THE PUBLIC HEALTH.

SINCE our last report the Registrar-General has published his yearly summary of the weekly returns of Births and Deaths, and causes of death in London during the year 1867. The whole is contained in a pamphlet of twenty-seven pages, which mainly consists of tables summarizing the information contained in the weekly returns issued from Somerset House. From these dry figures, however, much useful information may be extracted for the use of those who are interested in the Public Health. Nor are we quite confined to the consideration of the Metropolis in the present annual survey. A new feature has been recently added to the weekly returns in the form of a return of the weekly mortality of thirteen of the largest cities and towns of the United Kingdom. The result of these returns is also given in the present summary, and we are thus enabled to compare the mortality of London with other towns in the kingdom. It would be, however, wrong in any estimate of sanitary conditions and requirements to regard London as one city. The Metropolis, in fact, is a congeries of cities and towns, which have become agglomerated by the growth of each. London and Westminster were once separated by a district as free from houses as London is now separate from Harrow, but the interspace has grown up, and thus Hampstead and Islington, Hackney, Bow, Greenwich, Woolwich, Dulwich, Clapham, Wandsworth, Kensington, and Paddington form now but parts of the great Metropolis, which takes its name from the central city, whose sleeping population does not at present exceed 115,000 persons. Nevertheless, the occupations, wealth, soil, elevation of these several united towns and cities vary so much as to render a close scrutiny necessary, in order to ascertain what are the physical and social conditions that are influencing the health of the Metropolis.

In 1867 the population of the Metropolis was estimated to he 3,082,372. The ascertained population in 1861 was 2.803,989. This vast aggregate of human beings live in a district of 122 square miles, which is intersected by the river. Thames. On the north side of the river lie 51 square miles, and this is occupied by three-fourths of the population; on the south side there are 71 square miles, with the remaining fourth of the population. This vast mass of people live in 340,917 houses, in which must be enumerated 46 workhouses, 12 prisons, 4 military and naval asylums, 31 civil hospitals, 8 military and naval hospitals, and 19 lunatic asylums. The Metropolis is, in fact, a kingdom in itself,

representing and repeating the whole empire. In this population of above three millions there died in 1867, 70,588 persons; during the same period there were born 112,264: thus giving to London an increase in her population by birth alone 41,676 persons. It is, however, to the death that we must turn our attention. The death of London in the last year contrasts favourably with that of the four preceding years. The proportion of deaths to 1,000 living persons being a little less than twenty three.

In 1862 it was twenty-three-and-a-half in the thousand, in 1863 it was twenty-four-and-a-half, in 1864 it was twenty-sixand-a-half, in 1865 it was twenty-four-and-a-half, and in 1866 it was twenty-six-and-a-half. In 1864 the large mortality was produced by the cold of that year, and in 1866 by cholera. The mortality of the present year, like all years succeeding visitations of great epidemics, has undoubtedly been reduced by the weaker members of the population having fallen victims to the epidemic cholera of the previous year, but also and chiefly to greater sanitary activity. In order to estimate the saving of life between 1867 and 1864 or 1866, we must multiply each thousand of the population by three, which gives us 9,000. Some estimate may be formed of the saving to the community thus occasioned, when we recollect that not only has much valuable and wealth-producing life been saved, but that the expense of funerals and the loss of time and expense occasioned by at least 120,000 illnesses-calculating that where one person dies from an unsanitary cause, twenty are attacked with illness and get well-have been avoided.

The death-rate of London contrasts favourably with the deathrate of the twelve large towns quoted in the Registrar-General's weekly reports.

Thus for the year 1867 we find the following death-rates :—

At the end of 1866, London did not stand so well in the list, and this was clearly due to the outbreak of cholera. Great com

parative credit must be given to London for this pre-eminence in health. In connection with this high sanitary position, it should be recollected that London has had now for above ten years a body of Medical Officers of Health, and none of the other towns on the list have had the advantage of such an officer for that period. We believe, however, with the exception of Manchester, that they all have a Medical Officer of Health. It is a significant fact, that Manchester in 1867 presents the highest mortality. We have, however, to announce that Manchester has at last appointed a Medical Officer of Health, and we hope soon to have to record the advantages conferred on the city by his agency. In order, however, that it may be seen what is the real difference between the mortality of London and Manchester as indicated in the above table, we would remind our readers that if the death-rate of Manchester had been in 1867 as low as that of London, that 3.258 lives would have been saved! Manchester has a school of politicians of its own, addicted according to some writers to a mercenary consideration of profit and loss. Will not some of their statisticians calculate for them the loss upon these three thousand two hundred and fifty-eight lives? Manchester has Christian Churches and Philanthropic Societies, and a Ladies' Sanitary Association. Cannot some of the ministers and secretaries of these associations cast up, for the benefit of Manchester people, the amount of agony that might have been saved, wretchedness and want and disease short of death that might have been prevented, had the causes that slew this mass of human beings been withdrawn in time?

It will be seen that Newcastle-upon-Tyne stands second on the list. The mortality of this town stands much higher than formerly, and its present high rate demands attention. It should be recollected in these towns that a few years ago a death-rate of 30 in the 1,000 was considered so exceptional, that the Government has power to interfere when the mortality of a town has continued above that rate more than a year.

Liverpool has gone through a fiery trial, and after long taking the lead as the most deadly city in the empire, may be congratulated in standing third on the list. It is to be hoped that even the present rate of mortality will be diminished before long. We need not comment further on this list except to point out the low mortality of Hull, Sheffield, Birmingham, and Bristol as compared with the other large towns of the United Kingdom. Hull more especially is to be commended: it lies low, below the sea-level (as the recent flood showed), and is surrounded by a swampy country. It should, however, be remembered that a death-rate of 24 in the 1,000 is unnecessarily high, and that where it exists at that point, it can most assuredly be reduced by sanitary measures to a lower figure.

Although London presented the low rate of 23 in the 1,000, it must not be supposed that this is not subject to lower and higher rates in its various districts. As a rule we find that the closer and thicker the population, the greater the mortality. We are not able to say how this influences the relative mortality of Manchester and Birmingham, but it is remarkable in the registration divisions into which London is grouped. The Registrar-General recognizes five divisions-1. The Central, which includes St. Giles, Strand, Holborn, Clerkenwell, St. Luke, East and West London, and the City in this group the mortality was 24 in the 1,000. 2. The Eastern district comprises Shoreditch, Bethnal Green, Whitechapel, St George's-in-the-East, Stepney, Mile End Old Town, and Poplar: the death-rate in this district was also 24 in 1,000. 3. The Northern division, including Marylebone, Hampstead with its Heath, Pancras, Islington, and Hackney, all with great unbuilt-on spaces; here the death-rate was only 23 in the 1,000. 4. The Western district, including Kensington, Chelsea, St. George's, Hanover Square, Westminster, St. Martin-in-the-Fields, and St. James, Westminster: in this group there is less free space, but it includes the wealth of London, and its mortality was 22 in the 1,000. 5. The Southern group; this includes all the south side of the water; it comprises the teeming populations of Lambeth, Southwark, Deptford, and Greenwich, but also the almost country districts of Wandsworth, Clapham, Dulwich, and Blackheath: here the death-rate is 21 in the 1,000. This last division has an area almost six times as great as the Eastern and Central divisions together, and a population not equal to these two divisions combined. It is a fact worthy of notice that the south side of the Thames from 1815 to 1864 has exhibited a higher rate of mortality than it does the present year. There is no doubt that this is due, first, to a supply of purer water, by the water companies having obtained supplies of purer water; and, secondly, that the new system of metropolitan drainage is beginning to tell favourably upon the health of the south side of London.

An interesting feature in the weekly bills of mortality of a large population is the fluctuation which it presents. Thus, taking the London returns, we find that the highest number of deaths registered in any week in the year 1867 was 1,891, occurring in the week ending the 12th of January. The lowest number of deaths in any week in the same year was in the week ending June 22nd, when only 1,052 deaths were registered. The study of these figures in connection with atmospheric vicissitudes, of which copious details are given in the Registrar-General's Reports, would appear to throw some light on the causation of disease; but, with the exception of temperature, we are not able to connect the fluctuation of the death-rate decidedly with any other meteoric condition. The

relation of temperature to the great death-rate of the second week in January, 1867, is very obvious. It not only occurred in London, but in all the other twelve populations. In London the death-rate went up from 27 in the 1,000 to 33, in Salford from 29 to 39, in Sheffield from 22 to 32, in Dublin from 25 to 31. Now during the first week in January the mean temperature at Greenwich was 25°, and the lowest temperature was 6°. It was in the second week this wave of cold told upon the communities of the United Kingdom, and although the temperature during the next three weeks was not so low, it was still low, and the populations all had high death-rates during the remainder of January. The first quarter of the year consequently presented a higher death-rate. The next highest death-rates we meet with are in the third quarter, and these manifestly arise from a high temperature. The mean temperatures of the first four weeks in August were above 60°, and we find during and after this increase of heat the death-rates increasing. Although sanitary arrangements can do nothing to prevent the fall and the rise of the thermometer, they can point out what ought to be done to mitigate the effects of cold and heat on the human body. Warm clothing and fires indoors are the great means of preventing the disastrous effects of cold in winter, whilst fresh air and pure water are needed to neutralize the effects of overcrowding and profuse perspiration in the summer.

Of the 69,000 deaths in London, 15,000, or nearly a fifth of the whole, were due to zymotic diseases. This is probably about the proportion that these diseases would bear to the whole death of each of the large populations whose death-rate has been given. Zymotic diseases are especially regarded as preventible diseases. They all depend on a contagious poison conveyed from one body to another, and it is quite possible by proper means to prevent their spreading. Amongst these diseases we mention first small-pox, because its very existence amongst us is a disgrace. We know how to prevent it, yet from ignorance, carelessness, and grosser oversight, 1,332 people died of this disgusting disease in London alone. We have no means of ascertaining the extent to which this disease prevailed in other populations of England in 1867; but in the Twenty-eighth Annual Report of the Registrar-General we find that in England and Wales alone there died of small-pox

These figures are truly alarming, and if the mere statement of facts in this way could produce any impression, it ought at once to