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to which the marked excess of infant mortality in urban over rural districts are commonly ascribed
and, eliminating those which lie regards as largely common to both, is led to conclude that the urban
excess has little relation to pre-natal conditions, but is due to some factor or factors peculiar to urban
districts, "of which possibly the most important is a polluted state of the atmosphere." In proof of
his thesis, Dr. Brend relies upon the fact that " in most large cities there is a steady rise in the infant
mortality rate as we go from the periphery to the central parts which never receive a wind that has
not passed over a smoke-laden area." He selects as a case in point the London area, which he divides
into (i) a central part, comprising Finsbury, Shoreditch, Bethnal Green, the City, Southwark, Bermondsey,
Stepney and Poplar, the infant mortality in this area in 191+ being 124; (ii) a surrounding
area, in which the rate was 97; and finally (iii) an outlying fringe which, north of the Thames, is
outside the county boundary, with a rate of 74.
In the heart of Dr. Brend's "London area" is the City, where certainly no wind blows that has
not passed over an air-polluting district, yet the rate there in 1911-14 was only 98. Moreover, in the
Council's dwellings on the Boundary-street area, Bethnal Green, the rate is consistently low, but before
the clearance of the area it was altogether excessive. The relatively low rate of infant mortality in
the city is consistent with the conditions indicated by the number of persons per room in tenements,
which at the last census was only 107 on the average, while in the other districts of Dr. Brend's
central area the figure varies from 133 in Poplar to 1G2 in Finsbury.
Dr. Brend, in conclusion, advocates, inter alia, the clearance of slums as a remedy for excessive
urban infant mortality. Practically all the slum areas of London are situated in just the very boroughs
which comprise his central area of maximum atmospheric pollution, and the London figures therefore
are of little value in support of his {hypothesis that atmospheric pollution is " possibly the most
important " factor in the excess of mortality in the central areas of large towns.
The marked decline in infant mortality of recent years has been attributed to the increased
attention given to infant welfare. Examination of the third section ("Deviation from an even rate
of decline") of the accompanying diagram. however, shows that the fluctuations in mortality at ages
0-5 during more than forty years past broadly follow those at ages 35-75. It would appear therefore
that no theory to account for the behaviour of the mortality at the youngest ages can be complete
which fails to explain the correspondence shown to exist at the other extreme of life.
Smallpox.
Infectious Diseases.
No cases of smallpox occurred during 1917. Three suspected cases were under observation,
but proved not to be cases of smallpox. During February to May 1918, an outbreak of smallpox has
occurred in London, comprising 35 cases, and in addition there were 3 cases in East Ham, 4 cases in
Dartford and 1 case in Mitcham. The outbreak originated in a very poor area in the borough of
Stepney frequented by British and foreign sailors. The first case was not recognised as smallpox, and
a crop of 8 cases occurred between the 2nd and 6th March. The unrecognised case was that of a female
child, aged six, who died on the 13th February from "pneumonia" accompanied by a profuse eruption.
The source from which this child was infected has not been traced, but it is surmised that a sailor from
abroad must have visited the house whilst suffering from a modified attack of the disease. There
is no doubt that the prompt vaccination and removal of the contacts to observation shelters during
the period of quarantine were responsible to a very large extent for restricting spread of the disease.
Chicken-pox was made a notifiable disease in London for a period of three months dating from
the 27th March, 1918. During the period under review 87 suspected cases of smallpox were seen by
Dr. Brincker or his assistant, 6 of which proved to bo smallpox.