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district. It would form a sound basis of local statistical knowledge to start with, and by pursuing the same course with regard to the registration and pauper returns, the more important of which might be obtained weekly, the health officer would be in a position at all times to inform the sanitary authority concerning the prevalence of infectious and preventable diseases, and advise as to what steps should be taken. But as the death-rate gives no sufficient indication of the sick-rate, he should also put himself in communication with poor-law medical officers, relieving officers, the medical officers of public institutions, and, as far as possible without making himself officious, with the other medical men in the district.
In order to obtain weekly returns of the births, deaths, etc., application should be made by the sanitary authority to the Registrar-General, and with his consent the district registrar would fill in the returns, and forward them to the health officer every Monday, the sanitary authority remunerating him for his trouble, and providing him with blank forms. According to Mr. Dyke, the cost of these weekly returns for Merthyr Tydfil does not exceed £8 annually, although the population amounts to 50,000, and the average numbers of births and deaths per annum to 2000 and 1400 respectively. The following is a copy of the form used:
Form of Weekly Return to be made by Subdistrict Registrars.
District of Merthyr Tydfil. Subdistrict of
of Number of Births and Deaths during the week ending Saturday, 18-. Births Legitimate, M., F., ; total,
; Illegitimate, M., —, Deaths: Male, —, Female, —,
(The Medical Officer will be glad to have this return every Monday.)
Particulars of Deaths registered in the week: Register No. ; when died; residence; names; sex; age; occupation; causes of death (1, 2); duration of diseases (1, 2); certified or not, or inquest.
By means of the information supplied by weekly returns of this description, the health officer would be enabled to tabulate all the mortality statistics in such a manner as would show the connection between the death-rate and the sanitary or unsanitary conditions of various parts of his district, the prevalency of any particular diseases in certain areas, and so on. "My habit," says Mr. Dyke in the paper already referred to, "has been to set down under each division of the district the details of the mortality of each week; thus, week ending male or female, cause of death, age at death. Summing up these each quarter, I obtain the numbers of males and females, the numbers under and over five years, the causes of death, and the total of years lived by the whole number. This total, divided by the whole number, yields the average age at death. From this district ledger (as it were) I post all cases into the several headings of the general mortality table, placing opposite the name of each disease, under one of the several ages, the score of the particular death of the male or female. The sum of the deaths from each cause, the sums of the deaths from each class of disease, and the total of deaths, would be brought out in the columns on the extreme right; while the base-line of each column would show the mortality at each age."
Other statistics as regards the number of marriages, and the number of children successfully vaccinated, might also be obtained from the district registrar every
quarter; and, as already stated, the half-yearly abstracts of the boards of guardians would be especially valuable in judging of the general prosperity or otherwise of the community, as influenced by the rate of wages and the price of food.
In drawing conclusions from statistical data, great care must be taken to guard against fallacies. For example, the death-rate of the whole of a district may be comparatively low by reason of the preponderance of adult or selected lives, while the sanitary conditions are far from satisfactory; or, again, the total death-rate may still not be above the average, while the death-rate in certain portions of the district may be excessively high. Generally speaking, the effects of sanitary improvements and precautionary measures are best indicated by a lowered death-rate amongst persons of all ages, from infectious diseases, diarrhoea, and phthisis, and, amongst children under five years of age, from all causes. Indeed, it may be said that the death-rate of children under five years of age is in many places a far more reliable criterion of the sanitary conditions affecting the health of a community than the total average mortality-rate, even although every allowance is made for neglect, maltreatment, deficiency of food, and exposure. Nor, again, in drawing conclusions from mortality returns, must the influence of social causes of disease be forgotten, for the effects of intemperance, immorality, and injudicious marriages, especially amongst the lower classes in all our large towns, can scarcely be over-estimated. (See Chapter I.) Thus, Drs. Parkes and Sanderson, in their reports on the sanitary condition of Liverpool, after describing numerous instances that came under their own obser
vation, write" It is not surprising that our informants, who, as we stated, have the fullest information on the habits of the people, say decidedly 'that drink and immorality are the two great causes of the mortality.'”
But without entering farther into this part of the subject, which admits of endless digression, the following statistical data will serve, more or less fully, to illustrate the previous remarks. They are given in the reports on the sanitary condition of Liverpool just referred to reports, by the way, which should be carefully perused by every newly-appointed health officer of an urban district:-The mean annual mortality of Liverpool during the decennium 1861-1870 calculated upon the mean annual population (1861-1871) was 38.59 per 1000 inhabitants. In 1865 it was 44:0 per 1000 when an epidemic of typhus prevailed, and in 1866 it rose as high as 50-7 per 1000 during the cholera epidemic. The ordinary annual mortality in years not marked by any epidemic was about 35 per 1000 inhabitants. In the same ten years the mean annual mortality per 1000 of population, calculated on the mean annual population, was as follows in the undermentioned seaport and manufacturing towns:—
Exclusive of the dangers arising from imported infectious diseases, to which Liverpool is undoubtedly exposed, and by which the population in certain years has greatly suffered, it became apparent that the exces
sive mortality over other large towns was due to local
TABLE showing the total Mortality of both Sexes, and of
The comparative mortality amongst children in the
5 die annually in Rodney Street;
found that " only
Street; 40, in Sawney Pope Street; 30, in Adlington;