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6
the deaths of children under 5 years amounts to 47 per cent.
of the total mortality while in London it amounts to but 41 per
cent., point to an excessive infant mortality. In a district like that
over which you possess sanitary jurisdiction, such a state of things
though deplorable is not to be wondered at. Yours is essentially a
labouring population and therefore subject to vicissitudes to which
their more fortunate brethren are strangers: when work is slack
food is scarce among them and the little ones are the first to feel it—
the mother has to add her mite towards the sustenance of the
family, and this means absence from and neglect of it—again, as the
family grows larger the means of keeping it become smaller. More
economical lodgings are sought and overcrowding becomes inevitable.
Under such circumstances as these, what wonder that children should
sicken and die, or that when infectious disease breaks out among them
that it should spread. This leads me naturally to the consideration
of the subject of compulsory notification of infectious disease. It is
a fact that of the number of cases of Scarlet fever which came to my
knowledge last year about one-third were reported to me as deaths,
that is to say, the disease had time to sow its seeds far and wide
before its existence became known to the Sanitary Authority. To
eradicate infectious disease or even stem its tide under such circumstances
becomes well-nigh impossible; everything depends upon early
notification of every case to the constituted authority; so far as
regards the pauper illness of the district this early notification already
exists with much benefit to the community, but as regards private
illness, generally, the first intimation I receive of its existence is
through the Registrar of Deaths; sometimes, but very rarely do I
receive information from private medical practitioners, and occasionally
when neighbours are frightened I hear of a case from them.
Cases of infectious disease are also met with in the course of our
sanitary inspections; these are the principal sources of my