduction into this country, has attracted attention to the means which we have available for combatting that and other epidemic diseases. Sanitary arrangements are useful for preventing the outbreak of disease, but cases may occur when persons are attacked notwithstanding every precaution, and medical assistance may become necessary. If members of the well-to-do classes are attacked, they would probably call in their own doctor, and be attended in the same way, whatever was the disease from which they suffered; and pauper patients have the same right to medical attendance if they are victims of an epidemic as when they suffer from ordinary diseases. But in case of epidemics it is specially important for the well-being of the community that medical assistance should be promptly rendered to all who may need it, and it is well to point out the means by which such assistance ought to be provided.

Under the provisions of the Public Health Act, 1875, which for this purpose is applicable to the whole of England, the Local Government Board may make regulations, amongst other things, 'for the provision of medical aid and accommodation, for promotion of cleansing, ventilation, and disinfection, and for guarding against the spread of disease.' The local authority of the district within which such regulations are in force is bound to superintend and see to their execution, and 'to appoint and pay such medical or other officers and persons, and do and provide all such acts, matters, and things as may be necessary for mitigating any such disease.' The expense of carrying this out must in the first instance be defrayed out of the rates, though in some cases the local authority may be able to recover some part of it from the individuals on whose behalf it has been incurred. In case of hospital accommodation, the Act expressly provides that expenses incurred by a local authority in maintaining a patient in a hospital shall be deemed a debt due from the patient to the local authority, and such expenses may be recovered in a court of law. The charges for medical attendance in ordinary cases can be recovered by a medical man from the person who has employed him to attend, as the law ordinarily implies a contract to pay by the person who calls him in. Such a contract may, however, in some cases be not proved, as recently a gentleman, who had called in a medical man to aid someone whom he saw suddenly taken ill in church, successfully maintained that he had made no contract to pay for the services then rendered. And

services are rendered on the requisition of the local 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 in attending to cases of dangerous disease, through In the any doubt as to payment being secure. disease making its appearance in a ship which enters not improbable case of cholera or any similar an English port, the charges for medical attendance on board the vessel, together with any reasonable expenses for the treatment of the sick, are made payable by the captain of the vessel on behalf of the owners. These charges may be recovered summarily, so that there need be no delay in enforcing payment. A case occurred a few years ago which went ultimately to the Court of Appeal, where it was decided that a local authority may make a valid contract to pay a medical man for attending to patients during an epidemic, without observing the formalities which are required by law for the ordinary contracts of corporate bodies. A verbal order to attend, given by a duly authorised member of a local authority, is a sufficient contract to render the authority liable to pay for the medical man's services. As we have seen such services may properly be paid for out of the rates, irrespective of the question of the patient being a pauper, and the question as to who is ultimately liable to pay is one with which the medical man at the time he is called in need not concern himself. Parliament has rightly considered that in case of epidemics it is most important to have medical attendance promptly available for all who need it, and has imposed on the local authorities the liability of providing such attendance, where it may be needed, and has not imposed on them any restric tions which would delay or prevent the employment of a medical man where his services are needed.

THE Local Government Board has appointed Mr. E. G. Ballard to be an inspector, and Mr. Adrian Blaikie, D.Sc., to be a sub-inspector under the Alkali, &c., Works Regulation Act, 1881.

SANITARY INSTITUTE OF GREAT BRITAIN.-At the anniversary meeting held at the Royal Institution, Albemarle Street, on Thursday, July 10, the Right Hon. Earl Fortescue in the chair, an address was delivered by Dr. H. C. Bartlett, entitled 'Some of the Present Aspects of Practical Sanitation,' and the medals and certificates were presented to the successful exhibitors at the exhibition held at Glasgow in September 1883. At the close of the address the chairman proposed a vote of thanks to Dr. Bartlett, which was seconded by R. B. Grantham, M. Inst. C.E., and a vote of thanks to the Right Hon. Earl Fortescue for presiding, was moved by Dr. A. Carpenter, and seconded by Professor de Chaumont, M.D., F.R.S.

VENTILATION OF PUBLIC BUILDINGS.-Messrs. Robert Boyle & Son, 64 Holborn Viaduct and Glasgow, have recently applied their system of ventilation to the Head Quarters of the Honourable Artillery Company, Finsbury; Liberal Club, Sheffield; Burton Club, Burton-on-Trent ;

County Hall, Menai Bridge; Franciscan Convent, Bridgwater; New Lecture Hall, Newcastle-on-Tyne; Bromley and Beckenham Joint Hospital; New Public Baths, Lewisham; London and County Bank; St. Austell Union; Hull Workhouse, Hull; New Workhouse, Wandsworth; Richmond Union, Surrey; Hanwell Police Station; New Police Station, Mitcham; Her Majesty's Prison, Leicester; and Her Majesty's Prison, Manchester.

THE LONDON WATER SUPPLY. Ir is greatly to be deplored that the merits of the controversy as to the London water companies, and the liquid they supply, should be obscured by the political and professional antipathies and disagreements that now rage around the question. Granted that the quality of the water is rendered infinitely worse than it might be by the carelessness of domestic storage in cisterns, the inquiry whether the sewage-polluted Thames can be regarded as a fit source for the potable water of some millions of people admits of but one answer. Yet we are invited by the water companies and their professional advocates to believe that really and truly the diminution in volume of the water in the Thames, and all the complaints that have been made about its condition in the papers, do not affect in the least its charms as a beverage; and that, in point of fact, | Londoners are exceptionally lucky in having so admirably pure a supply to drink.

In view of the possible introduction of cholera into London, and the desire expressed by the metropolitan medical officers of health for the rectification of defects (if any) in the water supply of the metropolis, and particularly for watchfulness over the reservoirs and mains of the water companies, a communication was recently addressed by Sir Francis Bolton to each of the eight companies on the subject, specially asking whether they had any defects to report, and whether they could suggest, in addition to their customary precautions for ensuring the purity of their water supplies, any improvements or increased precautions capable of being taken during the present summer. The replies received from the companies are reproduced in the last report of the water examiner, and will be read with some curiosity and not a little scepticism. It was hardly to be expected that the companies would foul their own nests by reporting defects in the fashion that Sir Francis Bolton ingenuously supposed. Accordingly, we find that with one voice they report their arrangements as the most perfect that could be devised, and as to improvements, these would be impossible. The companies are severe, however, in their condemnation of householders of all classes in not looking after their cisterns as they ought. A variety of pains and penalties are suggested as fitting punishments for those who do not keep their cisterns in a condition meet for the extraordinarily pure and lavish supply of water which the companies bountifully bestow. All the improvements, the vast filtering beds, the constant supply, the perennial analyses, the hydrants, and the rest of it, are set at nought by the neglect of the householder to clean out his cistern with due regularity and frequency. No doubt domestic water receptacles are very often sadly neglected, but is not this perpetual harping upon the carelessness of the householder a little suspicious, with our knowledge of the omissions and neglects of the companies?

We should have thought that the revelations of the Medical Department of the Local Government Board as to the fallacies of the results declared by water analysts ought by this time to have exploded any arguments based upon the largeness or smallness in a given bottle of water of the decimal fraction of a grain of some particular chemical compound. When a sample of water, to which has been added an appreciable quantity of the excreta from a patient suffering from typhoid fever, gives, in the

hands of an eminent chemist, results which would place it in his first class of waters, those, namely, of 'extraordinary organic purity,' it is time to consider how far we are justified in relying upon laboratory inferences rather than upon the evidence of the senses. Yet Messrs. Crookes, Odling, and Tidy, who are paid by the London water companies to make to the President of the Local Government reports which he does not want, and refuses to recognise, would apparently have us believe that the Thames is still the same pellucid and silvern stream whose merits the Elizabethan poets were wont to sing. These gentlemen report that during the first half of 1884 they examined 1,071 samples drawn from the mains of the seven companies taking their supply from the Thames and the Lea, and have been able to register these many samples as being, without a single exception, clear, bright, and efficiently filtered. Judged by the eye, they had all of them the further claim to be described as being, even when in considerable bulk, colourless. Subjected to more exact examination in this particular, their degree of brownish tint proved to be exceedingly low, so as in no case to preponderate over the proper blue tint of the water. The whole of the 1,071 samples were further examined for organic matter by the permanganate process, and for dissolved oxygen by the Schutzenberger process, with similar satisfactory results. As regards the quantities of organic carbon, and consequently of organic matter, present in the Thamesderived samples, the mean result for January, exceptionally low for this season of the year, was 118 part of organic carbon in 100,000 parts of water. The mean result for February was 140 part, for March 165 part, for April 139 part, for May '104 part, and for June 114 part of organic carbon in 100,000 parts of the water; while the highest result furnished by any single sample examined during the last two months was 129 part, equivalent to about a quarter of a grain of organic matter per gallon.

The Report of the Royal Commission on Water Supply is quoted to show that a minute proportion of organic matter, variable in amount with season, is a normal constituent of river water, and it is argued that there is no reason whatever to consider this proportion of natural organic matter as in any way prejudicial to health; and that there is absolutely no chemical evidence to indicate that the small proportion of organic matter present in the water supply of London is different, either in quantity or kind, from the natural organic matter of the river, as met with, for instance, at Lechdale, 120 miles above the intake of the companies. Still, in view of the importance which is attached, unwarrantably the reporters think, to the not inconsiderable variations in the proportion of organic matter present in the London supply, the consolatory remark is added that at periods of summer heat and drought like the present the natural agencies at work to keep down the proportion of organic matter existing in the water of the river are at their maximum of activity. It results in this way, that the water supply of London is at its best just at those seasons, like the present, when any failure in the quality of the supply might be considered likely to be of exceptionally serious import.' On reading this report one is tempted to repeat the inquiry, Can these things be?'

THE Corporation of Newcastle have agreed to erect a refuse destructor of twelve cells at Byker Hill, at an estimated cost of 7,000/.

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