438

which such extension would modify the present age, sex, andclass distribution of the borough, and thus affect the birth,death, and disease rates. In dealing with the arrangementsfor isolation accommodation Mr. Collins shows that muchadvantage both as regards efficiency and economy would begained by providing one large hospital for the whole districtinstead of several small ones. In short, Mr. Collins thinks thatan amalgamation such as that proposed will be likely to affordthe sanitary authority "greater facility in dealing with out-breaks of disease, and to give the best practical working schemefor draining the whole of the district." In the matter of vacci-nation Mr. Collins suggests, among other things, that all personshaving conscientious scruples against vaccination should becompelled to register themselves and their families as un-vaccinated, and that only by this means should they beexempt from prosecution for non-vaccination ; he alsosuggests that all persons registering themselves as vaccinatedor revaccinated should receive a small fee in return forservices rendered to the State. Mr. Collins thinks thatsome such regulations as these would ensure a thoroughvaccination of the community with little or no increase ofexpenditure, "as the vaccination officers could be almostentirely dispensed with and small-pox hospitals would notbe required." We must confess we are not so sanguine asMr. Collins as to the good effect of the means he proposes,and we think that the possibility of evading vaccination byregistration would be widely taken advantage of, so much soindeed that small-pox hospitals would be as much a necessityas at the present time.Aston Manor Urban Sanitary District.-Mr. Henry May is

always prompt in the compilation of his annual reports, andthat now before us is one of the earliest we have received for1894. The general death-rate for the year in question wasbut 14 per 1000, the lowest on record for the last twenty-one years with the exception of 1885, when the rate was13’9. The Warwickshire County Council, adverting toMr. May’s report for 1893, wrote to the Aston urbansanitary authority expressing their opinion that no chargeshould be made for the admission of patients to thefever hospital. The Aston sanitary authority, however,apparently resented this action on the part of the countycouncil, and replied that they were unaware of anycase where admission had been refused and that it was theirpractice to excuse the fee in the case of patients beingunable to afford it. Experience has certainly shown thatcharges for admission to the general wards of a fever hospitalare undesirable, but perhaps this is a question which may onthe whole be left to the discretion of local authorities.

Kettering Urban Sanitary District.-The general death-rate of this district during 1894 was 14 9 per 1000 and thezymotic death-rate 2-4 per 1000. Phthisis has, Mr. WinterDryland reports, claimed fewer victims in Kettering in pro-portion as new factories with improved methods of ventila-tion and more air space have sprung up ; but it seems thatin a large number of cases pneumonia and bronchitis haveoccurred in newly erected houses occupied before the walJswere perfectly dry. In referring to infantile mortality Mr.Dryland points out that, if the mothers of Kettering wouldbe guided by their medical attendants as to the feeding oftheir infants, many lives might be spared. Many of the casesof scarlet fever which occurred during 1894 were, Mr. Dry-land states, followed by rheumatism, and he attributes thisto want of care during slight attacks. There seems to be a

good prospect of a joint fever hospital being shortly procuredby the Kettering urban and rural district councils.

Mirfield Urban S’anitary District.-In his annual reportfor 1893 Mr. Thomas Fairclough states that the water-supplyof the district has been abundant notwithstanding theexceptionally dry spring and summer. He reports, however,that it is still necessary to draw off the water which hasbeen standing in the lead ser vic ipes and also to filter it

through a charcoal filter before drinking, as the water stillretains the power of acting upon lead. He advises that theuse of lead service pipes should be discontinued. Mr. Fair-clough cannot understand why the Huddersfield corporationare "so obstinate in this water question," as it must even-tually be faced and dealt with.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thuty-three of the largest English towns 6870 blIthea 11 4210 deaths were registered during the week ending

Feb. 9th. The annual rate of mortality in these towns,which had been 18’7 and 19’7 per 1000 in the two preceding.weeks, further rose last week to 20.7. In London the ratewas 21-0 per 1000, while it averaged 20 4 in the thirty-two provincial towns. The lowest rates in these towns-were 13’5 in Derby, 14’5 in Leicester, 15.0 in Bradford’and in West Ham, and 15 2 in Gateshead ; the highest.rates were 23-8 in Birkenhead, 24-0 in Plymouth, 24 8 ir,Manchester, 27-1 in Bolton, and 30 9 in Liverpool. The4210 deaths included 312 which were referred to the principalzymotic diseases, against 328 and 299 in the two precedingweeks ; of these, 78 resulted from whooping-congh, 67 fromdiphtheria, 56 from measles, 39 from diarrhoea, 36 from"fever" (principally enteric), 32 from scarlet fever, and 4from small-pox. No fatal case of any of these diseasesoccurred last week in Swansea ; in the other towns theycaused the lowest death-rates in Bristol, West Ham, Brad..ford, Leeds, and Hull, and the highest rates in Croydon,Blackburn, Manchester, Gateshead, and Plymouth. Thegreatest mortality from measles occurred in Croydon, Ply-mouth, Bolton, Preston, and Halifax; from whooping-coughin Plymouth, Oldham, Burnley, Blackburn, and Gateshead;,and from "fever" in Birkenhead and Gateshead. Themortality from scarlet fever showed no marked excess in anyof the large towns. The 67 deaths from diphtheria in-cluded 34 in London, 5 in Birmingham, 5 in Manchester,3 in Wolverhampton, and 3 in Liverpool. Three fatalcases of small-pox were registered in London, and Lin Derby, but not one in any other of the thirty-three towns. There were 56 cases of small-poxunder treatment in the Metropolitan Asylum Hospitals,and in the Highgate Small-pox Hospital on Satur.day last, the 9th inst., against 32, 35, and 51 at the end ofthe three preceding weeks ; 18 new cases were admittedduring the week, against 6, 8, and 21 in the three precedingweeks. The number of scarlet-fever patients in the Metro-politan Asylum Hospitals and in the London Fever Hospitalat the end of the week was 1667, against 1653, 1662, and1653 on the three preceding Saturdays; 149 new cases wereadmitted during the week, against 154, 186, and 160 in thethree preceding weeks. The deaths referred to diseases ofthe respiratory organs in London, which had been 324 and377 in the two preceding weeks, further increased last weekto 480, and slightly exceeded the corrected average. Thecauses of 86, or 2’0 per cent., of the deaths in the thirty-three towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were

duly certified in Brighton, Cardiff, Leede, Snnderland, andin six other smaller towns ; the largest proportions ofuncertified deaths were registered in Birmingham, Liverpool,Preston, Sheffield, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had declined in the three preceding weeks from 28 3to 23 9 per 1000, rose again to 26-2 during the week endingFeb. 9bh, and exceeded by 5’5 per 1000 the mean rate

during the same period in the thirty-three large Englishtowns. The rates in the eight Scotch towns rangedfrom 17-5 in Dundee and 20-5 in Edinburgh to 26 0 inGreenock and 324 in Glasgow. The 757 deaths in thesetowns included 27 which were referred to whooping-cougb, 26 to measles, 8 to diarrhoea, 7 to diphtheria, 6to"fever," 4 to scarlet fever, and 3 to small-pox. Inall, 81 deaths resulted from these principal zymoticdiseases, against 92 and 89 in the two preceding weeks.These 81 deaths were equal to an annual rate of 28per 1000, which was 1-3 above the mean rate lastweek from the same diseases in the thirty-three largeEnglish towns. The fatal cases of whooping-cougb,which had been 18 and 25 in the two preceding weeks,further rose to 27 last week, of whch 20 occurred in

Glasgow. The deaths referred to measles, which haddeclined from 58 to 37 in the four preceding weeks,further fell to 26 last week, and included 10 in Glasgow,9 in Aberdeen, and 4 in Edinburgh. The fatal cases ofdiphtheria, which had been 9, 5, and 3 in the preceding threeweeks, rose again to 7 last week, of which 4 occurred inGlasgow. The 6 deaths referred to different forms of" fever " corresponded with the number in the precedingweek, and included 3 in Edinburgh and 2 in Glasgow. Of the3 fatal cases of small-pox, 2 were recorded in Edinbargh and1 in Glasgow. The deaths referred to diseases of the

439

respiratory organs in these towns, which had been 186 and168 in the two preceding weeks, rose again to 214 lastweek, and exceeded by 93 the number in the correspondingperiod of last year. The causes of 43, or nearly 6 percent., of the deaths in these eight towns last week were notcertified.

-

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 310 and 31-9per 1000 in the two preceding weeks, was again 31-9during the week ending Feb. 9th. During the past sixweeks of the current quarter the death-rate in the city hasaveraged 32.5 per 1000, against 19’1 in London and 23 2 inEdinburgh. The 214 deaths registered in Dublin during theweek under notice corresponded with the number in the

previous week, and included 19 which were referred to theprincipal zymotic diseases, against numbers declining from23 to 16 in the three preceding weeks ; of these, 7 resultedfrom small-pox, 5 from whooping-cough, 4 from "fever," 2 from diarrhoea, 1 from scarlet fever, and not one eitherfrom measles or diphtheria. These 19 deaths were equal to anannual rate of 2 8 per 1000, the zymotic death-rate during thesame period being 1’5 in London and 25 in Edinburgh. Thefatal cases of small-pox, which had declined from 11 to 5 inthe four preceding three weeks, rose again to 7 last week.The 5 deaths from whooping-cough showed a further increaseupon the numbers recorded in recent weeks. The deathsreferred to different forms of "fever," which had been 5and 4 in the two preceding weeks, were again 4 last week.The 214 deaths in Dublin last week included 35 of infantsunder one year of age and 66 of persons aged upwards ofsixty years ; the deaths both of infants and of elderly personsshowed an increase upon those recorded in the precedingweek. Eight inquest cases and 4 deaths from violence wereregistered ; and 75, or one third, of the deaths occurred inpublic institutions. The causes of 21, or nearly 10 percent., of the deaths in the city last week were not certified.

VITAL STATISTICS OF LONDON DURING JANUARY, 1895.IN the accompanying table will be found summarised

complete statistics relating to sickness and mortality duringJanuary in each of the forty-three sanitary areas of London.With regard to the notified cases of infectious disease inthe metropolis during last month, it appears that the numberof persons reported to be suffering from one or other ofthe nine diseases specified in the table was equal to 7’0per 1000 of the population, estimated at 4,392,346 personsin the middle of this year. In the three preceding monthsthe rates had been 10’0, 9 5, and 8’4 per 1000 respectively.Among the various sanitary areas the rates were considerablybelow the average in Paddington, St. Giles, Strand, St. OlaveSouthwark, Lewisham, and Woolwich; while they showedthe largest excess in Marylebone, St. Pancras, Limehouse,Mde End Old Town, Poplar, Rotherhithe, Battersea, and Plum-stead. The prevalence of small-pox in London showed anincrease during January, 53 cases being notified duringthe month, including 39 in Marylebone, 5 in Battersea,and 3 in Greenwich sanitary areas. The Metropolitan AsylumHospitals contained 51 small-pox patients at the end of

January, against numbers declining from 93 to 16 at theend of the four preceding months ; the weekly admissionsaveraged 10, against 9, 6, and 3 in the three preceding- months. The prevalence of scarlet fever in London showeda slight further decline from that recorded in recent months ;this disease was proportionally most prevalent in St. JamesWestminster, Bethnal Green, Limehouse, Mile End Old Town,Poplar, Rotherhithe, Battersea, and Plumstead sanitary areas.The Metropolitan Asylum Hospitals contained 1633 scarletfever patients at the end of January, against 2207, 2114,and 1865 at the end of the three preceding months ;the weekly admissions averaged 148, against 246, 208,and 171 in the three preceding months. The prevalence ofdiphtheria in London showed a marked further declinedaring January ; among the various sanitary areas thisdisease showed the highest proportional prevalence inSc Luke, lvhitechapel, St. George-in-the-East, Mile End0 d Town. Poplar, St. Saviour Southwark, Rotherhithe, andB There were 515 cases of diphtheria under treat-ment in the Metropolitan Asylum hospitals at the end ofJanuary, against 537, 517, and 521 at the end of the three

preceding months ; the weekly admissions averaged 71,against 100, 90, and 93 in the three preceding months. Theprevalence of enteric fever in London also showed a

marked decline during the month under notice; amongthe various sanitary areas this disease showed the highestproportional prevalence in St. Martin-in-the-Fields, Strand,St. George Southwark, Rotherhithe, and Lee sanitary areas.Erysipelas was proportionally most prevalent in Marylebone,St. Pancras, Bethnal Green, Whitechapel, Mile End Old Town,and Poplar sanitary areas. The prevalence of puerperalfever showed a marked increase during January, and con-siderably exceeded that recorded in any recent month ; the41 cases notified durirg the five weeks ending Feb. 2nd in-cluded 9 in St. Pancras, 6 in Camberwell, 4 in Lambeth,4 in Hackney, 3 in Islingtor, and 3 in Chelsea sanitaryareas.

The mortality statistics in the accompanying table relateto the deaths of persons actually belonging to the varioussanitary areas, the deaths occurring in the institutions ofLondon having been distributed among the various sani-tary areas in which the patients had previously re-

sided. During the five weeks ending Saturday, Feb. 2nd,the deaths of 7691 persons belonging to London were

registered, equal to an annual rate of 18.3 per 1000,against 15 8, 15-2, and 17 7 in the three precedingmonths. The lowest death-rates during January in thevarious sanitary areas were 6 2 in Lee, 10 8 in Hampstead,11’5 in Stoke Newington, 14 4 in St. George Hanover-square,147 in Wandsworth, and 15’1 in Westninster and in

Lewisham ; the highest rates were 24’7 in St. Saviour South-wark, 25-5 in St. Giles, 25-6 in Holborn, 26-1 in St. George-in-the-East, 26 6 in Limehouse, 27 6 in St. Luke, and 29 6in Strand. During the five weeks of January 656 deathswere referred to the principal zymotic diseases in London ; ofthese, 3 resulted from small-pox, 133 from measles, 53 fromscarlet fever, 187 from diphtheria, 136 from whooping-cough,76 from enteric fever, 1 from an ill-defined form of "fever,"and 67 from diarrhoea. These 656 deaths were equal to anannual rate of 1 6 per 1000, against 1-6 and 1 8 in the twopreceding months No fatal case of any of these diseaseswas recorded last month in St. James Westminster ; in theother sanitary areas they caused the lowest death-rates inSt. James Westminster, Marylebone, Hampstead, St. SaviourSouthwark, and Bermondsey ; and the highest rates in Chelsea,Strand, Holborn, St. George-in-the-East, Limehouse, Poplar,Lee, and Plumstead. Only 3 fatal cases of small-pox wereregistered in London during the month under notice, thecorrected average in the corresponding periods of the tenpreceding years being 22; these 3 cases belonged to Mary-lebone sanitary area. The 133 deaths referred to measleswere little more than half the corrected average number ;among the various sanitary areas this disease showed thehighest proportional fatality in Paddington, Holborn,Bethnal-green, Poplar, Greenwich, and Plumstead. The 53fatal cases of scarlet fever were only half the correctedaverage number ; this disease was proportionately mostfatal in Poplar sanitary area. The 187 deaths fromdiphtheria exceeded by 35 the corrected average number;among the various sanitary areas this disease showedthe highest proportional fatality in Fulham, BethnalGreen, St. George-in-the-East, Mile End Old Town,Poplar, Newington, and Plumstead. The 136 fatal casesof whooping - cough were less than a third of thecorrected average number ; among the various sanitary areasthis disease was proportionately most fatal in Clerkenwell,Shoreditch, St. George-in-the-East, Limehouse, Battersea,and Lee. The 76 deaths referred to enteric fever slightlyexceeded the corrected average number ; this disease showedthe highest proportional fatality in Strand and City of Vmdonsanitary areas. The 67 fatal cases of diarrhoea were within3 of the corrected average number. In conclusion, it maybe stated that the mortality in London during the monthunder notice from these principal zymotic diseases was nearly40 per cent. below the average.

Infant mortality in London during January, measured bythe proportion of deaths under one year of age to registeredbirths, was equal to 123 per 1000, and was considerably belowthe average. Among the various sanitary areas the lowestrates of infant mortality were recorded in Hampstead, StokeNewington, Strand, St. Olave Southwark, Lewisham, andPlumstead ; and the highest rates in St. Martin-in-theFields, City of London, St. George-in-the-East, St. SaviourSouthwark, Woolwich, and Le.