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8
And now, on reviewing this table, the first question that will no
doubt suggest itself to your minds is this: "Can you show that the
result of twenty years' sanitary work has proved in any way a
means of reducing our death-rate ?" Or, to put the question in
another and perhaps more practical form, "Can you show as the
result of our spending money on drains, and sewers, and sanitary
inspectors, that our chances of living are greater, and our chances
of dying less in 1876, than they were in 1856 ?" A very fair
question surely ! Well, judging by the death-rate, and by the deathrate
only, I am compelled to admit that the results of twenty years'
thought and work are rather discouraging, and appear at first sight
anything but satisfactory. In 1856 we had a death-rate of 18.9 per
1000; in 1875 we had a death-rate of 19.02 per 1000. Further, it
is a remarkable circumstance that within the past twenty years the
smallest death-rate occurred in 1857—that is, one year after the
appointment of a health officer, and at the very threshold of
sanitary work. Do not suppose, however, this state of things is
peculiar to Islington. On the contrary, it differs but little from
what is recorded of London generally; 22.0 per 1000 was the deathrate
of London in 1856, and the death-rate for 1875 is not less than
22.0, but rather more.
Infant mortality, again, is much about the same as it was
twenty years ago. Certainly in this there are slight signs of
improvement of late years, but as certainly, this improvement is not
sufficiently great to allow us to boast of what we have effected by
our work. We may trust it is the harbinger of better things. In
this matter we should be thankful for small mercies. The cloud,
the size merely of a man's hand, betokened an abundance of rain.
Phthisis is nearly as fatal now as in 1856. This year, in
Islington, I record with pleasure the fact, that the percentage
number of deaths from consumption is lower than it has ever been.
This is satisfactory. Whilst, however, I would claim the full influence
of improved sanitary measures, I cannot forget that probably this
improvement may be in the main due to our increased facilities of
diagnosing the disease in the earlier stages, our more perfect
knowledge of the pathology of tubercle, and also in the fact that
patients and their friends are more alive now, than formerly, to the
necessity of early treatment, and of constant watchfulness and
attention.