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A STATISTICAL REVIEW OF 1923.
501 almost complete arrest of hostilities is a matter of common knowledge. Within six months of that period the ordinary business of life was in many parts of the world temporarily brought to a standstill by the ravages of the disease ; in North America the coffin-makers were unable to cope with the demands for their wares ; whilst in tropical Africa, Asia, and the Oceanic Islands natives in unknown thousands crawled into the forests to die. To-day little more is known concerning the agency responsible for these dramatic occurrences than was available at the moment when the document on Rival " three-day fever " was originally drafted. bacteriologists may sometimes indulge in learned disputes on the subject, but no man can say with absolute authority whether certain diseases, such as encephalitis lethargica, are entirely unrelated to influenza. Without suggesting that it is in any way probable, we can say that it is a possibility that minor epidemics such as that recorded in the article in our columns to-day bear some relation to pandemic influenza. The possibility gives an important incentive to efforts to discover their true pathology.
A STATISTICAL REVIEW OF 1923. ’
Registrar-General has issued, in the third week of August, his medical tablesfor the previous year, and, alongside the statistical " records " which this review contains, should be gratefully noted the timeliness of its appearance. For the tables are of great importance to executive health officers as the basis for their local reports, while last year the review was given out in November, in the previous year not at all. The edge of the interest has been tken off these truly wonderful vital statistics by the forecast issued in January,2when the Registrar-General remarked that the birth-rate for England and Wales as a whole was (apart from the war years) the lowest recorded, while the death-rate and infantile mortality were actually the lowest on record. His provisional figures have undergone no substantial modification, the corrected birth-rate for 1923 being 19-7, the death-rate 11-6, and the infant mortality-rate 69. From the figures now given it appears that the actual number of births was 758,131 (or 21,993 fewer than in 1922), the actual number of deaths 444,365 (or 41,864 fewer than in 1922), leaving a plus balance of 313,766, equivalent to a rate of 8-1 per 1000 living, denoting the natural increase of population. This increase shows a higher rate (the Registrar-General calls it an " improvement ") than in 1922, when the rate was 7-6 per 1000. The deaths in 1923 were, in fact, little more numerous than in 1862, when the population was hardly over 20,000,000 and the death-rate was 21-4 ; now it has fallen below 12 per 1000 for the first time. The infant mortality-rate of 69 is a measure of deaths under 1 year of age amounting to 52,582, an appalling enough figure when stated in this form. The mortality of children of school age has also reached its lowest record. In regard to infectious diseases, the deathrates from enteric fever, diphtheria, and phthisis are the lowest on record, as also (with one exception) is that from scarlet fever. Influenza shows the lowest mortality since 1917 and whooping-cough since 1919. Cancer, in the unvarnished words of the report, " shows the highest rate yet received " ; the total figures, and those which we have given week by week in our summaries of health officers’ reports, denote a vast amount of unrelieved misery which weighs heavily upon medical science. We hope it will not be long before we receive Dr. Stevenson’s illuminating commentary upon this compendium, which should in the meantime be studied in the light of Sir George Newman’s cautionary tale issued by the Ministry of Health. THE
1 The Registrar-General’s Statistical Review of England and Wales for the Year 1923. Tables, Part I., Medical. H.M. Stationery Office. 2 15s. THE LANCET, 1924, i., 191.
Annotations. "
A
GREAT
Dr. E. W.
Ne quid nimis."
MUNICIPAL OFFICER.
Hope’s impending
HEALTH
retirement from the
position of medical officer to the City and Port of His severs a very intimate connexion. tenure of office has been synchronous with the great activity in public health matters which has been in progress since the passing of the Public Health Act of 1875. Liverpool was a pioneer in municipal hygiene. The first medical officer of health in England, Dr. H. Duncan, was appointed there in 1842. His successor, Dr. W. S. Trench, was followed in turn by Stopford Taylor, to whom, in 1883, Dr. Edward W. Hope was appointed assistant. In 1887 Dr. Hope became medical superintendent of Park Hill Fever Hospital, and in 1894, on the retirement of Dr.
Liverpool
W.
Dr.
I
Taylor, he was appointed medical officer of health of the city. From early days Dr. Hope was associated with the University movement; in 1886 he became lecturer on public health to University College, and subsequently was appointed professor of public health, first at the College when it was affiliated to the Victoria University, and latterly at the University of Liverpool, when it obtained its charter in 1903. Dr. Hope has frequently pointed out that the unenviable notoriety for disease and mortality which characterised’ Liverpool at the time of his appointment was due in large measure to the rapid growth of the city at a time when public health requirements were disregarded, and in the second place to its peculiar vulnerability to the attacks of imported disease. In 1883 the city had no hospital for infectious diseases, and there was practically no port sanitary administration to check the importation of exotic disease. The great needs of Liverpool necessitated
a
forward
policy,
and under the wise
guidance of Dr. Hope the city council repeatedly obtained special legislative powers, while utilising to the full the provisions of the public health measures applying to the whole country. When Dr. Hope took office the population of Liverpool was only 540,000; in 1921 it had increased to 817,000, but the total deaths in this larger population were less by nearly one quarter. During this period housing received much attention, for in 1883 there were 23,690 cellars occupied as human dwellings and sanitation was in other respects in a very backward state. In the late ’eighties Liverpool was one of the few places where typhus fever could still be studied. During Dr. Hope’s connexion with the city there have been built up a system of hospitals for infectious disease, an efficient and elaborate port sanitary administration, and all the other essentials of a modern civic health department, including an up-to-date school medical service and maternity and child welfare department. Throughout his work as municipal officer Dr. Hope never came into conflict with independent medical practice. The good feeling existing between him and his medical colleagues found expression in his election some years ago to the presidency A recent of the Liverpool Medical Institution. example of effective cooperation is afforded by the harmonious working of the city council with the Consular Corps, His Majesty’s Customs, the Mersey Docks and Harbour Board; the shipowners, and the neighbouring Merseyside sanitary authoriDr. Hope himself is known to be in favour ties. of a more complete unification of the medical public health services. In his retirement, where the warm wishes of all public health workers go with him, it is to be hoped that he will still assist us with his wise and practical idealism.
A STATISTICAL REVIEW OF 1923. ’
Registrar-General has issued, in the third week of August, his medical tablesfor the previous year, and, alongside the statistical " records " which this review contains, should be gratefully noted the timeliness of its appearance. For the tables are of great importance to executive health officers as the basis for their local reports, while last year the review was given out in November, in the previous year not at all. The edge of the interest has been tken off these truly wonderful vital statistics by the forecast issued in January,2when the Registrar-General remarked that the birth-rate for England and Wales as a whole was (apart from the war years) the lowest recorded, while the death-rate and infantile mortality were actually the lowest on record. His provisional figures have undergone no substantial modification, the corrected birth-rate for 1923 being 19-7, the death-rate 11-6, and the infant mortality-rate 69. From the figures now given it appears that the actual number of births was 758,131 (or 21,993 fewer than in 1922), the actual number of deaths 444,365 (or 41,864 fewer than in 1922), leaving a plus balance of 313,766, equivalent to a rate of 8-1 per 1000 living, denoting the natural increase of population. This increase shows a higher rate (the Registrar-General calls it an " improvement ") than in 1922, when the rate was 7-6 per 1000. The deaths in 1923 were, in fact, little more numerous than in 1862, when the population was hardly over 20,000,000 and the death-rate was 21-4 ; now it has fallen below 12 per 1000 for the first time. The infant mortality-rate of 69 is a measure of deaths under 1 year of age amounting to 52,582, an appalling enough figure when stated in this form. The mortality of children of school age has also reached its lowest record. In regard to infectious diseases, the deathrates from enteric fever, diphtheria, and phthisis are the lowest on record, as also (with one exception) is that from scarlet fever. Influenza shows the lowest mortality since 1917 and whooping-cough since 1919. Cancer, in the unvarnished words of the report, " shows the highest rate yet received " ; the total figures, and those which we have given week by week in our summaries of health officers’ reports, denote a vast amount of unrelieved misery which weighs heavily upon medical science. We hope it will not be long before we receive Dr. Stevenson’s illuminating commentary upon this compendium, which should in the meantime be studied in the light of Sir George Newman’s cautionary tale issued by the Ministry of Health. THE
1 The Registrar-General’s Statistical Review of England and Wales for the Year 1923. Tables, Part I., Medical. H.M. Stationery Office. 2 15s. THE LANCET, 1924, i., 191.
Annotations. "
A
GREAT
Dr. E. W.
Ne quid nimis."
MUNICIPAL OFFICER.
Hope’s impending
HEALTH
retirement from the
position of medical officer to the City and Port of His severs a very intimate connexion. tenure of office has been synchronous with the great activity in public health matters which has been in progress since the passing of the Public Health Act of 1875. Liverpool was a pioneer in municipal hygiene. The first medical officer of health in England, Dr. H. Duncan, was appointed there in 1842. His successor, Dr. W. S. Trench, was followed in turn by Stopford Taylor, to whom, in 1883, Dr. Edward W. Hope was appointed assistant. In 1887 Dr. Hope became medical superintendent of Park Hill Fever Hospital, and in 1894, on the retirement of Dr.
Liverpool
W.
Dr.
I
Taylor, he was appointed medical officer of health of the city. From early days Dr. Hope was associated with the University movement; in 1886 he became lecturer on public health to University College, and subsequently was appointed professor of public health, first at the College when it was affiliated to the Victoria University, and latterly at the University of Liverpool, when it obtained its charter in 1903. Dr. Hope has frequently pointed out that the unenviable notoriety for disease and mortality which characterised’ Liverpool at the time of his appointment was due in large measure to the rapid growth of the city at a time when public health requirements were disregarded, and in the second place to its peculiar vulnerability to the attacks of imported disease. In 1883 the city had no hospital for infectious diseases, and there was practically no port sanitary administration to check the importation of exotic disease. The great needs of Liverpool necessitated
a
forward
policy,
and under the wise
guidance of Dr. Hope the city council repeatedly obtained special legislative powers, while utilising to the full the provisions of the public health measures applying to the whole country. When Dr. Hope took office the population of Liverpool was only 540,000; in 1921 it had increased to 817,000, but the total deaths in this larger population were less by nearly one quarter. During this period housing received much attention, for in 1883 there were 23,690 cellars occupied as human dwellings and sanitation was in other respects in a very backward state. In the late ’eighties Liverpool was one of the few places where typhus fever could still be studied. During Dr. Hope’s connexion with the city there have been built up a system of hospitals for infectious disease, an efficient and elaborate port sanitary administration, and all the other essentials of a modern civic health department, including an up-to-date school medical service and maternity and child welfare department. Throughout his work as municipal officer Dr. Hope never came into conflict with independent medical practice. The good feeling existing between him and his medical colleagues found expression in his election some years ago to the presidency A recent of the Liverpool Medical Institution. example of effective cooperation is afforded by the harmonious working of the city council with the Consular Corps, His Majesty’s Customs, the Mersey Docks and Harbour Board; the shipowners, and the neighbouring Merseyside sanitary authoriDr. Hope himself is known to be in favour ties. of a more complete unification of the medical public health services. In his retirement, where the warm wishes of all public health workers go with him, it is to be hoped that he will still assist us with his wise and practical idealism.