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George, Bloomsbury, having been slightly in excess. The death-rate for
the whole district was consequently less, by 2.8 per 1000, than the average
of the ten years, and lower than for any year of which I have a record;
the year 1858 approaching it the nearest, when the death-rate was 25.8.
This is the more remarkable in the presence of a severe epidemic of
Small pox.

* Correction has been made for the extra length of the registration years 1863 & 1868, and for the
proportion of deaths due to each sub-district among the deaths in the Workhouse and in Hospitals outside
the respective sub-districts.
The Mortality among Infants.
41. The reiteration of the fact, year after year, of the excessive mortality
among infants in this district, fulfils but imperfectly the duties of a
Medical Officer of Health, and almost forces upon him the consideration of
the causes of that mortality. These are various; but the chief of them
may be ranged under four heads.
Causes of Infant Mortality. 42. First—Degeneracy of constitution at
birth, arising either from natural parental defects, or from syphilis. 2nd—
Zymotic diseases. 3rd—Mal-nutrition, from " want of breast-milk," or
from insufficient or improper food. 4th—Neglect or violence. 5th—
Pulmonary affections.
43. The first, second and third causes come immediately within the
sphere of duty of the Medical Officer of Health, who is empowered to
advise your Board concerning them, and to deal with them under various
Acts of Parliament. The fourth cause is less subject to his intervention, and
the events are usually registered, as " suffocated in bed," " suffocated in the
mother's arms," " convulsions or they become the subject of legal inquiry
Syphilis. 44. With reference to the first cause, and, more particularly,
syphilitic poisoning, it is certain that a large amount of infantine mortality
is caused by it, notwithstanding the fact that only a small comparative
number of deaths (7) among children is registered this year under that head.
One reason of this is that medical practitioners do not like to write such
a designation on the face of a certificate that is put into the hands of parents
for transmission to the Registrar. This disinclination operates in other
cases, as well as in syphilis, and should be obviated under a good system
of registration.
Zymotic Diseases. 45. Secondly—Zymotic diseases carried off 94
children under one year of age. Each form of these diseases having been
already adverted to, specially, in another part of this Report, the only one
that requires notice now is diarrhoea; this affection having caused a large
number of the infant deaths. As nearly the whole of these deaths occurred
in the months of July, August, and September, it is obvious that the temperature,
and other associated atmospheric conditions, had an important
influence in producing them. This high temperature, however, operates less
prejudicially in the open air than in the close and vitiated atmosphere of the
dwelling-houses.