An infantile life table

396

AN I N F A N T I L E L I F E TABLE..

medical officers of Brighton, i~{anchester, and Glasgow, and these tables form a more satisfactory bas s of comparison than the English life table 1871-8o , although the reservations as to diffzrences in method (see footnote, page 394) should here be borne in mind.

show that for males the chance of surviving to age 5 in London is only equal to the chance, of surviving to age 25 in the healthy districts, and that for females the chance of surviving to age 5 in London is only equal to the chance of surviving to about 22 in the healthy districts.

EXPECTATION OF LIFE ("~A:> AT VARIOUS AGES A N D FOR EACI~I SEX IN L O N D O N , I~RIGHTON, I~iANCHESTER,

I88I-90.

A N D GLASGOW,

MALES,

FEMALES.

z~

E~

Age. x.

London.

o

40 '66

IO

50"77 47 "22

I5 2O

25 35 45 55 65

Brighton. Manchester. Glasgow.

2 I 'OO

43"59 52"87 49"I2 44"67 40'55 36"51 29"o2 2z'36

I5"31

16 "48

42 "88 387 ° 34'70 27"39 10"59

io'96

34"71 45'59 42"75 38"78 34"62 30"69 23"76 17"8o 12 "49 8.i 5

35"I8 46 '97 44"32 40"51 36'9° 33'29 26"o6 19"54 I3"99 9"38

The above table shows the expectation of life (Ex) at various ages and for each sex in the towns iust mentioned. It is interesting to note that at each age and for each sex the expectation of life in London exceeds that in Manchester and Glasgow, but is less than that of Brighton. From this point of view therefore, London occupies an intermediate position between Brigh~ ton, a fashionable health resort, on the one hand, and Manchester and Glasgow, important industrial centres, on the other. In the absence of more recent material for the comparison of the vital conditions of London with those of "healthy districts," comparison may be made between the London life table o f , 8 8 i - 9 o and Dr. Fart's Healthy Districts life table, based on the mortality of certain English districts in the five years 1849-53. The extent to which London conditions of the present time fall short of those of healthy districts some forty years ago can then be seen. The most noticeable feature is the excessive mortality in London under 5 years of age. Whereas, according to this standard, i,ooo,ooo males, should be reduced in these 5 years by 186,898 , and i,oeo,ooo females by 164,44% in London i,oo%ooo males are reduced by 277,ooi and i,ooo,ooo females by 249,6o8, the excess of mortality in each case being almost exactly 50 per cent. At subsequent ages the London figures are more favourable, but this, it must be presumed, is in great measure due to the constant influx of healthy persons who directly lessen the London death rates, and many of whom return to their homes in the country if their health becomes impaired. From another point of view, the figures

London.

Brighton.

44 '91 54"42 50"95 46"65 42 '45 38"34 30"69 2380 17"34 11 '78

49"00

56"92 53"15 49'07 44"76 40"48 32 "48 25"07 18"48 I2"I9

Manchester. Glasgow. 38"44 48'o6 45"43

41 '5° 37"33 33"38 2630 t9 79 I3"9[ 9 II

37"70 48 "27 45'44 4I '59

38'oo 34 '60 28"c6 21 "6I 15"6°

Io'69

In a comparison of expectations of life in London 1881-9o with those in Dr. Farr's Healthy Districts life table, the effect of the influx of healthy lives alluded to above is very apparent ; and, as might have been anticipated, this influx effects the figures relating to females more than it does the figures relating to males. Among other reasons, it is probable that a larger proportion of females (principally domestic servants)than of males return to their homes when their health breaks down. A reasonable inference is that the figures relating to males are a more trustworthy index of the effect of London life on longevity than those relating to females. But even these figures are unduly raised by immigration of healthy young men, and it is therefore highly probable that the life expectation of persons born, and living their lives, in London is at all ages considerably less than 9 ° per cent. of the normal expectation.

AN

INFANTILE

LIFE

TABLE.

~

By A. JASeZ~ A~DERSO~, M.A., M.B. Oxon, M.O.H. of

Blackpool. I HAVE continued my investigations into the causes of the rate of infant mortality being higher in Blackpool than would be expected from the healthy situation of the town, and the attention which is given to its sanitary condition. Firstly, I have constructed a table of the causes of death, and the ages at death of children dying in Blackpool in the ten years I884-93. I am thus enabled to compare these results with those of the children * From Dr. Anderson's Annual Report for I894.

AN INFANTILE

dying in Preston, Leicester, and Blackburn (the three towns with the highest infantile mortality) during the years 1889-91 ; and also with those dying in the three counties of Hertfordshire, Wiltshire, and Dorsetshire in the same years. In the three counties mentioned the infantile mortality is the lowest, and shows what is attainable, though the sanitary conditions under which many of the inhabitants live are far from being perfect. (See Registrar.General's Fifty-fourth Annual Report.) There were 5,533 births in Blackpool in the ten years I884-93, and 9~7 deaths of infants under twelve months old--i.e., a rate of I65" 7 per I,ooo births, as compared with 97"I in the three counties, and 2,8 in the three towns. Of the 9 t 7 deaths in Blackpool, 524 were males, and'393 females. The births were 2,793 males, and 2,74o females. The deaths under one year of males per I,ooo male births were 187"6, and of females per I,ooo female births 143"4. Age at Deatk.--During the first day of life 1,59o children wouId die in BlackpooI Out of Ioo,ooo births, whilst, in the three counties the deaths would be only ~,oo2 and 1,198 in the three towns. Of lOO,OOO births in Blackpool, 2,98a

LIFE TABLE.

397

would die in the first week, whilst the numbers are 2,][63 for the three counties, and 2,646 for the three towns. This shows at once that a larger proportion of children are born in Blackpool who only survive birth for a few days, than in any of the districts used for comparison. I n the first month of age 5,078 deaths would occur out of lO%OOO births, as compared with 3,488 in the three counties, and 4,947 in the three towns. Over one and under twelve months there would be 11,494 deaths in Blackpool, whilst i n the three counties there would only be 6,229, and in the three towns the large number of I6,856 per

lO%OOO births. Then I have constructed a life table for the first year of life, and placed in adjoining columns the similar figures for the three selected towns and counties. From that it will be seen at a glance that the deaths in each month of life diminish rapidly at first after the first month, with the exception of a slight rise in the third month, and then more gradually until the twetftli month. he 917 deaths were distributed as follows:--2I 3 occurred in the first quarter of the year, i72 in the second, 3Ol in the third, and 231 in the fourth.

LIFE TABLE FOR THE FIRST YEAR OF LIFE. Of IOO,ooo born, the numbers surviving at each age. AG~.

Days. o I

2

3 4

5

6 7

Three Rural Counties.

Three Selected Towns.

IO0,O00

IO0,O00

I00,000

98,4IO 97,886 97,56I 97,344 97,I99 97,I45 97,OI8

98,998 98,702 98,42I 98,189 98,O37 97,917 97,837

98,802 98,317 97,973 97,737 97,593 97,463 97,354

I00~000

IO0,O00

97,837 97,364 96,902 96,571

97,354 96,581 95,749 95, Io3

Blackpool.

3 4

3 4 5 6 7 8 9 IO II 12

Blackpool. {

O I 2

3 4 6s

Three Rural Counties.

Three Selected Towns,

1,198 485 344 236 1~¢ 13o lO9

1,59o

i'

I jO02,

52~

I

295

305 217 I45 54 I27

281 232

152 120

80

7 Weeks.

I0%000

97,o18 96,277 95,41o 94,922

Months. O I 2

AGZ.

Days.

Weeks. O I 2

Deaths in each successiveinterval of age.

O I 2

3 ,4

2,982 741 867 488

2,163

5,078 1,518 I~8o7 I1446

3,488 985 707 673 618 461 483 483 454 476

473 462 a31

2,646 773 832 646

Months. IO0,OOD

94,912 93,404 9h597 9o, t5I 89,049 87,947 87,o~5o 86,285 85,56I 84,837 8bII3 83,416

I00,000

96,512 95,527 94,820 94, t 47 93,529 93,068 92,585 92~IO2

91,648 91,172 90,717 9%283

IOO~O00

95,053 92,923 o,874 8;907 87, I59 85,574 84,099 82,873 81,556 80,336 79,226 78,197

~

O I 2

3 4

5

6 7 8 9 IO II I2

1:102 I,I02

867 795 724 724 724 687

455

434

4,947 2,130 2,049 1,967 1,749 1,584 1,475 1,226 1,317 1,220 I~IIO

I~029

398

AN I N F A N T I L E L I F E T A B L E .

Causes of .Deaf,~.--Prematurity and atelectasis accounted for 3,289 deaths out of 10%ooo births, as compared with numbers 1,436 and 2,428 for the counties and towns respectively. This is a very significant fact, and especially when taken in conjunction with the previous result of the excessive number of deaths in the first week of life. There are several possible explanations of this. (i) That the stamina of the inhabitants of the Borough is not up to the average even of dwellers in the three selected large towns, in consequence of the immigration of partially worn-out townsfolk into the Borough; (2) that the climate of sea-side places conduces to premature births; (3) that the ,social conditions of Blackpool, especially the hurry and bustle of the season, favour premature confinements ; and (4) perhaps the certification and registration of children, who survive birth a few moments, may be more carefully carried out here than elsewhere. I am unable to state which is the true explanation, although I incline to the belief that the first and the third ones are the chief acting causes. In this connection it is noteworthy that the Registrar-General has drawn attention to the gradual increase in the deaths from prematurity and congenital defects which has been going on in England and Wales during recent years. The deaths from congenital defects were slightly more than in the towns or counties chosen for comparison. Whooping cough was responsible for 578 deaths per ioo,ooo births, a number midway between those for the counties and towns. Measles was only responsible for ai~ deaths per lOO,OO% which is slightly higher than 176 the number in counties, and much less than 626 the rate in the three towns. In this there is some evidence that the notification of measles is beneficial. Including diarrhoea, enteritis, and other diseases of the digestive organs as diarrboeal diseases, I find a rate of 3,163, as compared with the lcw figure of 792 for the counties, and the high figure of 4,742 for the towns. Erysipelas was more frequently ascribed as a cause of death in Blackpool than elsewhere. "1he rate for syphilis was 198 , as compared with 19o for the three towns per ioo,ooo births. Under the present unsatisfactory system of certification and registration of deaths, this cause is more frequently returned under the head of a prominent symptom of the disease. Deaths from convulsions and diseases of the nervous system are midway between the rates of the towns and counties. Deaths from tubercular disease were nearly twice as many as in the counties, and about twothirds the deaths in the towns. The rate for deaths from atrophy was only r,283, as compared with 1,738 for the counties, and 2,734 for the towns. The rate for deaths from diseases of the respiratory organs were 3,oi8~

as compared with 2,io 5 and 3,7Ol for counties and towns respectively. An inquiry has been made into the circumstances of children who died under 12 months old since 1891 , and the particulars with regard to the feeding of 255 children who survived above a month are classified below : - ~IANNER OF FEEDING. Breast alone . . . . . . . . . . . . . . . . . Breast with other food . . . . . . Breast less than one month and'then or'her food ... Breast less than two months and then other food .., Breast less than three months and then other food ... Breast tess than six months . . . . . . . . . . . . Milk and water alone . . . . . . . . . . . . Milk and water and various infant food's . . . . . . Totals

...............

56 45 4 3" 3 3 92 40 259

From this table it will be gathered that 51 per cent. of these children were never fed on the breast at all, whilst 25' 5 per cent. only had breastmilk alone during the whole of their lives. Just over I 5 per cent. were fed largely on one of the many forms of objectionable infant foods. If the information I was supplied with is correct, there was no evidence of infant insurance being a cause of infant mortality. Space will not allow me to enter more fully into other results of this inquiry. To sum up, the high infantile mortality in Blackpool appears to be caused b y - (I.) "Ihe excessive number of deaths of prematurely born infants. (2.) The large number of deaths from diarrhoeal diseases, caused by injudicious methods of feeding, to some extent by parental neglect, and also in the summer months to overcrowding of the dwellings. And (3.) By the large proportion of deaths from respiratory diseases, possibly induced by the children being improperly clothed. As means which might be adopted to lower this death-rate I should suggest-(i.) That mothers be educated in the proper manner of feeding, clothing, and rearing children, by the circulation of handbills and other means. (2.) That the cleanliness of dwellings be strongly insisted upon. And (3.) That a crbche or day nursery be established~ to which lodging-house keepers could take their infants during the busy months of the year. ENTERIC FEVER AND THE PAIL SYSTEM.Dr. H. E. Armstrong reports that in Newcastleon-Tyne, during 1893, examination of the returns as to the comparative prevalence of enteric fever in households, on the water-closet or pail-closet system respectively, showed that of the houses on the water-closet system only 0"3 per cent. were infected with the disease, whereas in houses on the pail-closet system the rate was o'6 per cent,