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A general review of our sanitary state for the year brings into relief two
facts, viz.: 1st., a remarkably small number of deaths from zymotic diseases,
and particularly from scarlet fever, in St. Giles District in comparison
with the Metropolis at large; and 2dly, an epidemic of relapsing fever, which,
although not increasing our last year's mortality, prevailed extensively.
On the Sanitary Condition of the Metropolis.
The population of London for the year 1869 is estimated at 3,170,754.
The total births were 1U,930, the total deaths 77,933 or nearly in the
ratio of 3 to 2. The death-rate per 1000 of population is 24.66, which
is higher than the mean of the last 10 years, viz., 24.25. The males died'at
the rate of 27 in the 1000 ; the females at the rate of 23 in the 1000.
These figures constitute the standard rates to which we refer in making
an estimate of the sanitary state of our own District.
The temperature during the year was very variable, and ran into
unusual extremes. The mean of the three months at the beginning of
the year, called the winter months, was °1.7 above the average; the mean of
the next three, or spring months, was °1.0 below the average ; the mean of
the three summer months was again °1.3 above the average, and the mean of
the three last or autumnal months was 1.7 below the average.
Among zymotic diseases, scarlet fever, whooping-cough and diarrhoea
were the most fatal. Relapsing fever was prevalent throughout the Eastern
districts, St. Giles and various Southern districts.
The death-rate from scarlet fever gradually increased up to the month
of August; doubled in September, and maintained its maximum with
little variation until the end of the year. Whooping-cough was most
fatal in the month of June. The mortality from both diseases was greatest
in those quarters when the mean temperature was below the average of the
period. Diarrhoea was as usual most prevalent in the three summer months,
July, August and September. Relapsing fever began to spread in the month
of October, and continued in full activity to the end of the year. Although
its epidemic extension was synchronous with the maximum severity of
scarlet fever, yet these diseases did not necessarily prevail together in the
same place;—a fact of which St. Giles is an evidence; for, whilst we suffered
unduly from relapsing fever, we had scarcely half of our proportion of scarlet
fever. It would seem therefore that the two epidemics were due to two
different special causes, though promoted by the same meteorological conditions.
In the case of relapsing fever, the special cause was rife and active in St.
Giles; whilst in the case of scarlet fever it was comparatively feeble.
"What these special causes may be it is difficult to determine; the problem,
in fact, as regards these and other zymotic diseases, engages the attention
and stimulates the curiosity of the ablest scientific men of our day.
In reviewing the mortality of London the Registrar General adverts to
the large number of deaths that occur in our public hospitals and infirmaries,
and he asks the question : "How can the advantages of hospital organization
bo enjoyed without visiting on the inmates the evil influences of the
atmosphere of disease in which they are steeped ? The spread of fever is
limited by dispatching patients to fever hospitals. But 518 deaths in a year
in one institution is a startling number."
This is a question which medical officers of health are bound to consider;
and there seems to me to be but one solution of it, viz., the abolition of the
practice of bedding numerous sick persons in one ward; and of placing several
wards under one roof. Cottage hospitals, or the same thing under another
name, would meet the difficulty. "With greater sub-division, a better classi-