We may note that since 1959 a public health department has been established in the privy council. atict.that the medical officer of the privy council, Mr. Simon, has, since that date. published an annual report of the proceedings taken under ilia public health act, 1858. These reports. of which nine have now appeared. are of the highest impor t:I/1-e; and we should not omit to mention that. the progress of sanitary science has been considerahly advanced by the publication of an annual volume (of which seven have now appeared) of statistical, sanitary, and medical army reports, by the establishment of the epidemiological society and the social science congress, and by the publication of their transactions.
It is touch to be regretted that the privy council does not more energetically carry out the powers conferred on them by the diseases prevention act, 1855, and the'ptiblic health act, 1858. Unfortunately, however, it requires some comparatively rare and startling disease, as yellow fever, plague, cholera, or cattle-disease, to stir that august body into activity; while typhus, typhoid, and small-pox may ravage our crowded towns and unclrained villages. and carry off their thousands of victims, unless in very extreme cases, to which the public press may have called attention. (Of the half million deaths that occur annually in England, more than 20,000 aro, due to typhus 211111 typhoid ;* while in England and Scotland, more than 5,000 persons annually fall victims to small pox. f) By the sanitary act, 1860, the Ironic secretary is empowered to interfere, if Le see lit, on complaint tirade to burn of the default of any local authority. It is sincerely to be hoped that he will unsparingly put forth tire power intrusted to him.
Passing from what has, and what has 'not, been done by government, let us consider what arc the duties of local authorities, and how they discharge them. On this subject, Dr. Stewart gives us much inforination in his pamphlet al•eally referred to. To such an extent has non-interference prevailed that, except in London, the appointment of medi cal officers of health, and even of inspectors of uuisances, is optional. Ile ascertained that of 570 places under the local government act, 1858, and the public health act, 1848, with populations varying from 214 to 200,000, 50 Lave no inspectors of nuisances, 153 have each one; while in 347 one man holds the double or treble offices of surveyor, inspector, and colle•tor. In the metropolitan districts, with a pcpulation of al.ove 3,000,000, the sanitary force is most unequally Divided, for; while 2 subdistricts, with a population of 4,000 and 10.000 respectively, have tire services of One inspeCtor, St. 3tiaryleboue and St. Pancras, with respective populations of 163,000 and 211,000, have each of them only two.
A few words on the duties, qualifications, and position of the medical officer of health, will turd a titling place here.$ Iris cloth s and qualifications are thus laid down in an instructional inhade of the general hoard of health, dated Dec. 20,1855r "He will make himself familiar with the genera] features of the place, with its previous sanitary state. Mid \Vitt! its ( provisions for hcalth—viz., the levels, inclinations, soil, wells, and wrocr-springs; with its meteorological peculiarities; with its burial-grounds, slaughter houses, lodging-houses. etc.; Ire will see to the general healthiness of his district, inquire into the elemtly and water-proof condition of houses, examine the drinking-water, and observe whether diseased meat or adulterated articles of food are exposed tor sale; and will report and annually to the local board." These are but a few of Iris duties, for the proper performance of which (as the minute goes on to add) special qualifications in science are required. "There lie in pathology, including vital statistics, in chemistry, and in natural philosop!iy." For these accomplishments, the town of Aberdare offers 84d. a day, or 12 guineas a year, for looking after the health of its 35.000 inhabitants; while Paisley gives £20 for the sanitary superintendence of a population of 48,000. Fifty pounds is a common salary. except in the metropolis; the most liberal salaries are R3:50 at. Pirkenlicad and Hackney, .f400 at St. Marylebone, £500 at. Edinburgh and Leeds, £600 at London (proper), while Liverpool has nohly raised the salary to £1000. Surely £500, £600, and £1000 arc not too much for Edinburgh, London, and Liverpool to pay, hi order to secure the services of such men as Littlejohn, Letheby, and Trench. Dr. Russell, the medical sanitary officer for Glasgow, has £600 a year; and Dr. Gairdner, one of the first of our living hygeists, is retained as consulting officer at £100 a year. Not only is the medical officer's salary dependent on the caprices of tire local board, may dismiss him at pleasure, but, as Dr. Stewart. truly observes, "the very efficiency with which he performs Iris dirties may be an unpardonable sin in the eyes of a majority of his masters. his statements of facts may touch the interests of some, his suggestions of remedies may excite the displeasure of others; and if the soundness of iris position cannot Imassailed by reasoning, passion may suggest—as it has before nqw suggested—a reduction of salary or a threat of dismissal, as likely to bring the offender to his senses." Not only is this disgraceful form of pressure brought to bear directly on the medical officer of health. but indirectly on those who have the power of electing or dismissing him. An anmsing incident of this nature is mentioned in Dr. Sfewart's pemphlet. When Dr. Robinson was appointed officer of health for Leeds, he,found that he had to grapple with unparalleled privy abominations, piggeries by hundreds, numerous slaughter houses, the gigantic smoke-nuisance, and an average death-rate of 30 in 1000. The battle between science and filth was prolonged and terrific, and the piggeries were made the 'battle-field. The pig-owners, taking alarm at Dr. Robinson's energy, formed themselves into it "pig protection society," summoned ward-meetings, and commenced an active canvass, for the purpose of turning out of the council all who would riot pledge them selves to vote for Dr. Robinson's dismissal. The case, after being twice heard before the magistrates, who declared that the•plgs were a nuisance, and must be removed, was finally settled on appeal by the recorder, who gave an order, not for eviction of the pigs, but for the daily removal of the manure, for the due enforcement of which a separate inspector would be required for every pig-styl Under these conditions, is a medical officer of health fairly encouraged to discharge his proper duties? The next points to which ‘ve shall direct attention are the NUMBER OF Dayrns occur ring annually in England and Wales, and the CAUSES OF THESE DEATHS; and we shall then proceed to inquire how far the deaths from some of our most fatal diseases might have been prevented by due attention to sanitary measures. We learn from the twenty
eighth annual report of the registrar-general of births, deaths, and marriages in England, which was published 'in 1867, and gives the results for the year 1865, the following statistical facts, which hear more or less closely on our subject. The population of England, the births, deaths, and excess of births over deaths, are tabulated from the year 1833. when the system of registration came in from this table we extract the numbers for 1833, 184S, 1833, and for 1861-63 inclusive: From these figures, we learn, inter alit, that in a quarter of a century the population has added 5,000,000 to its strengtb, and that there is a steady increase (with occasional excep tions) in the annual number of births and deaths, and in the excess of the former; the num ber of births having increased during that period 46 per cent, and that of deaths 43 per cent. The following is an abstrt Farr's letter to the registrar-general on the causes of death in England in 1865: In every 1000 deaths, 381 of the population fell before local diseases, 235 were struck down by zvmotic diseases, 18:3 by constitutional diseases, 160 by developmental diseases, and 36 died violent deaths; the remaining 6 were deaths from -causes not ascertained. Local diseases—the inflammations and functional diseases of organs—carried o!f 181,877 personS in England, causing 9 of the 23 deathS per 1000 of the living. It is the deaths from diseases of the vital organs that swell this number so high-22.272 deaths fromheart diseases, nearly as many (21,774) from diseases of the digestive organs, more than thrice as many (69,952) from diseases of the respiratory organs so essetitial to life. and a number nearly as large as this last (60,201) fro:n diseases of the nervous system. The number of deaths in England ascribed to bronchitis has rapidly increased: it was but 21,528 in 1856. had advanced to 32,346 in 1860, and in 1801 reached 33,428. Softening of the brain is another disease that has increased rapidly of late years, and in 1835 was fatal to 1351 males and 627 females: these deaths would for. merly have been classed tinder paralysis and other heads. The deaths from diseases of the nervous system include 26,722 from convulsions, occurring chiefly in children. Among the rarer deaths from local diseases, 5 are referred to fright, 3 to grief, and 43 to melancholy. The second most fatal class of diseases—the zymotie (epidemic and c•u tagious)—is swelled chiefly by fevers and by diarrheal disease. It swept front life in England 113,943 persons in 1865, the majority of them young children under 5 years of age. The deaths by cholera in England in 186.5 were 1201; by diarrhea, 23,531. The deaths by fever—typhus, typhia, and typhinia*—which were 13,012 in the year 1860, rose to 23,031 in 1835. and five-tenths of them were registered among four-tenths of the population. The deaths from scarlatina were 17.700, and from diphtheria, 4,145• The deaths attributed to syphilis rose to 1617; 4:37 persons'died from intemperance, and 612 from deliriam tremens; 71 from privation; 19 from hydrophobia; 4 from glanders. for horses alwell as dots communicate some of their diseases to men. Worms are put down -to cause of death in 153 cases, one of which is ascribed to trichina spiralis. The third class of deaths is from ennstitatirmal diseases, diathetic or tubercular, which were fatal to 83.504 persons in 1865. These diseases have this in common with the zymotie, that they are diffusive; and human tuhercle is, even when introduced by inocu lation, capable of inducing tubercular deposits in the organs of animals. The preva lence of phthisis in the armies of Europe is considered to be probably due in part to the Inhalation of exneetcrated tubercular matter, dried, broken up into dust, and fi ontin in Me air of close barracks. Dr. Farr remarks that to test this may be difficult, but the origin and propagation of the most fatal of all human diseases deserves full investiga tion. The inquiry should also extend to cancer and the other constitutional diseases, among which should perhaps be included diabetes. Among the deaths tram constitu tional diseases may be noted gout, as increasing every year. Gout is live times as corn tnon in men as in women, and is very rarely fatal under 35 years of age. To it, 361 deatha were attributed in 18d3. Unlike gout., dropsy is most fatal to women; and the substitution of dropsy in women for gout in mea after the age of 45 is worthy the atten tion of pathologists. Cancer is more than twice as fatal to women as it is to men. The mortality by all constitutional diseases is rather less than it was in the decade 18.50-59; and 11113 is partly due to the decrease of the number of deaths referred to plithisis; still these deaths reached 53,734 in 1805, the greater part of them occurring in adalts: and more than half the deaths of young women between 20 and 25 were caused by ph thisia. • The fourth class of diseases—the developmental—were fatal to 77,806 persons in Englaud in 1865: 8,791 infants born alive died from being premature; and other 22.436 died of debility before they were a year old. Besides 1883 deaths by puerperal fever, and 2.490 ascribed to ehild-birth, 490 women died of specitic diseases complicated by parturition. The deaths by ordinary diseases of the 560,000 eneetate women, constantly existing in the population of England, could not be entirely distinguished front the deaths of other women of the same age; of course they were subject to the saute diseases as others, but probably the class of mothers belongs to what, in it certain sense, the insurance offiges ' call select lives. The list of developmental diseases doses with the deaths of 2a,709 persons from old age, 154 of the men and 402 of the women being of the age of 85 and upward. Thus we reach the last class of deaths—the 17,874 persons who were destroyed by viatent deatha; 15,23a by accident or negligence, 443 under circumstances bringing the case under the, legal denomination of homicide, 1392 by suicide, 6 on the scaffold, and 'the remaining 301 not classed. These are the several ways in which 420.009 persons died in England in 1865.