APRIL 20, 1895.] PlUBLIC HEALTH AND POOR LAW. LxMuB^rounu 901

C. E. Hibbard, Guy's Hospital; E. A. Le Maistre, Hos- quarter of the current year. The mortality figures in the table relate to pital; R. C. Morris, Birmingham; W. P. R. Newth, St. Thomas's the deaths of persons actually belonging to the various sanitary areas, Hospital; L. E. Owen, University College Hospital; W. Taylor, and are the result of a complete system of distribution of deaths oc- Birmingham. curring in the institutions of London among the various sanitary Physiology.-S. R. Bhagtani, Bombay; H. J. Brookes, St. Mary's Hos- areas in which the patients had previously resided. pital; C. F. W. Dunn, Cambridge and Middlesex Hospital;- C. F. The 35,573 births registered in London during the three months ending Eddowes, St. George's Hospital; S. H. Greene, Charing Cross March last were equal to an annual rate of 32 5 per 1,000 of the popula- Hospital; A. Hay, St. Bartholomew's Hospital; A. R. Hoare, St. tion. estimated at 4,392,346 persons in the middle of this year; this rate Thomas's Hospital; G. L. Meredith, London Hospital; H. Morris, almost corresponded with the mean rate in the first quarters of the St. Bartholomew's Hospital; A. Ross, Guy's Hospital; D. Steele, preceding five years, 1890-94, which was 32.6 per 1,000. The birth-rates Edinburgh. during the period under notice in the various sanitary areas showed, Chemistry.-H1. K. C. De La Motte, Charing Cross Hospital; E. Dodds, as usual, wide variations, owing principally to the differences in Sheffie1d; H. Greenwood. London lHospital; C. J. H. Riches, the sex and age distribution of the population. In Kensington, St. Middlesex Hospital; E. Ioxali, Birmingliam. George Hanover Square, St. James Westminster, Hampstead, St. Martin- Materia Medica and Pharmacy.-S. C. Hague, Manchester and Edin- in-the-Fields, London City, and Lee the birth-rates were considerably burgh; A. G. Lang, Guy's Hospital. below the average; while in St. Luke, Whitechapel, St. George-in-the- Materia Medica.-J. Freeman, Bristol. East, Limehouse. Old Town, St. George Southwark, and Pharmacy.-O. Hall, Durham. Bermondsey the birth-rates showed a marked excess. The 28,001 deaths of persons belonging to London registered during the quarter under notice were equal to an annual rate of 25.6 per 1,000; this death-rate exceeded that recorded in the corresponding period of any of the ten preceding years, with the single exception of 1892, when the rate PUBLIC HEALTH was as high as 27.8 per 1,000. During the March quarters of the ten preceding AND years 1885-94 themean death-rate was only23.0 per 1,000. The high death-rate in London last quarter was largely due to the influenzaepidemic. The lowest death-rates in the various sanitary areas were 15.7 in Hampstead, 18.1 POOR-LAW MEDICAL SERVICES. in Plumstead, 18.6 in , 19.2 in Lee, and 21.4 in Lewis- ham and in ; the highest rates were 31.8 in Newington, VITAL STATISTICS OF LONDON SANITARY DISTRICTS DURING 32.9 in Limehouse, 33.0 in St. George-in-the-East, 33.3 in St. Saviour THE FIRST QUARTER OF 1895. Southwark, 33.5 in Holborn, 33.9 in St. Giles, 38 1 in St. Luke, and 36.9 IN the accompanying table will be found summarised the vital and in Strand. During the quarter under notice 1,677 deaths were referred mortal statistics of the forty-three sanitary areas of the metropolis, to the principal zymotic diseases in London; of these, 511 resulted from based upon the Registrar-General's returns for the first or winter whooping-cough, 420 from diphtheria, 300 from measles, 165 from dia.r- Analysis of the Vital and Mortal Statistics of the Sanitary -Districts of the Metropolis, after Distribution of Deaths occurring in Public Institutions, during the.First Quarter of 1895.

Annual Rate per E " * * 1,OOOLiving. o Ela N. SANiTARay ARzAS. 042- ~ ~ ~

0 0 M 0 of 4)~~~~~~ I 00.)'

LONDON .. .. 4,392,346 35,873 28,001 32.5 25.6 1.6 1,677 10 300 141 420 511 1 '126 3 165 2,329 158 West Districts. Paddington . . 122,756 790 749 25.8 24.5 1.0 31 - 12 4 8 3 - 1 - 3 54 162 Kensington .. .. 167,671 972 957 23.3 22.9 0.9 .39 - 3 2 11 8 - 7 - 8 75 157 Hammersmith.. .. 108,429 799 629 29.6 23.3 1,3 34 - 1 2 9 14 - 4 - 4 39 176 Fulham...... 117,745 1,005 738 34.2 25.1 1.5 44 - 5 8 14 9 - 3 - 5 42 197 Chelsea . 99,930 758 690 30.4 27.7 1.5 37 - 4 4 8 12 - 3 - 6 62 154 St. George Hanover Sq. 74,037 361 485 19.6 24.7 1.2 22 - 2 1 3 13 - 1 - 2 28 188 - - - Westminster .. .. 54,003 349 388 25.9 28.8 0.7 10 - - - 5 5 - 39 183 St. James Westminster 23,14J 138 164 23.9 28.4 0.9 5 - - - 1 4 - - - - 9 210 North Districts. Marylebone .. .. 137,392 1,154 1,034 33.7 30.2 1.3 43 9 2 5 4 15 - 6 1 1 92 142 Hampstead . .. 77,592 373 303 19.3 15.7 0.8 15 - 4 2 2 2 - 3 - 2 19 139 St. Pancras ..233,543 1,8A7 1,549 31.7 26.6 1.8 106 - 8 13 22 47 - 7 - 9 122 175 Islington...... 335,929 2,618 1,937 31.3 23.1 1.4 116 - 8 22 27 35 1 9 1 13 185 134 - Stoke Newington . 35,234 230 163 26.2 18.6 0.8 7 - 1 - 1 2 - 3 - 8 122 ...... 215,623 1,682 1,184 29.4 22.0 1.3 70 - 14 5 17 20 - 6 - 8 107 127 Central Districts. St. Giles... ..37,654 303 318 32.3 33.9 1.3 12 - 3 1 1 6 - - - 1 35 139 St. Martin-in-the-Fields 13,536 5k 85 16.0 25.2 1.8 6 - - - 4 2 - - - - 7 289 - - Strand ...... 22,586 160 208 28.4 36.9 2.0 11 - 1 4 3 - 3 - 23 181 - - Holborn ...... 32,188 229 269 28.5 33.5 2.1 17 - 11 1 1 1 - 3 29 210 - .. 65,036 591 453 '36.5 27.9 1.9 30 - 3 6 18 - 2 - 1 38 176 - St. Luke... .. 40,763 532 367 52.4 36.1 1.8 18 - 1 2 3 11 - 1 - 30 141 - London City .. .. 33,824 148 241 17.6 28.6 1.2 10 - 1 1 2 1 - - 14 162 East Districts. .. .. 122,932 1,173 897 38.3 29.3 2.1 65 - 18 2 7 33 - 4 - 1 88 175 Bethnal Green .. .. 130,061 1,222 826 37.7 25.5 1.4 46 - 16 3 14 8 - 2 - 3 74 151 Whitechapel 75,820 774 517 41.0 27.4 0.8 16 - 5 - 5 3 - 2 - 1 61 123 St. George-in-the~-East 45,227 524 372 46.5 33.0 2.4 27 - 6 2 5 11 - - - 3 28 195 Limehouse 56,885 57.3 467 40.4 32.9 3.3 47 - 11 2 10 18 - 2 - 4 42 178 Mile End Old'Town 108,443 1,127 698 41.7 25.8 1.7 46 - 7 4 22 10 - - - 3 55 138 Poplar... ..171,230 1,704 1,198 39.9 28.1 2.9 124 - 47 9 33 23 - 4 - 8 81 163 South Districts. St. Saviour Southwark 26,570 23.5 210 35.5 31.7 0.6 4 - - 1 2 - - - - 1 22 204 St. George Southwark 60,168 611 500 40.7 33.3 1.1 16 - - 2 5 8 - 1 - - 56 191 Newington .. .. 119,358 1,120 946 37.6 31.8 1. 52 1 5 3 11 19 - 3 - 10 90 194 St. Olave Southwark 13,063 ill 96 34.1 29.5 1.2 4 - - - - 1 - 2 - 1 10 198 Bermondsey 83,861 902 585 43.2 28.0 1.0 20 - 3 3 2 5 - 3 - 4 56 142 .. 40,713 376 246 37.1 24.2 1.7 17 - 1 1 3 6 - 3 - 3 22 168 Lambeth...... 284,883 2,486 1,873 35.0 26.4 1.4 97 - 5 6 18 48 - 5 1 14 164 152 Battersea .. .. 165,130 1,377 922 33.4 22.4 2.2 90 - 22 4 23 28 - 6 - 7 71 1688 Wandsworth .. .. 185,956 1,230 1,086 27.8 23.4 1.0 48 - 11 3 11 6 - 8 - 9 67 129 Camberwell .. .. 252,737 1,946 1,485 30.9 23.6 1.5 94 - 5 8 42 15 - 9 - 15 127 164 Greenwich .. .. 175,183 1,443 1,064 33.0 24.4 2.1 92 - 23 3 38 17 - 4 - 7 66 139 Lee...... 38,832 20.5 186 21.2 19.2 1.9 18 - 10 1 1 4 - 1 - 1 11 176 Lewisham .. .. 82,410 515 440 25.1 21.4 1.5 30 - 5 2 4 16 - 2 - 1 31 130 - Woolwich . .. 42,768 340 228 31.9 21.4 1.0 11 - 3 1 3 1 - - 3 26 176 - .. - - .Plumstead .. 61,494 526 278 34.3 18.1 2.0 30 - 17 4 8 - 1 24 116 2KDICAL JOURNALlI OBITUARY. LAPRIL 20, 1895. Thoia, 141 from scarlet fever, 13) from different forms of "fever" (in- modation of persons during the disinfection of their rooms. No houses 'eluding 126 from enteric fever, t from Atyphus, and 3 from ill-defined have been registered under the by-laws relating to premises occupied by forms of continued fever), and 10 from small-pox. These 1,677 deaths inembers of more than one family; the by-laws, in fact, have only just were equal to ani annual rate of 1.5 per 1,000, which was 0.9 below the been drawn up by the vestry and submitted to the Local Government mean rate in the corresponding periods of the ten preceding years, Board. There is very great need for improvement in all the points re- and was lower than the rate in any March quarter on record. The ferred to. since Bethnal Green is almost entirely inhabited by an lowest zymotic death-rates during last quarter in the various sanitary industrial population, a large proportion of which belongs to the poorer areas were 0.6 in St. Saviour Southwark, 0.7 in Westminster, 0.8 in Hamp- classes. stead, Stoke Newington, and Whitechapel, 0.9 in Kensington and St. James Westminster, and .Oin Paddington, Bermondsey, Wandsworth, and Woolwich: while the rates ranged upwards to 2.0 in Strand and Plum- THE COST OF SMALL-POX. -stead, 2.1 in Holborn, Shoreditch. and Greenwich, 2.2 in Battersea, 2.4 in WITH reference to the outbreak of small-pox in Dublin, the total amount St. George-in-the-East, 2.9 in Poplar, and 3.3 in Limehouse. of expenditure incurred at the Kilmainham Hospital up to March 25th Ten deaths from small-pox of persons belonging to London were was £1,865 Os. 2d. registered during the three months ending March last, of which 9 belonged to Marylebone and 1 to Newington sanitary areas. Measles THE ANTITOXIN TREATMENT. showed the highest proportional fatality in Holborn, Shoreditch, St. AT the last meeting of the Hampstead Board of Guardians, Mr. J. S. George-in-the-East, Limehouse, Poplar, Battersea, Greenwich, and Plum- Fletcher, L C.C., presiding, the consideration was resumed of a letter -stead; scarlet fever in Fulham, Islington, and Plumstead; diphtheria from the Islington Board of Guardians, stating that they had passed a in St. Martin-in-the-Fields, Strand, Limehouse, Mile End Old Town, resolution requesting the Local iovernment Board to prohibit the use Poplar, Battersea, Camberwell, and Greenwich; whooping-cough in St. of antitoxin, and asking this Board to pass a similar resolution and Pancras, Clerkenwell, St. Luke Shoreditch, St. George-in-the-East. forward it to the Local Government Board. Mr. J. C. Cooper moved: ¶Limehouse, and Lewisham; and " fever" in Strand, London City, and " That this Board, believing that the Metropolitan Asylums Board and St. Olave Southwark sanitary areas. other managers of medical institutions are competent and anxious to During the three months ending March last, 2,329 deaths from deal wisely with the treatment of the patients committed to their care, phthisis were registered in London, equal to an annual rate of 2.1 per declines to interfere with the discharge of their duty." A discussion 1,000. Among the various sanitary areas the lowest phthisis death-rates ensued, and the motion was carried by a large majority. were recorded in Hammersmith, Hampstead, Stoke Newington, Green- wich, Lee, and Lewisham; the highest rates in St. Giles, Strand, MEDICAL CERTIFICATION OF PAUPER LUNATICS. Holborn, Whitechapel, St. George Southwark, and St. Olave South- A. W. W. writes, saying: A. is a Poor-law medical officer; B. is in private -wark. practice in attendance on a labourer, and finds it necessary to send his Infant mortality in London last quarter, measured by the proportion patient to an asylum. A magistrate is applied to, who sends to the -of deaths under one year of age to registered births, was equal to 158 per relieving officer for the usual pauper forms to enable him to make the 1,000; this rate was, with one exception, higher than in any March necessary order. The magistrate wishes B. to certify as to the -quarter in the ten preceding years, during which the rate averaged 142 of per 1,000. Among the various sanitary areas the rates of infant mortality insanity the patient, but the relieving officer says A. ought to do this, were lowest in Islington, Stoke Newington, Hackney, Whiteebapel, as the case has become a pauper one. A. W. W. asks if there is any rule Camberwell, Lewisham, aud Plumstead; while they showed the largest as to which should certify, or does it rest with the magistrate to -excess in Fulham, St. James Westminster, St. Martin-in-the-Fields, decide? Holborn, St. George-in-the-East, St. Saviour Southwark, Newington, and *** It rests entirely with the magistrate, and for his own protection St. Olave Southwark. he usually selects the medical practitioner he has most confidence in.

HEALTH OF ENGLISH TOWNS. THE DUTIES OF M.O.H. IN INFECTIOUS CASES. IN thirty-three of the largest Eniglislh towns, including London, 6,105 births MR. WAt. C.'S second letter supplies additional particulars, tending to and 4,160 deaths were registered during the week ending Saturday show that tihe M.O.H., afterreceiving an informal notification of searlet April 13th. The annual rate of mortality in these towns, which had fever which lie knew to emanate froin the practitioner in charge of the declined from 35.0 to 21 1 per 1,000 in the five preceding weeks, further case, visited the house and insisted upon seeing another patient who -fell to 20.5 last week. The rates in the several towns ranged from 14.0 was suffering from sore throat only, although told that she was being in Swansea, 14.1 in Croydon, and 16 1 in Portsmouth to 24.9 in Wolver- attended by the same practitioner and for sore throat only. If so, the 'hampton, 26.7 in Bolton, and 28.2 in Preston. In the thirty-two provincial M.O. H. acted unwisely and interfered unnecessarily, but his version of -towns the mean death-rate was 21 4 per 1,000, and was 2.1 above the the facts is not before us, and in its absence we cannot pretend to rate recorded in London, which was 19.3 per 1,000. The zymotic death- pronounce any final opinion. rate in the thirty-three towns averaged 1.6 per 1,000; in London the rate was equal to 1.6 per 1,000, while it also averaged 1.6 in the thirty- FEES FOR NOTIFICATION OF INFECTIOUS DISEASES. two provincial towns, and was highest in Blackburn, Plymouth, and H. S. writes to ask whether a district medical officer is compelled to re- Manchester. MIeasles caused a death-rate of 1.1 in Manchester, 1.7 in port cases of infectious disease for a fee of ls. per case, whether he is Bolton, and 1.8 in Plymouth; and whooping-cough of 1.3 in Salford, 1.5 in attendance on paupers or others. Manchester, and 1 7 in Brighton. The mortality from scarlet fever and *i* For all pauper cases a Poor-law medical officer can only claim ls. 'from " fever " showed no marke(& excess in any of the large towns. The case for 57 deaths from diphtheria in the thirty-three towns included 27 in Lon- per notifying; for other cases, if not patients of a medical in don, 5 in West Ham, 5 in Cardiff, 5 in Birmingham, and 2 each in Man- stitution, he can claim 2s. 6d. per case. chester, Salford, and Leeds. One fatal case of small-pox was registered last week in Birmingham, but not one in London or in any other of -the thirty-three large towns. There were 47 small-pox patients under treatment in the Metropolitan Asylums Hospitals and in the Highgate -Small-pox Hospital on Saturday last, April 13th, against 58, 55, and 53, at OBITUARY, the end of the three preceding weeks; 9 new cases were admitted during the week, against 14, 11, and 7 in the three preceeding weeks. EDWIN J. MILES, M.D.ST.AND., M.R.C.S., L.S.A. The number of scarlet fever patients in the Metropolitan Asylums Hos- WE regret to announce the death of Dr. Miles of Rome, Vpitals and in the London Fever Hospital, which had been 1,587, 1,555, which took place in that city on April and 1,519 at the end of the three preceding weeks, had further declined to 10th. He was 65 years 1,463 on Saturday last, April 13th; 117 new cases were admitted during of age. In 1852, as soon as he obtained his diplomas, he -the week, against 184, 161, ar.d 143 in the three preceding weeks. joined his father in his practice at Gillingham, Dorsetshire. After his father's death he continued practising in Gilling- HEALTH OF SCOTCH TOWNS. ham until 1876 when, through ill-health brought on by over- DURING the week ending Saturday, April 13th, 894 births and 714 deaths work, he was obliged to give up the arduous duties of a were registered in eight of the principal Scotch towns. The annual large country practice and went to live in Brighton, where ,rate of mortalitv in these towns, which had declined from 42.8 to 24.7 per he took a 1,000 in the six preceding weeks, was again 24.7 last week, and exceeded great interest in local affairs. He was a member of by 4.2 per 1,000 the mean rate during the same period in the thirty- the Hove School Board, a member of the committee of the three large English towns. Among these Scotch towns the death-rates Brighton Museum, and, chiefly through his exertions, a 'ranged from 20.6 in Perth to 31.1 in Aberdeen. The zymotic death-rate in branch of the School of Science in connection with the Sout," these towns averaged 3 0 per 1,000, the highest rates being recorded in Aberdeen and Leith. The 334 deaths registered in Glasgow included 20 Kensington Museum was established at Hove. In 1883 he from whooping-cough, 5 from scarlet fever. and 3 from diphtheria. Ten went to reside in Rome. where he devoted bis energies 'fatal cases of measles were recorded in Edinburgh, 8 in Leith, and 6 in chiefly to the work of the British and Americain Archaeo- Aberdeen. logical Society of Rome. He was at first honorary librarian of that Society, and in 1888 he was elected THE SANITARY CONDITION OF BETHNAL GREEN. honorary secre- THE results of the inquiry by the Medical Officer of the London tary, posts which he retained up to his death. At the time Council into the sanitary condition of Bethnal Green do not reveal a of his appointment as secretary the Archieological Society -very satisfactory state of affairs. The deatlh-rates in the parish from all was much in debt, but, owing to his sound business capa- causes are higher than the corresponding rates relating to London gener- ally. Although there is evidence of a good deal of work having been bilities, it was soon placed on a sound financial basis. He done and considerable improvements effected in the parish, there is was accustomed to spend the summer months in Northern still a large proportion of houses where defective conditions exist. Sys- Italy, and a few years ago lie published, an interesting little tematic house-to-house inspection is not carried out in the district; in 'fact, the sanitary staff is not adequate for it. The inspection of work- book entitled Byewvays in the Southern Alps. Dr. Miles was shops has been commenced, but only a small proportion have been in- much respected not only by his colleagues in Rome, but also spected. There is no shelter in Bethnal Green at present for the accom- by all those who had the pleasure of knowing him.