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some districts, the services of health visitors employed by the sanitary authorities are supplemented
by aid given by local health societies. At the present time, the majority of the local authorities
have arranged that the services of one or more health visitors or female inspectors shall be available
for this purpose. Thus health visitors are included in the staff of the following districts:—
Kensington (2), Hammersmith (1), Finsbury (2), Shoreditch (1), Stepney (1), Poplar (1), Bermondsey
(1), Lambeth (1), Battersea (1), Deptford (1), Westminster (1 unpaid) and part of the time of one
or more female sanitary inspectors is devoted to this work in Paddington, Fulham, Chelsea, St.
Marylebone, Hampstead, St. Pancras, Stoke Newington, Holborn, the City, Bethnal Green, Southward,
Wandsworth, Lewisham, and Woolwich. The recommendation of the medical officer of health of
Islington that three health visitors should be appointed for that borough has not yet been adopted.
The local health societies are evidently doing useful work in districts where they exist. In
Woolwich, Dr. Davies states such service cannot be obtained and the women inspectors are
unable adequately to cope with the work. "Consultative centres," to which mothers can take
their infants for advice, have been instituted in Paddington, Kensington, Fulham, Westminster,
St. Marylebone, Hampstead, St. Pancras, Finsbury, Poplar, and Greenwich. In Battersea, Lambeth
and Woolwich milk depots have been established where specially prepared milk is supplied
for infants who cannot be fed from the breast. In Holborn arrangements have been made with
a dairy company, by which such milk is supplied on the order of the medical officer of health.
Arrangements had formerly existed in Finsbury, by which the sanitary authority supplied milk from
a country farm, but these were discontinued in March, 1909. In Kensington, Fulham, Chelsea, Westminster,
Hampstead, and St. Pancras, necessitous nursing and expectant mothers are able to avail
themselves of the opportunity of obtaining meals at trivial cost, such meals being provided by
philanthropic bodies. Thus in various directions effort is being made in many districts to safeguard
infant life, and it may be anticipated that in the remaining districts the necessity of making similar
effort will soon be recognised by the sanitary authorities.
Many of the annual reports contain information of interest and value in connection with the
prevention of infantile mortality, and the experience of 1909 emphasises the great advantage which
breast-fed children have over those which are wholly or in part artificially fed. Among other matters
which are discussed in a few of the reports, is the effect of employment away from home upon nursing
mothers. Larger figures are necessary for reliable inferences than are as yet available, but inquiry
into 1,030 cases in the northern part of Westminster by Dr. Allan points to advantage in respect
of their health to infants of mothers who have no occupation. Figures published by Dr. Sykes concerning
a smaller number of cases in St. Pancras point in the same direction.
In a report on infant and child mortality recently issued, the medical officer of the Local
Government Board (Dr. Arthur Newsholme) discusses inter alia the possibility that the variations in
infantile mortality, owing to varying environment, may exercise a selective influence on the children
surviving beyond the first year of life. The conclusions arrived at by Mr. G. Udny Yule, who made a
statistical study of the subject, are thus stated by Dr. Newsholme :—"There is little definite evidence
of such selection beyond the second year of life, and after the third year the environmental
influences even of infancy alone appear to preponderate over any possible selective influence."
Principal Epidemic Diseases.
The number of deaths in the Administrative County of London from the principal epidemic
diseases, viz., smallpox, measles, scarlet fever, diphtheria, whooping-cough, typhus, enteric fever,
pyrexia1 and diarrhoea during 1909 (52 weeks) was 6,285, giving an annual death-rate of 130 per 1,000
persons living.
The death-rates in successive periods have been as follows:—

It will be seen from the following table that in the quinquennium 1904-8, London had a
lower death-rate from these diseases than any of the undermentioned English towns, except Bristol,
Bradford, Newcastle-on-Tyne and Leicester, and in 1909 had a lower death-rate than any, except
Leeds, Bristol, Bradford, Newcastle-on-Tyne and Leicester.
1 Origin uncertain. Originally described as simple continued fever.
2 See footnote (2), page 6.