- Email: [email protected]
THE PUBLIC HEALTH.
132 In cases where medical officers draw provisions or fuel from public stores, they will be charged for the same at cost price. 5. The scale of travelling allowances, extra pay, lodging money, and compensation for losses, to be fixed for naval medical officers according to their relative rank with other
THE PUBLIC HEALTH.
Quarterly Report of the Registrar-General for what, in, naval officers. style, is reckoned the spring quarter of the year6. In regard to cabins : to meet the requirements of the which, for the benefit of the uninitiated into the mysteries of service it is necessary that the senior executive officer and the the Registrar-General’s division of the calendar, we may say staff commander, or master, should have the cabins placed includes the three months ending June 30th-possesses that most advantageously for the performance of their special additional the fear of an impending epidemic interest which duties ; with these exceptions, medical officers are to havee lends all information respecting the to accredited cabins according to their relative rank in the service. Cabins commonly health of the will be allotted to assistant-surgeons. general country. 7. Staff surgeons to be placed on the same footing as comIt is undoubtedly true, as the Saturday Review has recently manders with regard to servants. remarked, that the actual approach of disease is the only 8. A staff surgeon to be appointed to all flag ships bearing is recognised as giving sufficient cause for the flag of a commander-in-chief on a foreign station, with an stimulus which attention to sanitary matters; and that " when the public allowance of 5s. a day in addition to his established pay. 9. The periods of retirement by age to be fixed as follows :- health is satisfactory, sanitary reform is naturally [held to be] Surgeons and assistant-surgeons at fifty-five years of age ; staff rather a dull subject, and sanitary reformers run the risk of surgeons at sixty years of age ; inspectors-general and deputy being voted at least equal nuisances with the abuses which inspectors-generals at sixty-five years of age. wish to get removed." The sudden and very significant 10. Assistant-surgeons at home, after completing their time they for examination for the rank of surgeon, may be granted two increase of deaths from cholera in London in the last three to months’ leave of absence on full pay, on condition of their resuming their studies at a medical school or hospital. 11. To place staff surgeons on an equality in rank with surgeons-major in the army, they are to rank with commanders according to date of commission. 12. Staff commanders, secretaries to commanders-in-chief under five years’ service, paymasters of fifteen years’ seniority, and chief engineers of fifteen years’ seniority, who now rank with staff surgeons, to rank with commanders according to date of commission. 13. Officers in command of her Majesty’s ships must, on all occasions, whether on shore or afloat, be considered senior in rank and precedence to officers placed under their command. A ship must always be represented by an executive or combatant officer, after whom all officers are to take precedence according to their relative rank. 14. The pay of naval medical officers to be increased in accordance with the following scale :-
THE official
weeks, from 32 346, and then to 904 in the last week of thethree, will no doubt have prepared people’s minds for a good
dose of sanitary lecturing; and the guardians of the public health may well believe that their directions and warnings are more likely to be heeded now than in ordinary times, when their more powerful arguments of cholera and fever are
wanting. Two thousand two hundred reporting officers, from far and even to the remotest districts of the country, have, according to their usual practice, just communicated to the Registrar-General the approximate results of registration in their several districts during the quarter ending June 30th ; and in forwarding their returns, they are presumed to act up to the following instruction :" If the deaths registered during the quarter have been above or below the average, state whether, in your opinion, the fact is wholly or partially accounted for by sanitary arrangements, by increase or decrease of population, the wea-
near,
ther, small-pox, measles, scarlatina, whooping-cough, fever (including typhus, typhoid, relapsing, infantile fever), cholera, diarrhœa (including bowel complaint), dysentery, bronchitis, or other disease. Also, with regard to increase or decrease of births, you may mention any circumstance to which it may be attributed. Byaverage’ must be understood, not the average of numbers in other quarters of the year, but the average of corresponding quarters in four or five previous years." It is evident, therefore, that if the registrars fulfil their duty, as thus plainly laid down, the Registrar-General’s Quar-
give a complete view of the hygienic conall over England up to the most recent and the value of such an organization, if fully possible date; cannot be over-estimated. developed, The result of the Registrar-General’s analysis of the returns for the whole of England is unsatisfactory, although the birthrate (3 ’644) was a little above the average. But a decidedly unfavourable feature of the present Return is the high death-rate that prevailed in the quarter. The mortality was much higher than it had been in any June quarter of the ten years 1856-65. The coldness of the season, and epidemics of measles and whooping-cough, appear to have exercised a very wide and fatal influence on the public health." One needs almost to see a diagram showing the fluctuations of temperature and of the death-rate, to get a full impression of the effect which sudden climatic changes must of necessity exercise upon bodily health. Mr. Glaisher, in his remarks on terly Return
15. Naval medical officers to be permitted to retire after twenty years’ service on full pay, but the rate of half pay awarded to officers so retiring not to exceed five-tenths of the full pay to which they may be entitled from lengh of service. 16. As a special reward to officers of long and good service, who, owing to the comparatively small numbers of the inspectorial ranks, have not been promoted to any higher position than that of staff surgeon, such officers of the rank of staff surgeon as have served for twenty-five years on full pay, to be allowed the half pay of £1a day, on being compulsorily retired at sixty years of age, or on medical survey. 17. My Lords will consider, and publish hereafter, the manner in which it may be found most advisable to assist naval medical officers in their professional education after examination and admission into the navy. The new scale of pay to come into operation on the 1st January, 1867 ; the other arrangements from this date. By command of their Lordships, T. G. BARING. To all commanders-in-chief, captains, commanders, and commanding officers of her Majesty’s ships and vessels. *
Provided he passes his examination before ten t Or on promotion.
years’
service.
THE Irish Poor-law Commissioners have called upon the East Coast Union Guardians to prepare cholera hospitals, in the event of the epidemic being brought in from Liverpool.
dition of the
should
people
"
the
weather, writes :-
At the beginning of the quarter the weather was cold, the temperature being below the average to the mean amount of 2-4° during the first nine days. The nights were also very cold, the thermometer frequently registering below the freezing "
and rain fell copiously throughout the first two weeks. On the 10th of April a sudden change to heat set in, continuing to the 28th, during which time the weather was unusually
point;
133 fine and very hot for the season, and but little rain descended. On the 29th a cold ungenial period set in, continuing through May to the 1st of June, with only an occasional day of somewhat warmer character. The mean daily deficiency of temperature during this time amounted to 3’1°, and at night the thermometer frequently fell to below 32°. On June 2nd the weather again changed, and became much warmer; and a mean daily excess over the average temperature occurred to the amount of 42° till the 11th. A cold period followed; but on the 21st the temperature again increased considerably, and fine weather followed till the end of the month, the mean daily excess of temperature amounting to nearly 5°. To the end of the quarter there were no choleraic meteorological
cholera is in our midst, to talk of preventive measures, which ought to have been taken long since ; but every day oi respite should be turned to account if thousands of hmnai lives are not again to be sacrificed to shameful neglect. In every one of the eleven registration divisions, with thie solitary exception of the Welsh counties, the death-rate showE rise on the same quarter of last year. In London, small-pox, measles, whooping-cough, bronchitis, and pneumonia became more fatal ; the deaths from cholera and diarrhœa in the quarter were very much below the average. The Registrar-General speaks strongly of the defective working of the Vaccination Act. He has administered it symptoms." ever since it became law, and he unhesitatingly pronounces these the fluctuations, Taking the whole quarter, despite it as "originally ill-conceived ;" the measure, he says, "redoes not differ which from was 530, appreciably temperature the average of ninety-five years. The rainfall also only dif- quires amendment, and the useless, impracticable registration we suggest that before fered seven-tenths of an inch from the average of fifty-one clauses should be struck out." next session the Privy Council officials a,nd the Registraryears. The mortality was at the rate of 2437 deaths per annum to General should consult together and devise such amendments every 1000 persons living, or 2’51 per 1000 above the average as would obviate the evil declared on such undoubted authority of the ten precedent corresponding quarters; and both in to exist ? Surely there can be no objection on the score of country and urban districts an increased ratio of deaths has departmental jealousy to such a sensible course of action ; if occurred. But, as one would expect, the town districts have there is, the public ought to know where the fault lies. The West Midland and the North Western counties, and suffered most, both relatively and absolutely. The health authorities in our great cities and towns are, no Yorkshire, embracing the chief centres of manufacturing indoubt, at this time troubled with many misgivings as to what dustry, with populations grouped in dense masses under cirmay come to pass if cholera should fall upon them as it has cumstances most unfavourable to health, have suffered more now fallen upon the unhappy eastern districts of London. The severely than other parts of the country. Measles, whoopingcontrast of between the death-rate of some the following largest Icough, scarlatina, and typhus find there congenial homes, and towns in the two corresponding June quarters of 1865 and 1866 carry off the children, who are always the most frequent victims to unhealthy conditions. The remaiks of the regisis very significant :— trars of large town districts are much more copious than those of their rural confrères, although we suspect that this arises rather from the fact that the town registrar is engrossed in his duties, whereas the country officer is less observant than he ought to be, than to absence of matters worth noting in the latter case. Weheard the other day of small-pox and fever being rife in a hamlet in the country, but we see no remark thereon from the registrar of the district in his quarterly return. Probably some of the notes are omitted from want of The registrar of Mansfield (Notts) writes :space. and pneumonia have caused many deaths. The No amount of statistical sleight-of-hand can get over suel whole sewage of the town is poured into a rivulet, which is facts as these. When one town is compared with another, ii: almost dry the greater part of the day, the water being diverted to work a water-wheel. The smell is often very bad, is always open to the champion of either place to question the and it is surprising that the town is not visited by a malignant of the on that the the conditions ; justice ground comparison fever." of the two are not alike, and that, therefore, there can be no At Birkenhead " 10 deaths from Asiatic cholera occurred fair basis to reason upon. But in the present case it is hard to understand what can be said on the part of a municipality in the emigrant depot among some German emigrants." In which shows an increased death-rate of nearly seven persons Liverpool " 27 fatal cases of cholera occurred on the river;" in every 1000 of its population in the same period of two con- and 9 more deaths are recorded from that disease in another part of the borough (Mount-pleasant sub-district), where also secutive years. The Registrar-General thus commentson the condition of typhus killed 178 persons out of a total of 908 deaths ; the births registered being 498, or little more than half the deaths these towns :recorded. " When we imd that, exposed to nearly the same temperaFrom Manchester, Mr. John Leigh, M. R. C. S., one of the ablest ture and not very dissimilar atmospheric conditions, the morof the which cited in have been so often registration officers, contributes a third scientific essay " On healthy districts, tality of the reports, was 20 per 1000, it is difficult to come to any other the Causes of the Vitiation of the Atmosphere of Manchester and than that there is still something radically wrong other large Towns," which deserves a more extended notice conclusion in the sanitary administration of the towns of the kingdom. than our present space will allow. We make one extract, The root of the evil has not been reached. Vast numbers of which will be quite enough to show that Mr. Leigh is a close the population, increasing every year, are blighted by causes which science has discovered, and which hygienic regulations observer, not of atmospheric conditions only, but of human might control. Condensation has an extraordinary tendency nature in its least intelligent aspect, and with which it is most to impair the health of the people, and should be met by ex- difficult to deal satisfactorily:traordinary measures. , , Very difficult is the task in a large town where abominaThere is a great deal to be said against the practice of com- tions have grown to a magnitude commensurate with the town paring the salubrity of urban and rural districts, and it is a itself. Private munificence-of which a splendid example has been given to the world-should be directed into this comparison which we should, as a rule, not make the ground lately in every English town. Unfortunately, in many dischannel of any reasoning except in the widest sense of approximation; the very habits of the people are fatal to all efforts at tricts, a standard admissible in of which but it is quite the light improvement. With water at their doors, their houses and ought to be tried for, even with the certainty of falling short persons are inconceivably dirty. With the windows constantly of so ideal a mark. It may seem almost like mockery, now closed, particularly of their sleeping-rooms, the atmosphere of
that
’J
a
May
"Measles
134 and noisome to an extent incomand it is in such districts that, when an it finds its greatest number of victims. In cholera maps, shaded in the ratio of mortality, the blackest tints cover these localities. But pestilence, once established. is not confined to these places-it spreads to better districts, and involves rich and poor in like disaster. All ranks of persons are vitally interested in the sanitary condition of their and upon all it rests as a sacred duty to towns or assist in promoting so great and noble an enterprise."
their
apartments
is
reeking
patible with health ; epidemic breaks out,
the
villages ;
The registrar of Preston writes :" The deaths are above the average. The change of employment consequent upon the resumption of work in the cotton mills, a greater indulgence in the use of intoxicating liquors, owing to the improved circumstances of the industrial classes, and the prevalence of measles and whooping-cough, have doubtless contributed to the great increase of mortality during the past quarter." From Sheffield (Brightside sub-district) we learn that zymotic diseases are very prevalent, and that the mortality among the young and the aged has been very great, arising from diseases of the respiratory organs, caused in a great measure by the very cold weather in the month of May and the early part of June, and the sudden change to extreme heat which took place in the latter part of June. Of 299 deaths, 187 were of children under five years of age. One death from Asiatic cholera and ten from ordinary cholera were recorded in Swansea ; and the registrar of Gower (eastern sub-district) makes the following remark, which we commend to the especial notice of the new President of the Poor-law Board, and to all whom it may concern :’’ There have been four cases of English cholera here during the quarter in one family, three of which were fatal. I did not attend them professionally, and in fact, being poor people, they received no medical attention." The Registrar-General asks, " Is there no board of guardians; no medical officer, in this deplorable district, where in on, family three people, ’being poor,’ received no medical atten tion?" We, in common with everyone who reads this las and most striking illustration of the condition of the poor ii places removed from public scrutiny, pause for a reply.
THE
stretches
as
far north
as
Victoria-park.
This is
essentially
port of London, inhabited by its maritime population. The canals and the basins are full of foul water, and are appa-
connected with the Limehouse-cut, the Hackney-cut, and the river Lea. The East-London Waterworks canal draws its supply from the river at Lea-bridge, where there is a reservoir, and runs for a couple of miles by the side of the Hackneycut down to its other reservoirs north of Bow and near the Lea. The present cholera field derives its waters from these works. It is right to add that the water has hitherto borne a comparison with the other London waters in Dr. Frankland’s analyses. To-day at Poplar the water looks clear, and no, complaints are made of its quality. The Company will, no doubt, take exemplary pains to filter its waters; but it is not easy to guarantee the purity of water drawn from such a river as the Lea, in dangerous proximity to sewers, cuts, and canals. " Whoever will take the trouble to go amongst the people now suffering in crowded dwellings will see the danger of the water-butt: poor women are washing the dirty linen of patients with water drawn from these vessels, which are often found close to the waterclosets. It would be a source of additional safety to London if the tanks and butts were all abolished, and the pipes were filled on the system of constant supply. The time has come for this reform."
rently
The following are the returns of death from cholera and diarrhcea during the past five weeks :-
"The epidemic," observes the Registrar-General, "takes the form of diarrhoea chiefly in young children." Thus in the week ending the 28th of July, 344 of the deaths from diarrhoea were children under five years of age, including 244 infants. Of cholera, 179 children of the same age died; 160 boys and girls of five years and under twenty ; 455 men and women in the prime of life ; and 110 people of ages above
sixty.
The returns of deaths from cholera in the principal towns follows during the week ending July 28th :-
are as
CHOLERA.
THERE is still a halt in the diffusion of the epidemic in this country, beyond the localities in which it had already shown itself at the time of our last report. Additional breathing space is thus afforded to local authorities in districts yet free from the malady for taking precautions against it, or for holding it in check. Still to hesitate is to expose masses of population to a disastrous confusion and unpreparedness, should the epidemic break out upon them, like to that which has paralysed all efforts rightly to combat the disease in East London. There the warnings of twelve months and a significant succession of cases six weeks ago were alike unheeded, and the epidemic has been suffered to break upon the densely packed population with a virulence which has left all hastily contrived efforts to contend against it in the rear. During the week ending July 28th, 904 deaths from cholera and 349 from diarrhma were registered in London. Of these deaths, no less than 811 from cholera and 113 from diarrhoea occurred in East London (including the six districts of Bethnalgreen, Whitechapel, St. George-in-the-East, Stepney, Mile-end Old Town, and Poplar with Bow), amongst about a seventh part of the population of London and on one-fourteenth pari of its area. In Poplar alone 145, and in Bow 188 people died last week, including Dr. Ansell, the meritorious health officer, and Mr. Ceeley, clerk to the Board of Works. "The attack," says the Registrar-General, "extends al along the north side of the Thames, from the river Lea anc the Isle of Dogs to the Tower of London. Limehouse-basir and the Regent’s-canal are the central line of the attack, whiel
Widnes (near Warrington) and Norwich. Two additional cases have also been imported into the port of Shields, one by a London and the other by a Baltic ship. The epidemic is From abroad the news is as follows: clearly more widely spread in France and Belgium than has hitherto been conceived. The Gazette Hebdomadaire de Medecine gives the accompanying return of deaths for Paris from the 17th to the 24th of July, since which date no returns have been published :— Cases
are
reported at Swansea,
Sherborne, Alverstoke, Guildford,
-
.
.
The disease is prevalent among the towns and villages along the whole length of the river Lys. At Dunkerque there has been no death since the 3rd of June. At Amiens the epidemic appears to be rapidly declining. On the 3rd of July, 71 deaths were registered; on the 5th, 31 ; on the 6th. 40 ; and on the 12th the deaths had fallen to 14. At Paimbœuf the disease has broken out seriously. Bordeaux has come within the range of infection, and many deaths are reported. At Anvers the mortality had reached from 40 to 50 daily. The epidemic has also appeared at Rouen, Forges, arrondissement Rochefort (Charente Inférieure). At Marseilles 19 deaths were registered on the 24th of July. Cholera is disappearing from Brussels. The cases have been numerous, and the fatality large. From the 30th of June to the 26th of July, 156 cases and 98 deaths occurred in Hamburg. Returns from Antwerp to the 25th of July show that since.
THE PUBLIC HEALTH.
Quarterly Report of the Registrar-General for what, in, naval officers. style, is reckoned the spring quarter of the year6. In regard to cabins : to meet the requirements of the which, for the benefit of the uninitiated into the mysteries of service it is necessary that the senior executive officer and the the Registrar-General’s division of the calendar, we may say staff commander, or master, should have the cabins placed includes the three months ending June 30th-possesses that most advantageously for the performance of their special additional the fear of an impending epidemic interest which duties ; with these exceptions, medical officers are to havee lends all information respecting the to accredited cabins according to their relative rank in the service. Cabins commonly health of the will be allotted to assistant-surgeons. general country. 7. Staff surgeons to be placed on the same footing as comIt is undoubtedly true, as the Saturday Review has recently manders with regard to servants. remarked, that the actual approach of disease is the only 8. A staff surgeon to be appointed to all flag ships bearing is recognised as giving sufficient cause for the flag of a commander-in-chief on a foreign station, with an stimulus which attention to sanitary matters; and that " when the public allowance of 5s. a day in addition to his established pay. 9. The periods of retirement by age to be fixed as follows :- health is satisfactory, sanitary reform is naturally [held to be] Surgeons and assistant-surgeons at fifty-five years of age ; staff rather a dull subject, and sanitary reformers run the risk of surgeons at sixty years of age ; inspectors-general and deputy being voted at least equal nuisances with the abuses which inspectors-generals at sixty-five years of age. wish to get removed." The sudden and very significant 10. Assistant-surgeons at home, after completing their time they for examination for the rank of surgeon, may be granted two increase of deaths from cholera in London in the last three to months’ leave of absence on full pay, on condition of their resuming their studies at a medical school or hospital. 11. To place staff surgeons on an equality in rank with surgeons-major in the army, they are to rank with commanders according to date of commission. 12. Staff commanders, secretaries to commanders-in-chief under five years’ service, paymasters of fifteen years’ seniority, and chief engineers of fifteen years’ seniority, who now rank with staff surgeons, to rank with commanders according to date of commission. 13. Officers in command of her Majesty’s ships must, on all occasions, whether on shore or afloat, be considered senior in rank and precedence to officers placed under their command. A ship must always be represented by an executive or combatant officer, after whom all officers are to take precedence according to their relative rank. 14. The pay of naval medical officers to be increased in accordance with the following scale :-
THE official
weeks, from 32 346, and then to 904 in the last week of thethree, will no doubt have prepared people’s minds for a good
dose of sanitary lecturing; and the guardians of the public health may well believe that their directions and warnings are more likely to be heeded now than in ordinary times, when their more powerful arguments of cholera and fever are
wanting. Two thousand two hundred reporting officers, from far and even to the remotest districts of the country, have, according to their usual practice, just communicated to the Registrar-General the approximate results of registration in their several districts during the quarter ending June 30th ; and in forwarding their returns, they are presumed to act up to the following instruction :" If the deaths registered during the quarter have been above or below the average, state whether, in your opinion, the fact is wholly or partially accounted for by sanitary arrangements, by increase or decrease of population, the wea-
near,
ther, small-pox, measles, scarlatina, whooping-cough, fever (including typhus, typhoid, relapsing, infantile fever), cholera, diarrhœa (including bowel complaint), dysentery, bronchitis, or other disease. Also, with regard to increase or decrease of births, you may mention any circumstance to which it may be attributed. Byaverage’ must be understood, not the average of numbers in other quarters of the year, but the average of corresponding quarters in four or five previous years." It is evident, therefore, that if the registrars fulfil their duty, as thus plainly laid down, the Registrar-General’s Quar-
give a complete view of the hygienic conall over England up to the most recent and the value of such an organization, if fully possible date; cannot be over-estimated. developed, The result of the Registrar-General’s analysis of the returns for the whole of England is unsatisfactory, although the birthrate (3 ’644) was a little above the average. But a decidedly unfavourable feature of the present Return is the high death-rate that prevailed in the quarter. The mortality was much higher than it had been in any June quarter of the ten years 1856-65. The coldness of the season, and epidemics of measles and whooping-cough, appear to have exercised a very wide and fatal influence on the public health." One needs almost to see a diagram showing the fluctuations of temperature and of the death-rate, to get a full impression of the effect which sudden climatic changes must of necessity exercise upon bodily health. Mr. Glaisher, in his remarks on terly Return
15. Naval medical officers to be permitted to retire after twenty years’ service on full pay, but the rate of half pay awarded to officers so retiring not to exceed five-tenths of the full pay to which they may be entitled from lengh of service. 16. As a special reward to officers of long and good service, who, owing to the comparatively small numbers of the inspectorial ranks, have not been promoted to any higher position than that of staff surgeon, such officers of the rank of staff surgeon as have served for twenty-five years on full pay, to be allowed the half pay of £1a day, on being compulsorily retired at sixty years of age, or on medical survey. 17. My Lords will consider, and publish hereafter, the manner in which it may be found most advisable to assist naval medical officers in their professional education after examination and admission into the navy. The new scale of pay to come into operation on the 1st January, 1867 ; the other arrangements from this date. By command of their Lordships, T. G. BARING. To all commanders-in-chief, captains, commanders, and commanding officers of her Majesty’s ships and vessels. *
Provided he passes his examination before ten t Or on promotion.
years’
service.
THE Irish Poor-law Commissioners have called upon the East Coast Union Guardians to prepare cholera hospitals, in the event of the epidemic being brought in from Liverpool.
dition of the
should
people
"
the
weather, writes :-
At the beginning of the quarter the weather was cold, the temperature being below the average to the mean amount of 2-4° during the first nine days. The nights were also very cold, the thermometer frequently registering below the freezing "
and rain fell copiously throughout the first two weeks. On the 10th of April a sudden change to heat set in, continuing to the 28th, during which time the weather was unusually
point;
133 fine and very hot for the season, and but little rain descended. On the 29th a cold ungenial period set in, continuing through May to the 1st of June, with only an occasional day of somewhat warmer character. The mean daily deficiency of temperature during this time amounted to 3’1°, and at night the thermometer frequently fell to below 32°. On June 2nd the weather again changed, and became much warmer; and a mean daily excess over the average temperature occurred to the amount of 42° till the 11th. A cold period followed; but on the 21st the temperature again increased considerably, and fine weather followed till the end of the month, the mean daily excess of temperature amounting to nearly 5°. To the end of the quarter there were no choleraic meteorological
cholera is in our midst, to talk of preventive measures, which ought to have been taken long since ; but every day oi respite should be turned to account if thousands of hmnai lives are not again to be sacrificed to shameful neglect. In every one of the eleven registration divisions, with thie solitary exception of the Welsh counties, the death-rate showE rise on the same quarter of last year. In London, small-pox, measles, whooping-cough, bronchitis, and pneumonia became more fatal ; the deaths from cholera and diarrhœa in the quarter were very much below the average. The Registrar-General speaks strongly of the defective working of the Vaccination Act. He has administered it symptoms." ever since it became law, and he unhesitatingly pronounces these the fluctuations, Taking the whole quarter, despite it as "originally ill-conceived ;" the measure, he says, "redoes not differ which from was 530, appreciably temperature the average of ninety-five years. The rainfall also only dif- quires amendment, and the useless, impracticable registration we suggest that before fered seven-tenths of an inch from the average of fifty-one clauses should be struck out." next session the Privy Council officials a,nd the Registraryears. The mortality was at the rate of 2437 deaths per annum to General should consult together and devise such amendments every 1000 persons living, or 2’51 per 1000 above the average as would obviate the evil declared on such undoubted authority of the ten precedent corresponding quarters; and both in to exist ? Surely there can be no objection on the score of country and urban districts an increased ratio of deaths has departmental jealousy to such a sensible course of action ; if occurred. But, as one would expect, the town districts have there is, the public ought to know where the fault lies. The West Midland and the North Western counties, and suffered most, both relatively and absolutely. The health authorities in our great cities and towns are, no Yorkshire, embracing the chief centres of manufacturing indoubt, at this time troubled with many misgivings as to what dustry, with populations grouped in dense masses under cirmay come to pass if cholera should fall upon them as it has cumstances most unfavourable to health, have suffered more now fallen upon the unhappy eastern districts of London. The severely than other parts of the country. Measles, whoopingcontrast of between the death-rate of some the following largest Icough, scarlatina, and typhus find there congenial homes, and towns in the two corresponding June quarters of 1865 and 1866 carry off the children, who are always the most frequent victims to unhealthy conditions. The remaiks of the regisis very significant :— trars of large town districts are much more copious than those of their rural confrères, although we suspect that this arises rather from the fact that the town registrar is engrossed in his duties, whereas the country officer is less observant than he ought to be, than to absence of matters worth noting in the latter case. Weheard the other day of small-pox and fever being rife in a hamlet in the country, but we see no remark thereon from the registrar of the district in his quarterly return. Probably some of the notes are omitted from want of The registrar of Mansfield (Notts) writes :space. and pneumonia have caused many deaths. The No amount of statistical sleight-of-hand can get over suel whole sewage of the town is poured into a rivulet, which is facts as these. When one town is compared with another, ii: almost dry the greater part of the day, the water being diverted to work a water-wheel. The smell is often very bad, is always open to the champion of either place to question the and it is surprising that the town is not visited by a malignant of the on that the the conditions ; justice ground comparison fever." of the two are not alike, and that, therefore, there can be no At Birkenhead " 10 deaths from Asiatic cholera occurred fair basis to reason upon. But in the present case it is hard to understand what can be said on the part of a municipality in the emigrant depot among some German emigrants." In which shows an increased death-rate of nearly seven persons Liverpool " 27 fatal cases of cholera occurred on the river;" in every 1000 of its population in the same period of two con- and 9 more deaths are recorded from that disease in another part of the borough (Mount-pleasant sub-district), where also secutive years. The Registrar-General thus commentson the condition of typhus killed 178 persons out of a total of 908 deaths ; the births registered being 498, or little more than half the deaths these towns :recorded. " When we imd that, exposed to nearly the same temperaFrom Manchester, Mr. John Leigh, M. R. C. S., one of the ablest ture and not very dissimilar atmospheric conditions, the morof the which cited in have been so often registration officers, contributes a third scientific essay " On healthy districts, tality of the reports, was 20 per 1000, it is difficult to come to any other the Causes of the Vitiation of the Atmosphere of Manchester and than that there is still something radically wrong other large Towns," which deserves a more extended notice conclusion in the sanitary administration of the towns of the kingdom. than our present space will allow. We make one extract, The root of the evil has not been reached. Vast numbers of which will be quite enough to show that Mr. Leigh is a close the population, increasing every year, are blighted by causes which science has discovered, and which hygienic regulations observer, not of atmospheric conditions only, but of human might control. Condensation has an extraordinary tendency nature in its least intelligent aspect, and with which it is most to impair the health of the people, and should be met by ex- difficult to deal satisfactorily:traordinary measures. , , Very difficult is the task in a large town where abominaThere is a great deal to be said against the practice of com- tions have grown to a magnitude commensurate with the town paring the salubrity of urban and rural districts, and it is a itself. Private munificence-of which a splendid example has been given to the world-should be directed into this comparison which we should, as a rule, not make the ground lately in every English town. Unfortunately, in many dischannel of any reasoning except in the widest sense of approximation; the very habits of the people are fatal to all efforts at tricts, a standard admissible in of which but it is quite the light improvement. With water at their doors, their houses and ought to be tried for, even with the certainty of falling short persons are inconceivably dirty. With the windows constantly of so ideal a mark. It may seem almost like mockery, now closed, particularly of their sleeping-rooms, the atmosphere of
that
’J
a
May
"Measles
134 and noisome to an extent incomand it is in such districts that, when an it finds its greatest number of victims. In cholera maps, shaded in the ratio of mortality, the blackest tints cover these localities. But pestilence, once established. is not confined to these places-it spreads to better districts, and involves rich and poor in like disaster. All ranks of persons are vitally interested in the sanitary condition of their and upon all it rests as a sacred duty to towns or assist in promoting so great and noble an enterprise."
their
apartments
is
reeking
patible with health ; epidemic breaks out,
the
villages ;
The registrar of Preston writes :" The deaths are above the average. The change of employment consequent upon the resumption of work in the cotton mills, a greater indulgence in the use of intoxicating liquors, owing to the improved circumstances of the industrial classes, and the prevalence of measles and whooping-cough, have doubtless contributed to the great increase of mortality during the past quarter." From Sheffield (Brightside sub-district) we learn that zymotic diseases are very prevalent, and that the mortality among the young and the aged has been very great, arising from diseases of the respiratory organs, caused in a great measure by the very cold weather in the month of May and the early part of June, and the sudden change to extreme heat which took place in the latter part of June. Of 299 deaths, 187 were of children under five years of age. One death from Asiatic cholera and ten from ordinary cholera were recorded in Swansea ; and the registrar of Gower (eastern sub-district) makes the following remark, which we commend to the especial notice of the new President of the Poor-law Board, and to all whom it may concern :’’ There have been four cases of English cholera here during the quarter in one family, three of which were fatal. I did not attend them professionally, and in fact, being poor people, they received no medical attention." The Registrar-General asks, " Is there no board of guardians; no medical officer, in this deplorable district, where in on, family three people, ’being poor,’ received no medical atten tion?" We, in common with everyone who reads this las and most striking illustration of the condition of the poor ii places removed from public scrutiny, pause for a reply.
THE
stretches
as
far north
as
Victoria-park.
This is
essentially
port of London, inhabited by its maritime population. The canals and the basins are full of foul water, and are appa-
connected with the Limehouse-cut, the Hackney-cut, and the river Lea. The East-London Waterworks canal draws its supply from the river at Lea-bridge, where there is a reservoir, and runs for a couple of miles by the side of the Hackneycut down to its other reservoirs north of Bow and near the Lea. The present cholera field derives its waters from these works. It is right to add that the water has hitherto borne a comparison with the other London waters in Dr. Frankland’s analyses. To-day at Poplar the water looks clear, and no, complaints are made of its quality. The Company will, no doubt, take exemplary pains to filter its waters; but it is not easy to guarantee the purity of water drawn from such a river as the Lea, in dangerous proximity to sewers, cuts, and canals. " Whoever will take the trouble to go amongst the people now suffering in crowded dwellings will see the danger of the water-butt: poor women are washing the dirty linen of patients with water drawn from these vessels, which are often found close to the waterclosets. It would be a source of additional safety to London if the tanks and butts were all abolished, and the pipes were filled on the system of constant supply. The time has come for this reform."
rently
The following are the returns of death from cholera and diarrhcea during the past five weeks :-
"The epidemic," observes the Registrar-General, "takes the form of diarrhoea chiefly in young children." Thus in the week ending the 28th of July, 344 of the deaths from diarrhoea were children under five years of age, including 244 infants. Of cholera, 179 children of the same age died; 160 boys and girls of five years and under twenty ; 455 men and women in the prime of life ; and 110 people of ages above
sixty.
The returns of deaths from cholera in the principal towns follows during the week ending July 28th :-
are as
CHOLERA.
THERE is still a halt in the diffusion of the epidemic in this country, beyond the localities in which it had already shown itself at the time of our last report. Additional breathing space is thus afforded to local authorities in districts yet free from the malady for taking precautions against it, or for holding it in check. Still to hesitate is to expose masses of population to a disastrous confusion and unpreparedness, should the epidemic break out upon them, like to that which has paralysed all efforts rightly to combat the disease in East London. There the warnings of twelve months and a significant succession of cases six weeks ago were alike unheeded, and the epidemic has been suffered to break upon the densely packed population with a virulence which has left all hastily contrived efforts to contend against it in the rear. During the week ending July 28th, 904 deaths from cholera and 349 from diarrhma were registered in London. Of these deaths, no less than 811 from cholera and 113 from diarrhoea occurred in East London (including the six districts of Bethnalgreen, Whitechapel, St. George-in-the-East, Stepney, Mile-end Old Town, and Poplar with Bow), amongst about a seventh part of the population of London and on one-fourteenth pari of its area. In Poplar alone 145, and in Bow 188 people died last week, including Dr. Ansell, the meritorious health officer, and Mr. Ceeley, clerk to the Board of Works. "The attack," says the Registrar-General, "extends al along the north side of the Thames, from the river Lea anc the Isle of Dogs to the Tower of London. Limehouse-basir and the Regent’s-canal are the central line of the attack, whiel
Widnes (near Warrington) and Norwich. Two additional cases have also been imported into the port of Shields, one by a London and the other by a Baltic ship. The epidemic is From abroad the news is as follows: clearly more widely spread in France and Belgium than has hitherto been conceived. The Gazette Hebdomadaire de Medecine gives the accompanying return of deaths for Paris from the 17th to the 24th of July, since which date no returns have been published :— Cases
are
reported at Swansea,
Sherborne, Alverstoke, Guildford,
-
.
.
The disease is prevalent among the towns and villages along the whole length of the river Lys. At Dunkerque there has been no death since the 3rd of June. At Amiens the epidemic appears to be rapidly declining. On the 3rd of July, 71 deaths were registered; on the 5th, 31 ; on the 6th. 40 ; and on the 12th the deaths had fallen to 14. At Paimbœuf the disease has broken out seriously. Bordeaux has come within the range of infection, and many deaths are reported. At Anvers the mortality had reached from 40 to 50 daily. The epidemic has also appeared at Rouen, Forges, arrondissement Rochefort (Charente Inférieure). At Marseilles 19 deaths were registered on the 24th of July. Cholera is disappearing from Brussels. The cases have been numerous, and the fatality large. From the 30th of June to the 26th of July, 156 cases and 98 deaths occurred in Hamburg. Returns from Antwerp to the 25th of July show that since.