March 14, 1891.] TEB BRITISH MEDlCAL JOURNAL. 613 Square, St. James Westminster, St. Martin-in-the-Fields, and City, the birth-rates were considerably below the PUBLIC HEALTH average; while in Fulham, , Bethnal Green, AND Whitechapel, St. George-in-the-East, and Mile-End Old- POOR-LAW MEDICAL SERVICES. Town, where the population contains a large proportion of young married persons, the birth-rates showed an excess. The deaths of persons belonging to London registered THE TRUE DEATTH-RATES OF LONDON SANITARY during the year under notice were 89,694, equal to an annual DISTRICTS DURING 1890. rate of 20.0 per 1,000 of the estimated population; this rate IN tlle accompanying table will be found summarised the vital exceeded that recorded in any year since 1884, since which and mortal statistics of the forty-one sanitary districts of the date, when the rate was 20.4, it had continuously declined to, metropolis, based upon the Registrar-General's returns for the 17.4 in 1889, the lowest rate since the establishment of civil year 1890. The mortality figures in the table relate to the registration in 1837. During the decade just ended, 1881-90, deatlhs of persons actually belonging to the respective sani- the rate of mortality in London averaged only 19.9 per 1,000;. tary districts, anid( are the result of a complete system of dis- in the ten years 1861-70, it was equal to 24.4, and in the fol- tribution of deaths occurring in the public institutions of lowing ten years, 1871-80, to 22.5 per 1,000. This marked de- London among the various sanitary districts in which the cline in the London death-rate since 1880 implies that nearly patients had previously resided. By this means alone cani! 150,000 persons in London have survived, wliose deaths would trustworthmy data be secured upon which to calculate re- lhave been recorded had the rate of mortality in the ten years liable rates of imortality. 1881-90 equalled that which prevailed during the preceding The 130,690 births registered in London during the year 1890 twenty years, 1861-80. The lowest death-rates in the forty- were equal to an annual rate of 29.1 per 1,000 of the popula- one sanitary districts during 1890 were 14.7 in Lewisham (ex- tion, estimated at 4,421,661 persomis, wlicil showed a further cluding Penge), 14.8 in Kensington, 14.9 in Hampstead, 15.0- decline fronm time rates in recenit years, and was actually lower in St. George Hanover Square, 15.8 in Camberwell, 16.3 in than in any of the past fifty years. In the various sanitary Battersea, 16.4 in , 16.7 in Plumstead, and 17.8 in districts the birth-mates showed time usual wide variations, Islington. In the other districts the rates ranged upwards owing to the differences in time sex and age distribution of to 26.9 in London City and in Stepney, 27.0 in St. George. their populations. In Kenisington, St. George Hanover Southwark, 28.2 in St. Saviour Southwark, 28.8 in White- Analysis oj the Vital and Iortal Statistics of the Sanitary Districts of the Metropolis, after Complete Distribution of Deaths occurring in Public Institutions, duringl the Year 1890. 'R 17. _~ . Annual Rate per - 11-15 0 cm, 3: C) = 1,000 Livirmg. o 0 =3 0,, c-, 2 ,-z-.C SANITA Ity AIlEAS. E .z C O) P ._ c C O- .;m T. = 0 _, "-r - Pe, E- c) P.4 (Z) = 14 cm -. O.I . I m ;.4 C.) '5 9: 0 - 1- 94.:. CL or .P ;m4 _m- PL4 z

LONDON ...... 4,421,011 130,6190 89,694 29.1 20.0 2 - 3 3,285 861 1,387 Vest I)istr ict,'. 12,188 592 3:3 2,744 162 Iladdingtoii ...... 113,215 2,903 2,109 25.2 18.3 2.4 274 1 79 71 40 80 94 .58 135; Kensin-ton ...... 198.122 :3,865 2.+983 19.2 14.8 1." 387 - 27 34 15; 77 171 liaminiX1ersImiitli 1(o3,000 2,826 1,910 27.0 18.2 .3:3 :346 957° 17 49 ;i 96 171 Full1aill ...... 77.500 3, 14 1,908 139.9 21.2 4.8 3,) - 125 32 22 112 (Chelsca 25.5 11) 182 ...... 10f6,)694 2,7;61 2.017 18.9 2.2 241 1 56t; 4.3 11 - 46 150 St. George, <(1510))Clr 87,862 1 1 343 17.9 15.0 1.6 144 I - 46 13 IX S(qulC" ,596 .3 1 2.5 1.55 estrninstelr 54,349 1,476 1,454 26.7 26.3 2.6 141 - 34 11 9 50 :3 160 St. James, WNestmlinAster ... 26,940 5.50 5521 20.1 19.0 1.8 49 I 3 3 12 2 North Dixtricts. 4 12 178 18 Marylehone ... 41,2i96, 4,455 3,313 29.4 21.8 2.5 '375 I; 123 14 27 18 :3 93 143 Ilanpstead ...... 59,537 1,504 899j 24.9 14.1) 1.8 107 l1 21 204621,_ 25 122 St. Pancras ...... 215,,ss:3 7, 082 5,161 28.3 20.6 2.5 621 - 12.5 27 132 1.53:_ :34 1 141) 164 1slington... 313S,181 9,0|419 6,11f8 27.0 17.8 2.2 j71 202 3.5 818 I ( .34 5 180 158 Ilackney ...... 250,078 6 751 8 26.6 16.4 2.4 4,17 618 36 4 (Cetral Districts. 4 118 143 St. Giles ...... 38,698 1,183 1,012 30.1 26.5 2.0 80 1 17 85 101 1 1 21 156 St. Martin-in-the-Fields ... 11.552 267 :32.5 18.1 22.0 1.6 24 1 1 3 210 Strand ...... 28,189 .159.8 730 20.6 25.2 2.0 58 I 20 2 4 118 2 16 211 lfolhoin ...... 29,895 916 96f;7 3lo.7 :32.4 4.1 122 22 1.5 18 31 223 (lerkenwell ...... 71,102 2,201 1 645 '30.4 22.7 :1.() 216 :34 22 I l.' 8 68 175 St. LI;ke's ...... 52.00(0 1,61 1,308 32.1 24.7 i.6 189 - 48 41 146i Londoin (itv ... :35,636 764 .47.5 21.1 265.9 1.5 11 5 11 East D)i.st icts. 12 147 Slhoreditch I -25.284 4,4619 3,164 35.1 21.8 4.2 5)3:3 121 45 58 204,;' 13 115 175 l3etliial Grecn...... 1:82.815 4,811 3,199 35.6 2:1.7 3.7 39 116 li- 91 162 Wh-Iiitcelhapel ... 6ti. 146 2.782 41.2 28.8 4.2 t 1,1(17 70 19 '1 17 68IS 185 St. George-in-the-l,ast ... 46,0)55 1,8141 1,618 39 1 31.6 5.5 219 68 20 ;30 75 234 Stepney ...... 1,901 5,0,,975 1,611 :31.8 26.9 4.6 278 1,3 28 69()1 1 49 195 Mile Enid 01(1 Tom ... 117.35'3 4,087 2,517 34.3 21.1 :3.1 368 23 44 74 161 Ploplar 198,636 5,932 3,883 1:0.1 19.7 3.1 619 - 199 41 7 11 1 Soath. Distit-ics. 0 40 1 11:1 168 St. Saviour, Soutlinwra1 26,938 895 773 32.7 28.2 4.5 1214 34 St. Geor .51 16:2 1ii) - 20 185 ge, Soutlhuvzrk.ar 60,404 2,051 1 ,)5.9 33.4 27.0 :3.6 218 1 57 15 14 4 1 ,r) 7 209 Newington ... . 12),15.56 3,992 2,7,57 31.3 21.6 2.8 362 - 10:3 :37 32 8 1 84 171 St. Olave, Sonthwvalz .. 1-1,500 4il8 317 30.4 21.5 :3.t) 44 !- 4 6; 4 139 18 4 14 .145; lierinoindsey 90,s17 3,082 2,046 3:3.4 22.2 3.0 280 30 19t 637 152 ... 45,068 1,416 931 30.9 20.3 3.1 144 38 7 8 934 1 260 - .35 170 Lambeth ... 291,261 9,017 5,862 30.1 19.6 2.3 698 -_ 183 57 76 :311i.)7 3 154 1.52 Blattersea ...... 171,709 5,105 2,899 28.7 1 6..3 2.9 5'20 _I l(;O 19 40 67 11 122 169' Wandsworth . 13:3,542 4,113 2,471 30.3 18.2 2.4 32:1 - 89 9' 22 84 148 (Camberwell ...... 28 276,'585 7,29)8 4,43-5 26.0 15 8 2.2 613 - 165 51 5l 1681248 1, 119 1.52 (Greenwicli ...... 162,697 5,375 3,235 32..5 19.6 2.6 423 127 27 47 19 - 108 159, Lewisham (excluding Penge) 6i9,952 1,722 1,042 24.2 14.7 1 . 108 1 17 4 15 6 _ 27 141 Woolvicll ...... 37:326 1,266 1(05 33.4 23.9 3.0 112 - 52 4 .1 4 - 19 171 Plumstead ...... 82,750 2,836 1,407 34.0 16.7 2.2 183 1 41 15 19 6 - 33 ,129@ 614 614THTH-E- BRITISHBRTHMECAMEDICAL JOURNAL.JORA.[ac1418. [AIlareli 14, 1891.

towns ranged from 16.6 in Brighton, 17.3 in WNolverlhampton, 17.4 in Nott- chapel, 32.4 in Holborn, and 34.6 ill St. George-in-tlie-East. inglhain, aiid 17.6 in Hull to 31.6 in Newcastle-upon-Tynie, 32.5 in Hudders- In the East group of sallitary districts thew rate of mortality field, 38.1 in Cardiff, and 33.9 in Halifax. In tlle twenity-seveil provincial -duriing 18901)-ls (e(qual1 to 23.8 per 1,(00, wlhile ill tIme rest of townis theimean death-rate was 23.9 per 1,000, and exceeded by 0.5 the Loindon- it didl iot exceed 19.2 per 1,0(0. rate recorded in Lonidon, wlhichl was 23.4 per 1,0o0. The 4,547 deatlhs regis- tered duning the week unde rnotice in the tuveinty-eiglht townis included 1)uring tle year tllulder notice 12,188 deatlhs resuiltedl 470 wlliell were referred to the principal zymotic diseases, against nium- from the prineipil zyniotic diseases- in Lonidon of these bers inereasing from 332 to 4;31 in the prece(inig four weeks ; of tlese, 23285 were referred to measles, 3,272 to whlooping-cougl, 161l resulted fromiwhoopinig-couglh, 16o fromn measles, 55 fromii diplhtlhelria, to 861 to scarlet 36 firomii scarlet fever,32 fromi diarrhliea, 25 firomII "fever" (priincipallv 2,744 to diarrli(-ca, 1,387 (liplitlceria, fever, eniteric), and 1 from smiiall-pox. These 47o deatlhs were equal to anl anniiual 636 to differenit formlis of fever (inelt(lingr 592 to eniterie rate of 2.1 per 1,000; in Lonidon tlle zymotic rate was 1.8, wlhile it averaged fever, 33 to simpl)]e)le and(1 ill-defined foriims of colitiitued 3.0 per 1,000 in the twenlty-seveni provinicial towns, aDd r-anged from o.o in fever, and(l 11 to typlilus), and 3 to siall-pox. Tlhese Wl'olver-liampton, aind 0..5 in Norwiclh, in Derby, anid in Birkenlhead to 4.4 in Halifax, 6.0 in Salford, 7.5 in Blackburnl, anid 10.8 in Huddersfield. 12,188 (leatls wvere equal to ani annual rate of 2.7 p)er MIeasles slowed the higlhest proportional fatality in Slieffield, Ports- 1,000; this rate (xceeded by 0..5 time rate from thle sanie imoutlh. Salford, Bristol, Blackburn, and Huddersfield; whooping-cough diseases iln 18(19, wlwichi was the lowest oni recordi, blut wlas 0.3 in Hallifax, lluddersfield, Birmingiam, aind Salford; anid "fever" in Ilalifax. Tlhemortalityfroiii scarlet fever slhoued no markedexcess ill below tihe neanim rate iii time preeetling tein years-1880-89. aniy of the large towns. Of the 55 deatlhs froimi diphltlheria in the twventy- 'The zyniotic deatli-rate during- lust year in thie variolus eiglht large towns, 31 occuuredin London, 7 in Liveipool,4 in Manchester, saniitary distriets rniigedi froim 1.5 in Lewisham alnd in London anid :, in Birminglam. Onic death fromii smiiall-pox was registeled ini 1.6 in St. (George Hanover alld iii St. Marftill-ill- Lonldoin during last week, but not one in aniy of the twenty-seven pro- {ity, Square vinicial townis, and no snmall-pox patienit was under tireatmenit in, the lime-Fie(lds, and 1.8 iii St. Jaimes lVestminster anid in lannp- Metropolitani Asylum Hospitals on Saturlday, March 7th. The nuni- steaad, to 4.1 in Ilolborn, 4.2 in Shloreclitch anid ini Wlite- ber of scarlet fever patieilts in these hospitals alnd in the London Fever ehmapel, 4.5 in St. Saviour Soutliwark, 4.6 in 4.8 in Hospital was 1,184, and showed a further declinie fromi- recent weekly Stepneyl, numbers; 87 new cases were admiitted durinig the week, against 113 and 80 Fullmamli, anid 5.5 in St. Geor-e-iii-the-ELast. Compairedl with in the preceding tWO weeks. The death-rate fr-oiim diseases of the respir a- tile preceding year tite mortality froni diphtiheria shlowi-ed a tory organs in London was equal to 7.9 per 1,000, and considerably ex- (leelille, whlile thlat from eaichl of time othier zymilotic dliseases ceeded the average. s--howed ai increase. Only 3 (leatimsrfrom silal-pox wvere re- cord(led ini Lon(lon (lililig the year under aiotice, anid in tle HEALTH OF SCOTCH TOWNS. Ix eight of the principal Scotch towvns 803 birtlhs and 628 deaths were precelillng tiree yeairs-1887-8-9-only 19 fatal cases of this registered durinig the week ending Saturday, March 7thi. The annual lisease were registered. Of the 3 deaths froim sniall-pox last rate of mortality in these towins, whicih had risinl from 21.4 to 2:3.8 per 1 belongedI to AMarylebonie, 1 to Holborn, ai1(1 1 to Pltui- 1,000 in the preceding tlhree weeks, fuirtlher increased to 24.1 during the ,year week under notice, and exceeded by 0.4 per 1,000 the mean rate during -steald saniitarv (ta-reas. Tihirty-twvo sniiall-pox patients wvere ad- the same period in the twenity-eiglht large EInglishi towns. Amnong these initted to the Metropolitan Asylum Hospitals durimn the year Scotch towns the lowest death-rates were recorded in Plerth and Leitlh, under moftic(c, but 110 patieiits relllllnecl llnclder treatineint at anid the higlhest in Glasgow and Paisley. The 6281, deatlhs registecred in the eind of Deeember last. Measles slhowed the higilest tllese towns included 79 w*hich were referred to the principal zymotic pro- diseases, equal to an annual rate of 3.0 per 1,000, wlich exceeded by 0.6 portionial fatality ini FulIanim, Wliiteclimapel, St. G'eorge-in-tlie- the mean zymnotic death-rate during the samiie period in the large Eng- East, Stepney, Poplar, St. Saviour Sotluthwark acid Woolwicl lish towvns. Tlhe higlhest zymotic death-rates wvere recorded in Edinlburhl', (diplitlheria in 11ammersinitim, St. Paineras, Shore(diteli, Betlh- Glasgow and Paisley. The 290 deaths registered in Glasgow included 16i wlich were referred to whooping-cough, 7 to scarlet fever, and 4 to hial Green-, Wliitecliapel, ai(1 St. (Geore-hin-thle-East; wlioop- measles. Three fatal cases of diphther-ia, and 7 of whooping-cough were inig-cougli iln St. Luke's, S}lioredlitclm, St. Geor-e-i1-tile-East recorded in Edinburglh, and 10 of mcasles il Paisley. Tle death-rate from Stepiney. AMile-End-Old-Townvi, St. Saviour Southwark, St. diseases of the respiratory organs in these Scotch towns was equal to 5.6 George Soutithark, ad(l Rothierllimle; a111(1 diarrlicwa ill Fll- per 1,000, against 7.93 in London. liamIi, hlolbo-ril, , Whiteelhapel, anid St. George-in- tlhe-East. Thle rate of mortality from scarlet fever and(i fromii HEALTH OF IRISH TOWNS. DuRiau-cx the week ending Saturday, February 28thi, the deaths registered "' fever'" showd(( markedl excess in ally of the sai1 itarv (lis- in the sixteen principal townl-distiicts of Ireland were equal to an annual tricts, but the mlillber of scarlet fever patienits in thew Metro- rate of 26.7 per 1,000. Tlle lowest rates were recorded in Sligo and politani Asyluiim lhospitals anid in the Londoin Fever Hospital, Galway, anid the highest in Lonidoinderry anid Lurgani. The deatlh-rate been of from the principal zymotic diseases averaged 1.7 per 1,o00. The 199) deaths whichlhad 1,609 at the beginning 1890, declined to in Dublin were equal to an annual rate of 29.4 per 1,000 (against 26.9 and 1,067 in MIay, increased to as mican-y as 2,122 in November, anid 27:3 in the preceding two weeks), the rate for the same period being .afterwards declined to 1,593 at the eiid of December last. T'he 23.7 in London and 24.6 in Edinburgh. The 19(9 deaths in Dublinl included lduring were the numbers in each 9 which were referred to the principal zymotic diseases (equal to an admissions thlie year 7,108, annual rate of 1.:3 per 1,000). of which 4 resulted from diarrhoia, 3 from -quarter beilgc 1,082. 1,445, 2,162, a31(1 2.419 respectively. typlhoid fever, 1 from diphtheria, and 1 froiii wvlhooping couglh. Infanit mortcality in London dtirii(r 1890, aieasiredl by tIle proportioli of deathis ulder 1 year of agre to births registeredl, was equal to 1J;2 per 1,000, against an -average rate of 151 in FEES FOR FRACTURES. ENQUTIRER, who is a district medical officer in attendance on a patient tlle precedling ten years-1880-89. AWhile the rate of infanit witl simple fracture of one leg and comnpounid fracture of the otlelr, mortality last veardiud not excee(l 122 in Hanipstead, 129 in asks wlhetlher lie is enititled to the full fee for eachl fracture-inamiiely, £3 Plumstead, 141 ill Lewisilam, 143 imi Hackniey, aiid 145 in St. anid £5. 01lave Sotlihwark, it ranlged uplwardls in tile otler saniitary dis- *** A district medical officer is only entitled to a special fee for one tricts to 182 in Ftllhan, 183 in Wliitechapel anid St. Saviour of any niumber of fractures in tlle same patien-t wlhiel lhave occurred at Southwark, 195 iln Stepney, 209 in St. George Soitiwark, 210 the same time and from the same cause; lie is entitled to make hiis in St. Alartin-in-tie-Fields, 211 in Stralid, 223 in Hlolborn, andl claim for that wllicll carries the highlest fec. 234 in St. George-imi-the-East. HOSPITALITY AND ELECTIONS. NORTH COUNTRY MEMBIERS.-Probably the Local Government Board CERTIFICATION OF LODGI(NG HOU-SES. could refuse to sanction the appointiimenit suipposing the eircuimistances IN his to the Aston Rural Dr. preceding the election were brought to tlleir- knowledge, tlhouglh we report Sanitary Authority doubt wlhether tlhcy would approve. In our opiniion the tactics adopted Bostock Hill calls special attention to two cases of typhoid by A. to secure B.'s election were reprelhensible and undignified. We fever imported from watering places as showing tile import- are inclined to think that the unsuccessful canididate should congratu- .ance of making sure that the sanitary arrangements at late himself on laving failed to establislh any coninectioin with. a local lodging houses are above suspicion. If people would insist board of tlle moral fibre described. on the production of a certificate from the healtlh authority, condition of the before SUPPRESSION OF QUAC1KERY IN ITALY.- During the first stating the sanitary premises, taking " -rooms, a great improvement would soon be manifest, and half of 1890 the number of complaints of illegal exercise of security would be established against contracting diseases the healing arts " brought before the authorities was 843. In from which visitors are now by no means safe. 325 of these a conviction was obtained; in 145 the accused were acquitted. What the result was in the remaining 373 HEALTH OF ENGLISH TOWNS. cases does not appear, but it is satisfactory to see that at least DURING the week endinig Saturday, March 7th, 6,149 birtlhs and 4,347 deaths a considerable proportion of the offenders were brought to were register-ed imi twenty-eiglht of the largest English towns, including justice. It is to be hoped that the penalties inflicted will be London. TIme annual rate of imlortality in these towns, wlhich had in- creased from 19.8 to 24.1 per 1,000 in the preceding four weeks, declined sufficient to deter not only the guilty persons themselves, but -Z5again- - to. - --.23.7. during--- --Z, the..-- week.. --- under --notice. The---- -rates---- in-- tlle------severa--- others from pursuing their evil ways.