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CLASS MORTALITY STATISTICS.
845
virgin forest abound. The map suggests a relation of the I bog and swamp, and rendering cultivation difficult and If we compare the unprofitable. Our inquiry, therefore, leads to the concludisease to temperature and water. malaria chart of Europe with a physical map of the Continent, z, sion that from political causes the local condition of the the relation ot the disease to low land, abundant water, and Campagna have been most profourdly altered, and that hot, moist climate is very evident. Make the same com- ’ pari passu malaria has arisen and HMreased in intensity. parison between a physical map of Italy and the map of A minute examination of the relation of local conditions Senator Torelli, showing the local distribution of the to the disease will form the subject of the next lecture. malaria, and the relation of the disease to altitude of the ’, land, to water, and to temperature becomes a certainty. A study of the local distribution and variations of intensity CLASS MORTALITY STATISTICS. of malarial fevers in the province of Rome shows us that local conditions have a most important bearing on the IT is not easy to overrate the importance of the subject subject, and are therefore worthy of minute and careful examination; the general conclusions drawn from the of a paper read before the Royal Statistical Society on consideration of large areas are still found to apply, and we Tuesday evening last by Mr. Noel A. Humphreys, of the find the disease to be generally most severe on low-lying Registrar-General’s Department. For elucidating the true land--in valleys and marshy districts. An examination value of local rates of mortality we have urban and rural of the distribution of the population in the province of we have death-rates at different age periods, death-rates, Rome shows us that the usual order of things is reversed, and that, whereas in most civilised countries the population we have death-rates from different causes, and we have the is densest in the plains and least dense in the mountains, in death-rates of male adults engaged in different occupations. the province of Rome exactly the reverse is the case, and Till recently, however, we have known very little of the we find the mountain population stands to that of the rates of mortality prevailing in the different classes of ,plains in the ratio of sixty-eight to twenty-eight persons society. The object of Mr. Humphreys’ paper was to discuss This to a wellper square kilometre. startling exception recoguised rule leads us to inquire whether political existing mortality statistics thiowing light upon this causes have led to the abandonment of the plain and important subject, and especially to examine critically the the. malaria has simply stepped in and taken posses- full bearing of the statistics issued during the last few years sion, or has the malaria itself been the cause of this by Dr. Grimshaw, the Registrar-General of Ireland, dealing abandonment; and in either case, when did the causes with the mortality prevailing in various social classes of begin to operate ? This is a historical question of the the of Dublin. population very greatest interest, and also of the very greatest importOn account of the marked variations of the age proance to the subject, as tending to show what are the ,conditions necessary for the development and spread of portions of the various social classes of the population, the malarial fevers. There is, however, one very great difficulty only thoroughly satisfactory method for comparing the in the inquiry, and that is that malaria develops so ’slowly mortality statistics of such classes is by the construction of that, unlike the " black deathor the " sweating sickness," it life tables, and the first part of the paper is devoted to the does not attract the attention of the historian, and thus we are examination of the principal English life tables, and espedriven to argue its presence or absence and its intensity cially of those which throw any light upon the special subject from the history of individual localities. The one great of the paper. It is pointed out, in the first place, that the fact that we have as a starting-point is that in even the various Euglish life tables based upon the general populalater days of the Roman Empire places now absolutely tion show a marked and steady increase in the mean durauninhabitable were not only inhabited, but held in tion of life in recent years. The Carlisle table gives 39 high esteem by the Romans as health-resorts, so much years as the mean duration of life, whereas Dr. Farr’s table, based upon the mortality of the 17 years 1838-54, gives so that the whole coast line of the province was covered with their villas and country houses, of which we can 41 years; a table based upon the mortality of the five years seethe ruins to-day; and we know from the writings of 1876-80 gives 44 years; and the mortality, of the next five Pliny and others that these villas were maintained in a state years, 1831-5, shows a still further extension of life. of luxury and magnificence, quite incompatible with the Dr. Farr’s healthy district table (based upon the morpresence of such an enemy to health as malaria. There is some tality statistics of sixty-three registration districts in - evidence, however, that the Pontine district was not all that which the mean death-rate in the ten years 1841-50 could be desired even in those times, and Seneca advises a did not exceed 17 per 1000) gives 49 years as the friend to avoid the neighbourhood of Ardea as not being very mean duration of life. Very few life tables based upon healthy. The invasions of the Goths swept away these class mortality statistics exist. The most important villas and the high cultivation which surrounded them, the examples of the class life tables referred to by Mr. gardens and sacred groves were destroyed, and the popula- Humphreys are Bailey’s and Day’s Peerage Tables, tion driven to the hills and secure places. Rome itself Ansell’s Tables of Upper Classes, and Hodgson’s Clergy sank almost to insignificance, the destruction done by the ! Tables. Although not, correctly speaking, class tables, the Northern barbarians was never repaired, and the Campagna Experience Tables of the Institute of Actuaries, and of the continued the battle-ground of Saracens, Lombards, rival American Life Offices, throw valuable light upon the morpopes, and barons, rendering a return to the ancient civilisa- tality of insured, and therefore of selected healthy lives, tion almost hopeless. In the seventh and eighth centuries belonging, for the most part, to the middle and upper classes. Ansell’s Upper Class Table gives a mean duration we hear of fever, not isolated but wide spread, and of serious attempts by various popes to recolonise and cultivate the of life of 53 years-an increase of four years upon that by desolate country. The so-called Domuscultse were estab- the Healthy District Table. Unfortunately, it appears that lished, with the double object of military defence and the no life table of the working classes exists, although the reclamation of the land, on the site of places which mortality statistics issued by Dr. Grimshaw for the General flourished under the empire; but they do not appear to Service Class in Dublin are such as to suggest that the mean have been successful, or at most, only partially so, and duration of life in this class can scarcely, if at all, exceed though some of them exist at the present day-e.g, the that by Dr. Farr’s Liverpool table-namely, 26 years. An examination of these several life tables shows that the Isola Farnee, the site of the ancient Etruscan City of Veu,— they are only aggregations of hovels, and so unhealthy that mean duration of life is mainly controlled by the rate of the population desert them in the summer and autumn. mortality in childhood. In all the life tables based upon Thus we see that the Campagna was abandoned from the mortality statistics of the general population, the morcauses purely political, and nature was allowed her own tality during infancy and early childhood is so great that way in a country where the unceasing toil of man is the expectation of life is greater at ten years of age than it required to keep her under control. There can be no doubt is at birth. By Dr. Farr’s English Life Table, for instance, that the reckless destruction of trees which has gone on the expectation at birth is 41 years, while at age 10 it is 47 steadily ever since it was begun by the Goths has played a years ; and even by the Healthy District Table it is 49 years most important part in altering the local conditions and local at birth and 51 years at age 10. Ansell’s Upper Class Table, climate of the country, and in comparatively recent times however, has such a comparatively low rate of child morthe reckless cutting of timber in the mountains has caused tality that the expectation of life is 53 years at birth, which the streams which rise in them to become uncontrollable declines to 52 years at age 10. The variations in the annual and destructive, converting large areas of the lowland into death-rate of children under five years of age by the different
’
! ,
846 tables is very noteworthy; itis G5’7 per 1000 by the English Calling specihl attention to the near approach of the deathLife Table (Dr. P’arr’s No. 3), and 39’4 by the Healthy Dis- rates among the clergy and labourers in agricultural counties, trict Table, while by Ansell’s Upper Class Table it does not he urges a stronger faith in the possibility of reducing theexceed 28’2. Dr. Grimshaw’s statistics show a rate of only present wide range between the death-rates of the upper and 22’0 among children of the professional and independent of the working classes. Comparing the rates of labourers class in Dublin during the three years ending 1885. in agricultural counties and of labourers in London, it is Subsequently to childhood the greater vitality of the suggested that this is due not so much to difference of middle and upper classes, compared with that of the general poverty and hardship, but to the unhealthy homes and population, is only somewhat less marked than it is under impure air from which the London labourer mainly suffers. five years of age. The marked reduction in the working-class mortality, The most recent statistics of occupational mortality, con- especially of infants, in the Peabody building, points, at structed by Dr. Ogle, and issued by the Registrar- General, any rate, to one effective method of bringing the mortality although not coming within the scope of class mortality of the working classes within sanitary control. These and statistics, as they only deal with adult males, throw, at any I other similar facts indicate further possible reductions in the rate, a side-light upon the subject. Taking the mortality of now rapidly declining English death-rate, the possible extent all males aged 25 to 65 years as 1000, the relative mortality of which it is not easy to estimate. of males engaged in different occupations, after due correction for age differences, is shown by Dr. Ogle to range from 556 for " Clergyman, Priest, Minister," 599 for " GarTHE LUNACY ACTS AMENDMENT BILL. dener, Nurseryman," 631 for " Farmer, Grazier," and 701 for " Labourer in Agricultural Counties"; to 1839 for " Miner A MEETING of the Council of the Poor-Law Medical (Cornwall)," 1879 for " Costermonger, Hawker, Street Seller," 2090 for " General Labourer (London)," and 2205 for " Inn, Officers’ Association, to which workhouse medical officers Hotel Servant." Many of these differences are evidently due had been invited, was held at their rooms, 3, Bolt-court, far more to the influences and risks of occupation than to on April 14th. Prior to commencing the the mere influence of class ; and it seems probable, however, Fleet-street, a business of the unanimous feeling of regret was evening, that the wide difference between the mortality of labourers in agricultural counties and labourers in London must be expressed at the continued absence from the chair of Dr. Rogers, owing to severe illness. Clause 14, submainly due to difference of housing and sanitary surround- Joseph sections 5 and 6, of the Lunacy Acts Amendment Bill was both as classes suffer about from probably equally ing, then discussed, and it was considered by the Council and poverty, hard work, and hard living. As information of the variations of child mortality in the visitors present that the alteration of the clause by the various classes is essential to a full appreciation of the lesson Parliamentary Bills Committee of the British Medical to be learned from class mortality statistics, Dr. Grimshaw’s Association fully met the requirements of the case, statistics, notwithstanding defects, in great measure un- and the secretary was requested to write to the chairavoidable in such an experiment, are especially valuable. man of that committee to tender the co-operation of the in what manner it may be deemed advisable, They demand attention, in the first place, to the marked Association, variations in the age distribution of the population in with a view to having the obnoxious clause amended in the different classes. For instance, 1000 of Dr. Grimshaw’s Commons. It was also suggested that the word shall be may in Clause 19, line 4, which refers to the professional and independent class contain only 75 children substitutedofforfees by the guardians under orders of the under five years of age, instead of 121 in the artisan class. payment Then the proportion per 1000 of persons aged upwards of justices. The opinion of the secretary of the Lunacy Commissioners as to the great value of the certifying of pauper sixty years is 158 in the professional and independent class lunatics by the workhouse medical officer was considered and only 63 in the artisan class. Mr. Humphreys shows that given identical iates of mortality in each of Dr. Grim- important in reference to the amendments proposed. shaw’s four classes, at each age period, the death-rate at all ages would, owingalone to the differences of age distribution, range from 19 5 in the middle class to 25’2 in the professional class. The actual mortality in the classes differs, however, very widely in the other direction. If 1000 be taken to represent the mortality that would occur in each class LOCAL GOVERNMENT DEPARTMENT. if English life-table rates prevailed, the mortality in Dublin in the three years 1883-4-5, in Dr. Grimshaw’s four classes, REPORTS OF MEDICAL OFFICERS OF HEALTH. corrected for age differences, was equal to 632 in the professional and independent class, 1093 in the artisan class, Chailey 7i*M)’ District.-The general survey of sanitary 1333 in the middle class, and 1659 in the general service districts carried out by the Local Government Board was class. extended to this area, and Mr. Graveley reports that as a The variations in the death-rates at different age periods in the several classes is especially striking. Thus, the mean consequence special attention was devoted to the drainage annual mortality under five years is just five times as great of several villages, to the abatement of nuisances from the in the general service class as in the professional and keeping of animals and from filth accumulations, and to the independent class. The difference at the next age-period, enforcement of bye-laws. The current systematic inspec5 to 20 years, is almost as great, and in each of the three tions were also carried out during the year, and the dairies age-periods of adult life the rates of mortality are more than and milkshops were placed under supervision. The annual twice as high in the general service class as in the prodeath-rate for 188G was 15 per 1000. Six deaths occurred fessional and independent class. The rates of mortality from various causes of death show from typhoid fever, the disease originating in an encampfully as wide differences as do the death-rates at different ment of people travelling in vans. Coventry Urban District.-Owsng to the prevalence of ages. For instance, mortality from measles is nearly ten times as great in the general service class as in the pro- measles in the city, and its extension on such a rapid scale fessional and independent class; from whooping-cough, that hospital isolation could not check it, the closing of more than four times as great ; from scarlet fever, more elementary schools became a necessity. Dr. Fenton exthan twice as great; from diarrhoea., nearly three times as plains that this step involved to the school managers great; from typhus, nearly five times as great; from and teachers a loss of 110, and hence that it is a phthisiq, more than four times as great; from lung diseases, serious one to adopt. It has generally been assumed more than three times as great; from convulsions, nearly that any loss of grant accruing from actual closure of thirteen times as great; and from violence, more than five schools would be made good if the closure were effected times as great in the general service class as in the pro- under the regulations of the education code; and it is certain that this should be so, otherwise a great hindrance fessional and independent class. In concluding his analysis and discussion of Dr. Grim- is placed in the way of checking the spread of disease. In shaw’s figures, Mr. Humphreys urges the necessity for eight weeks ending with the second week of October, 570 further investigation in the same direction, and expresses fresh attacks took place, the schools being open. School the hope that medical officers of health and others may follow closure was then resorted to, and the new attacks fell in Dr. Grimshaw’slead and improve upon his statistics. three weeks from 76 to 10. They were then reopened,.
I
Public Health
and
Poor Law.
virgin forest abound. The map suggests a relation of the I bog and swamp, and rendering cultivation difficult and If we compare the unprofitable. Our inquiry, therefore, leads to the concludisease to temperature and water. malaria chart of Europe with a physical map of the Continent, z, sion that from political causes the local condition of the the relation ot the disease to low land, abundant water, and Campagna have been most profourdly altered, and that hot, moist climate is very evident. Make the same com- ’ pari passu malaria has arisen and HMreased in intensity. parison between a physical map of Italy and the map of A minute examination of the relation of local conditions Senator Torelli, showing the local distribution of the to the disease will form the subject of the next lecture. malaria, and the relation of the disease to altitude of the ’, land, to water, and to temperature becomes a certainty. A study of the local distribution and variations of intensity CLASS MORTALITY STATISTICS. of malarial fevers in the province of Rome shows us that local conditions have a most important bearing on the IT is not easy to overrate the importance of the subject subject, and are therefore worthy of minute and careful examination; the general conclusions drawn from the of a paper read before the Royal Statistical Society on consideration of large areas are still found to apply, and we Tuesday evening last by Mr. Noel A. Humphreys, of the find the disease to be generally most severe on low-lying Registrar-General’s Department. For elucidating the true land--in valleys and marshy districts. An examination value of local rates of mortality we have urban and rural of the distribution of the population in the province of we have death-rates at different age periods, death-rates, Rome shows us that the usual order of things is reversed, and that, whereas in most civilised countries the population we have death-rates from different causes, and we have the is densest in the plains and least dense in the mountains, in death-rates of male adults engaged in different occupations. the province of Rome exactly the reverse is the case, and Till recently, however, we have known very little of the we find the mountain population stands to that of the rates of mortality prevailing in the different classes of ,plains in the ratio of sixty-eight to twenty-eight persons society. The object of Mr. Humphreys’ paper was to discuss This to a wellper square kilometre. startling exception recoguised rule leads us to inquire whether political existing mortality statistics thiowing light upon this causes have led to the abandonment of the plain and important subject, and especially to examine critically the the. malaria has simply stepped in and taken posses- full bearing of the statistics issued during the last few years sion, or has the malaria itself been the cause of this by Dr. Grimshaw, the Registrar-General of Ireland, dealing abandonment; and in either case, when did the causes with the mortality prevailing in various social classes of begin to operate ? This is a historical question of the the of Dublin. population very greatest interest, and also of the very greatest importOn account of the marked variations of the age proance to the subject, as tending to show what are the ,conditions necessary for the development and spread of portions of the various social classes of the population, the malarial fevers. There is, however, one very great difficulty only thoroughly satisfactory method for comparing the in the inquiry, and that is that malaria develops so ’slowly mortality statistics of such classes is by the construction of that, unlike the " black deathor the " sweating sickness," it life tables, and the first part of the paper is devoted to the does not attract the attention of the historian, and thus we are examination of the principal English life tables, and espedriven to argue its presence or absence and its intensity cially of those which throw any light upon the special subject from the history of individual localities. The one great of the paper. It is pointed out, in the first place, that the fact that we have as a starting-point is that in even the various Euglish life tables based upon the general populalater days of the Roman Empire places now absolutely tion show a marked and steady increase in the mean durauninhabitable were not only inhabited, but held in tion of life in recent years. The Carlisle table gives 39 high esteem by the Romans as health-resorts, so much years as the mean duration of life, whereas Dr. Farr’s table, based upon the mortality of the 17 years 1838-54, gives so that the whole coast line of the province was covered with their villas and country houses, of which we can 41 years; a table based upon the mortality of the five years seethe ruins to-day; and we know from the writings of 1876-80 gives 44 years; and the mortality, of the next five Pliny and others that these villas were maintained in a state years, 1831-5, shows a still further extension of life. of luxury and magnificence, quite incompatible with the Dr. Farr’s healthy district table (based upon the morpresence of such an enemy to health as malaria. There is some tality statistics of sixty-three registration districts in - evidence, however, that the Pontine district was not all that which the mean death-rate in the ten years 1841-50 could be desired even in those times, and Seneca advises a did not exceed 17 per 1000) gives 49 years as the friend to avoid the neighbourhood of Ardea as not being very mean duration of life. Very few life tables based upon healthy. The invasions of the Goths swept away these class mortality statistics exist. The most important villas and the high cultivation which surrounded them, the examples of the class life tables referred to by Mr. gardens and sacred groves were destroyed, and the popula- Humphreys are Bailey’s and Day’s Peerage Tables, tion driven to the hills and secure places. Rome itself Ansell’s Tables of Upper Classes, and Hodgson’s Clergy sank almost to insignificance, the destruction done by the ! Tables. Although not, correctly speaking, class tables, the Northern barbarians was never repaired, and the Campagna Experience Tables of the Institute of Actuaries, and of the continued the battle-ground of Saracens, Lombards, rival American Life Offices, throw valuable light upon the morpopes, and barons, rendering a return to the ancient civilisa- tality of insured, and therefore of selected healthy lives, tion almost hopeless. In the seventh and eighth centuries belonging, for the most part, to the middle and upper classes. Ansell’s Upper Class Table gives a mean duration we hear of fever, not isolated but wide spread, and of serious attempts by various popes to recolonise and cultivate the of life of 53 years-an increase of four years upon that by desolate country. The so-called Domuscultse were estab- the Healthy District Table. Unfortunately, it appears that lished, with the double object of military defence and the no life table of the working classes exists, although the reclamation of the land, on the site of places which mortality statistics issued by Dr. Grimshaw for the General flourished under the empire; but they do not appear to Service Class in Dublin are such as to suggest that the mean have been successful, or at most, only partially so, and duration of life in this class can scarcely, if at all, exceed though some of them exist at the present day-e.g, the that by Dr. Farr’s Liverpool table-namely, 26 years. An examination of these several life tables shows that the Isola Farnee, the site of the ancient Etruscan City of Veu,— they are only aggregations of hovels, and so unhealthy that mean duration of life is mainly controlled by the rate of the population desert them in the summer and autumn. mortality in childhood. In all the life tables based upon Thus we see that the Campagna was abandoned from the mortality statistics of the general population, the morcauses purely political, and nature was allowed her own tality during infancy and early childhood is so great that way in a country where the unceasing toil of man is the expectation of life is greater at ten years of age than it required to keep her under control. There can be no doubt is at birth. By Dr. Farr’s English Life Table, for instance, that the reckless destruction of trees which has gone on the expectation at birth is 41 years, while at age 10 it is 47 steadily ever since it was begun by the Goths has played a years ; and even by the Healthy District Table it is 49 years most important part in altering the local conditions and local at birth and 51 years at age 10. Ansell’s Upper Class Table, climate of the country, and in comparatively recent times however, has such a comparatively low rate of child morthe reckless cutting of timber in the mountains has caused tality that the expectation of life is 53 years at birth, which the streams which rise in them to become uncontrollable declines to 52 years at age 10. The variations in the annual and destructive, converting large areas of the lowland into death-rate of children under five years of age by the different
’
! ,
846 tables is very noteworthy; itis G5’7 per 1000 by the English Calling specihl attention to the near approach of the deathLife Table (Dr. P’arr’s No. 3), and 39’4 by the Healthy Dis- rates among the clergy and labourers in agricultural counties, trict Table, while by Ansell’s Upper Class Table it does not he urges a stronger faith in the possibility of reducing theexceed 28’2. Dr. Grimshaw’s statistics show a rate of only present wide range between the death-rates of the upper and 22’0 among children of the professional and independent of the working classes. Comparing the rates of labourers class in Dublin during the three years ending 1885. in agricultural counties and of labourers in London, it is Subsequently to childhood the greater vitality of the suggested that this is due not so much to difference of middle and upper classes, compared with that of the general poverty and hardship, but to the unhealthy homes and population, is only somewhat less marked than it is under impure air from which the London labourer mainly suffers. five years of age. The marked reduction in the working-class mortality, The most recent statistics of occupational mortality, con- especially of infants, in the Peabody building, points, at structed by Dr. Ogle, and issued by the Registrar- General, any rate, to one effective method of bringing the mortality although not coming within the scope of class mortality of the working classes within sanitary control. These and statistics, as they only deal with adult males, throw, at any I other similar facts indicate further possible reductions in the rate, a side-light upon the subject. Taking the mortality of now rapidly declining English death-rate, the possible extent all males aged 25 to 65 years as 1000, the relative mortality of which it is not easy to estimate. of males engaged in different occupations, after due correction for age differences, is shown by Dr. Ogle to range from 556 for " Clergyman, Priest, Minister," 599 for " GarTHE LUNACY ACTS AMENDMENT BILL. dener, Nurseryman," 631 for " Farmer, Grazier," and 701 for " Labourer in Agricultural Counties"; to 1839 for " Miner A MEETING of the Council of the Poor-Law Medical (Cornwall)," 1879 for " Costermonger, Hawker, Street Seller," 2090 for " General Labourer (London)," and 2205 for " Inn, Officers’ Association, to which workhouse medical officers Hotel Servant." Many of these differences are evidently due had been invited, was held at their rooms, 3, Bolt-court, far more to the influences and risks of occupation than to on April 14th. Prior to commencing the the mere influence of class ; and it seems probable, however, Fleet-street, a business of the unanimous feeling of regret was evening, that the wide difference between the mortality of labourers in agricultural counties and labourers in London must be expressed at the continued absence from the chair of Dr. Rogers, owing to severe illness. Clause 14, submainly due to difference of housing and sanitary surround- Joseph sections 5 and 6, of the Lunacy Acts Amendment Bill was both as classes suffer about from probably equally ing, then discussed, and it was considered by the Council and poverty, hard work, and hard living. As information of the variations of child mortality in the visitors present that the alteration of the clause by the various classes is essential to a full appreciation of the lesson Parliamentary Bills Committee of the British Medical to be learned from class mortality statistics, Dr. Grimshaw’s Association fully met the requirements of the case, statistics, notwithstanding defects, in great measure un- and the secretary was requested to write to the chairavoidable in such an experiment, are especially valuable. man of that committee to tender the co-operation of the in what manner it may be deemed advisable, They demand attention, in the first place, to the marked Association, variations in the age distribution of the population in with a view to having the obnoxious clause amended in the different classes. For instance, 1000 of Dr. Grimshaw’s Commons. It was also suggested that the word shall be may in Clause 19, line 4, which refers to the professional and independent class contain only 75 children substitutedofforfees by the guardians under orders of the under five years of age, instead of 121 in the artisan class. payment Then the proportion per 1000 of persons aged upwards of justices. The opinion of the secretary of the Lunacy Commissioners as to the great value of the certifying of pauper sixty years is 158 in the professional and independent class lunatics by the workhouse medical officer was considered and only 63 in the artisan class. Mr. Humphreys shows that given identical iates of mortality in each of Dr. Grim- important in reference to the amendments proposed. shaw’s four classes, at each age period, the death-rate at all ages would, owingalone to the differences of age distribution, range from 19 5 in the middle class to 25’2 in the professional class. The actual mortality in the classes differs, however, very widely in the other direction. If 1000 be taken to represent the mortality that would occur in each class LOCAL GOVERNMENT DEPARTMENT. if English life-table rates prevailed, the mortality in Dublin in the three years 1883-4-5, in Dr. Grimshaw’s four classes, REPORTS OF MEDICAL OFFICERS OF HEALTH. corrected for age differences, was equal to 632 in the professional and independent class, 1093 in the artisan class, Chailey 7i*M)’ District.-The general survey of sanitary 1333 in the middle class, and 1659 in the general service districts carried out by the Local Government Board was class. extended to this area, and Mr. Graveley reports that as a The variations in the death-rates at different age periods in the several classes is especially striking. Thus, the mean consequence special attention was devoted to the drainage annual mortality under five years is just five times as great of several villages, to the abatement of nuisances from the in the general service class as in the professional and keeping of animals and from filth accumulations, and to the independent class. The difference at the next age-period, enforcement of bye-laws. The current systematic inspec5 to 20 years, is almost as great, and in each of the three tions were also carried out during the year, and the dairies age-periods of adult life the rates of mortality are more than and milkshops were placed under supervision. The annual twice as high in the general service class as in the prodeath-rate for 188G was 15 per 1000. Six deaths occurred fessional and independent class. The rates of mortality from various causes of death show from typhoid fever, the disease originating in an encampfully as wide differences as do the death-rates at different ment of people travelling in vans. Coventry Urban District.-Owsng to the prevalence of ages. For instance, mortality from measles is nearly ten times as great in the general service class as in the pro- measles in the city, and its extension on such a rapid scale fessional and independent class; from whooping-cough, that hospital isolation could not check it, the closing of more than four times as great ; from scarlet fever, more elementary schools became a necessity. Dr. Fenton exthan twice as great; from diarrhoea., nearly three times as plains that this step involved to the school managers great; from typhus, nearly five times as great; from and teachers a loss of 110, and hence that it is a phthisiq, more than four times as great; from lung diseases, serious one to adopt. It has generally been assumed more than three times as great; from convulsions, nearly that any loss of grant accruing from actual closure of thirteen times as great; and from violence, more than five schools would be made good if the closure were effected times as great in the general service class as in the pro- under the regulations of the education code; and it is certain that this should be so, otherwise a great hindrance fessional and independent class. In concluding his analysis and discussion of Dr. Grim- is placed in the way of checking the spread of disease. In shaw’s figures, Mr. Humphreys urges the necessity for eight weeks ending with the second week of October, 570 further investigation in the same direction, and expresses fresh attacks took place, the schools being open. School the hope that medical officers of health and others may follow closure was then resorted to, and the new attacks fell in Dr. Grimshaw’slead and improve upon his statistics. three weeks from 76 to 10. They were then reopened,.
I
Public Health
and
Poor Law.