- Email: [email protected]
The infantile mortality in Calcutta
PUBLIC HEALTH.
1908.
DISCUSSION. SIR SHIRLEY MURPHY (Chairman) said that they were very much indebted to Dr. Fremantle for having dealt with a very attractive subject in a very attractive manner. He had raised many points, but," unfortunately, there was not much time left to deal with them. Ma. G. MOSTAQUE }IaaalS (County Councils Association) criticised the Housing Bill. He considered that it would be a very great advantage if County Councils had greater powers in regard to sanitary administration. MISS CHURTO~ considered that the crux of the whole question was the sanitary administration in the country, which seemed to have been entirely overlooked in the Housing Bill. DR. WM. BUTLER said that there was no doubt that it was due to defective sanitary administratiou in this country that towns grew up in a haphazard way ; but he thought that they had too much to consider before arriving at conclusions as to any detailed method of reform of the sanitary service. D~. F. J. BUItMAN urged the necessity of security of tenure for medical officers of health in small districts, as at present they were at the mercy of persons who chose to put np for the local council. DR. HEaBEt~T JONES criticised the figures quoted by Dr. Fremantle in regard to suggested houses at Chipperfield, and pointed out that it demonstrated the fallacy of dealing with small areas. DR. FRE~A~TLE briefly replied, and formerly moved the suspension of the bye-laws, with a view to the consideration of the following motions : - 1. T h a t t h i s Society, h a v i n g considered t h e " H o u s i n g , T o w n - P l a n n i n g , etc., Bill," is of opinion t h a t no f u r t h e r h o u s i n g m e a s u r e s are likely to be effective u n t i l steps h a v e been t a k e n to reorganise t h ~ s a n i t a r y service of t h e c o u n t r y , a n d p u t s a n i t a r y officers in a po:dtion, indep e n d e n t of local influence. 2. T h a ~ copies of t h e resolutions be signed wil, h t h e seal of t h e So::iel,y, a n d f o r w a r d e d to t h e P r i m e Minister, t h e P r e s i d e n t of t h e Local G o v e r n m e n t Board, ~nd t h e official h e a d s of I~he o t h e r G o v e r n m e n t d e p a r t m e n t s concerned.
The resolution was seconded by Dr. g. Musgrave Craven, but was not carried unanimously, and Dr. Fremantle's motions were therefore referred to the Council for consideration. THE
INFANTILE MORTALITY CALCUTTA.
BY FREDERICK
IN
PEARSE, M.D., F.R.C.S., (Eng.), D.P.H., Health Officer, Calcutta.
URING the year 1907 no less than 6,754 d e a t h s of i n f a n t s w e r e r e g i s t e r e d in Calcutta. T h e n u m b e r of b i r t h s r e g i s t e r e d a m o u n t e d to 16,224, so t h a t a s s m n i n g this n u m b e r to b e correct, the d e a t h - r a t e of infants was 2 9 3 p e r 1,000. T h e r e is some d o u b t w h e t h e r all the b i r t h s are r e g i s t e r e d as the b i r t h - r a t e Calculated on t h e f e m a l e p o p u l a t i o n b e t w e e n the ages of fifteen a n d forty-five y e a r s is only 107"9 p e r 1,000. T h i s is low, b u t e v e n if we a s s u m e a b i r t h - r a t e of 150 p e r 1,000 females, a g e d fifteen to forty-five, the m o r t a l i t y of i n f a n t s w o r k s out at 238 p e r 1,000.
D
147
Still-births (1,243) are not i n c l u d e d in the above figures, b u t they c o n s t i t u t e a b o u t 76 p e r 1,000 on the mm~ber of r e g i s t e r e d births. T h e f o l l o w i n g table, g i v i n g the n u m b e r s o f deaths u n d e r the several classes will explai~ the p e c u l i a r incidence of diseases in this city. INF~NTILE DEATHS.--(?alc~tta, 1907. Total.
[Til(lel'l llloaLh. Ul) to 1 3,ear.
Smallpox ... 10 Measles ... 2 Fever . . . . . . 27 Malaria ... 5 Diarrhoea . . . . . . 24 Enteritis ...... 24 Cholera . . . . . . -Dysentery ... 10 P r e m a t u r e Births 524 Debility at, o r ) 683 fi'om b i r t h ] MarasmusNegleet,&c. 5 Bronchitis ... 334 Pneumonia ... 2 TllberenIosis t (all forms) ~ "'" 4 Tetanus and } ConvaIsions ... 955 69 I n f a n t i l e L i v e r ... 4 Syphilis . . . . . . 97 All o t h e r causes ... 2759
... ... .. .. .. .. .. .. ..
173 15 100 19 92 92 39 64
IS3 17 127 24 116
7
(~90
28 953 80
33 f 287 82
"" .'.. ... ...
116 39 74 524
...
... ...
73
... ... ...
179 12 66 1995
... 1028 ... ... ...
228 16 163 4754
So that 29 per cent. of children born (registered births) die before r e a c h i n g 12 m o n t h s of age, a n d 17 p e r cent. die b e f o r e a t t a i n i n g e v e n the a g e of one m o n t h . T h e f o l l o w i n g c o m p a r i s o n m a y b e interesting. Iniantile Deaths, England and Calcutta, 19{)[. Wales, ]90L
I n f e c t i o u s Diseases ... Diarrhoea Diseases ... Convulsions and Tetanus P u h n o n a r y Diseases ... Prematm'ity and ~ W a s t i n g Diseases ) "" All o t h e r causes . . . . . .
21"63 21"26 63'36 84'38 76"86
9"82 31"87 13"65 23"25 45'79
25'53
20"95
P e r 1000 r e g i s t e r e d b i r t h s 293"02
145"33
So far as this table affords o p p o r t u n i t y for c o m p a r i s o n it shows t h a t while diarrh(x~al diseases c a r r y off m a n y m o r e i n f a n t s in E n g land, t h a n in Calcutta, the opposite is the case w i t h r e g a r d to p u l m o n a r y diseases. C o n w d sions a n d p a r t i c u l a r l y T e t m m s kill of'f a l a r g e p r o p o r t i o n of infants in Calcutta. T e t a n n s is p r o b a b l y e x p l a i n e d b y the c u s t o m of r l f b b i n g d i r t y e a r t h into the navel. Careless e x p o s u r e explains the large incidence of p u l m o n a r y diseases. T h e l a r g e n u m b e r s of still-births a n d p r e m a t u r e b i r t h s and deaths from cong e n i t a l debility, show the i n h e r e n t weakness of the g r e a t m a s s of t h e p o p u l a t i o n .
1908.
DISCUSSION. SIR SHIRLEY MURPHY (Chairman) said that they were very much indebted to Dr. Fremantle for having dealt with a very attractive subject in a very attractive manner. He had raised many points, but," unfortunately, there was not much time left to deal with them. Ma. G. MOSTAQUE }IaaalS (County Councils Association) criticised the Housing Bill. He considered that it would be a very great advantage if County Councils had greater powers in regard to sanitary administration. MISS CHURTO~ considered that the crux of the whole question was the sanitary administration in the country, which seemed to have been entirely overlooked in the Housing Bill. DR. WM. BUTLER said that there was no doubt that it was due to defective sanitary administratiou in this country that towns grew up in a haphazard way ; but he thought that they had too much to consider before arriving at conclusions as to any detailed method of reform of the sanitary service. D~. F. J. BUItMAN urged the necessity of security of tenure for medical officers of health in small districts, as at present they were at the mercy of persons who chose to put np for the local council. DR. HEaBEt~T JONES criticised the figures quoted by Dr. Fremantle in regard to suggested houses at Chipperfield, and pointed out that it demonstrated the fallacy of dealing with small areas. DR. FRE~A~TLE briefly replied, and formerly moved the suspension of the bye-laws, with a view to the consideration of the following motions : - 1. T h a t t h i s Society, h a v i n g considered t h e " H o u s i n g , T o w n - P l a n n i n g , etc., Bill," is of opinion t h a t no f u r t h e r h o u s i n g m e a s u r e s are likely to be effective u n t i l steps h a v e been t a k e n to reorganise t h ~ s a n i t a r y service of t h e c o u n t r y , a n d p u t s a n i t a r y officers in a po:dtion, indep e n d e n t of local influence. 2. T h a ~ copies of t h e resolutions be signed wil, h t h e seal of t h e So::iel,y, a n d f o r w a r d e d to t h e P r i m e Minister, t h e P r e s i d e n t of t h e Local G o v e r n m e n t Board, ~nd t h e official h e a d s of I~he o t h e r G o v e r n m e n t d e p a r t m e n t s concerned.
The resolution was seconded by Dr. g. Musgrave Craven, but was not carried unanimously, and Dr. Fremantle's motions were therefore referred to the Council for consideration. THE
INFANTILE MORTALITY CALCUTTA.
BY FREDERICK
IN
PEARSE, M.D., F.R.C.S., (Eng.), D.P.H., Health Officer, Calcutta.
URING the year 1907 no less than 6,754 d e a t h s of i n f a n t s w e r e r e g i s t e r e d in Calcutta. T h e n u m b e r of b i r t h s r e g i s t e r e d a m o u n t e d to 16,224, so t h a t a s s m n i n g this n u m b e r to b e correct, the d e a t h - r a t e of infants was 2 9 3 p e r 1,000. T h e r e is some d o u b t w h e t h e r all the b i r t h s are r e g i s t e r e d as the b i r t h - r a t e Calculated on t h e f e m a l e p o p u l a t i o n b e t w e e n the ages of fifteen a n d forty-five y e a r s is only 107"9 p e r 1,000. T h i s is low, b u t e v e n if we a s s u m e a b i r t h - r a t e of 150 p e r 1,000 females, a g e d fifteen to forty-five, the m o r t a l i t y of i n f a n t s w o r k s out at 238 p e r 1,000.
D
147
Still-births (1,243) are not i n c l u d e d in the above figures, b u t they c o n s t i t u t e a b o u t 76 p e r 1,000 on the mm~ber of r e g i s t e r e d births. T h e f o l l o w i n g table, g i v i n g the n u m b e r s o f deaths u n d e r the several classes will explai~ the p e c u l i a r incidence of diseases in this city. INF~NTILE DEATHS.--(?alc~tta, 1907. Total.
[Til(lel'l llloaLh. Ul) to 1 3,ear.
Smallpox ... 10 Measles ... 2 Fever . . . . . . 27 Malaria ... 5 Diarrhoea . . . . . . 24 Enteritis ...... 24 Cholera . . . . . . -Dysentery ... 10 P r e m a t u r e Births 524 Debility at, o r ) 683 fi'om b i r t h ] MarasmusNegleet,&c. 5 Bronchitis ... 334 Pneumonia ... 2 TllberenIosis t (all forms) ~ "'" 4 Tetanus and } ConvaIsions ... 955 69 I n f a n t i l e L i v e r ... 4 Syphilis . . . . . . 97 All o t h e r causes ... 2759
... ... .. .. .. .. .. .. ..
173 15 100 19 92 92 39 64
IS3 17 127 24 116
7
(~90
28 953 80
33 f 287 82
"" .'.. ... ...
116 39 74 524
...
... ...
73
... ... ...
179 12 66 1995
... 1028 ... ... ...
228 16 163 4754
So that 29 per cent. of children born (registered births) die before r e a c h i n g 12 m o n t h s of age, a n d 17 p e r cent. die b e f o r e a t t a i n i n g e v e n the a g e of one m o n t h . T h e f o l l o w i n g c o m p a r i s o n m a y b e interesting. Iniantile Deaths, England and Calcutta, 19{)[. Wales, ]90L
I n f e c t i o u s Diseases ... Diarrhoea Diseases ... Convulsions and Tetanus P u h n o n a r y Diseases ... Prematm'ity and ~ W a s t i n g Diseases ) "" All o t h e r causes . . . . . .
21"63 21"26 63'36 84'38 76"86
9"82 31"87 13"65 23"25 45'79
25'53
20"95
P e r 1000 r e g i s t e r e d b i r t h s 293"02
145"33
So far as this table affords o p p o r t u n i t y for c o m p a r i s o n it shows t h a t while diarrh(x~al diseases c a r r y off m a n y m o r e i n f a n t s in E n g land, t h a n in Calcutta, the opposite is the case w i t h r e g a r d to p u l m o n a r y diseases. C o n w d sions a n d p a r t i c u l a r l y T e t m m s kill of'f a l a r g e p r o p o r t i o n of infants in Calcutta. T e t a n n s is p r o b a b l y e x p l a i n e d b y the c u s t o m of r l f b b i n g d i r t y e a r t h into the navel. Careless e x p o s u r e explains the large incidence of p u l m o n a r y diseases. T h e l a r g e n u m b e r s of still-births a n d p r e m a t u r e b i r t h s and deaths from cong e n i t a l debility, show the i n h e r e n t weakness of the g r e a t m a s s of t h e p o p u l a t i o n .