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INFANTILE MORTALITY IN ISLINGTON.

Meteoroiogioal Conditions.THE almost unprecedented persistence of fine weather and

high temperature during the present Coronation year, thatcontributed so much to the success of festivities of all kindsand the enjoyment of all classes, has had, as was to be

expected, another aspect in the serious increase of infantilemortality in London. Laertes tells us that "the canker

galls the infants of the spring," but it is the infants of thesummer that die off most quickly. From the last week inJune until the middle of September the shade temperature,as recorded in THE LANCET office, reached 700 F. or more onevery day but three ; temperatures in the "eighties" werevery frequently recorded, and five times in July and Augustthe shade maximum exceeded 900. In the previous

Report of Medical Ot1ioe’l’ of Health.Mr. A. E. Harris, whose report for the year 1910 as medical

officer of health of Islington we dealt with in our issue ofNov. 18th, p. 1423, has addressed a special report to hishealth committee on this matter, which we trust will be takenseriously into consideration by the whole council. He pointsout that actually more than one-fifth of the infants born in theborough within the year have died-viz., 407 out of 1989-thechief causes being diarrhoea, dysentery, and enteritis, generallyof the epidemic form. In the sub-districts of Lower Hollowayand Barnsbury the infantile mortality rate was as high as268 and 297 per 1000 respectively. If the breeder of horses,cattle, or sheep were to lose 20 per cent. of his foals, calves,or lambs, a commission of inquiry would be instituted by theBoard of Agriculture to examine into the causes of such adisaster, and when these had been found the application ofa remedy would be insisted on. With regard to the deaths

FIG. 2.

Laboratory for Plant Physiology, third floor, University of Manchester.

year a shade maximum of 700 to 770 was only reachedabout 20 times from the middle of July to theend of September. The effect of the great eleva-tion of temperature has naturally been seen in a riseof the diarrhoeal death-rate in children under two yearsold during the third quarter of the year; the deaths inLondon from this cause, which numbered 58, 239, and 342in the months of July, August, and September, 1910, rose to276, 2666, and 1369 in the same three months of the presentyear ; these last figures correspond to an (annual) infectiousdisease death-rate of 1 3, 6 - 6, and 4-4 per 1000 for thesethree months severally, the diarrhceal deaths constituting byfar the largest proportion of the total deaths from infectiousdiseases. The boroughs that have been most affected havebeen Poplar and Bethnal Green, which had infectious diseasedeath-rates of 11-9 and 11- 8 respectively in August.

of infants, advice is tendered by the Local GovernmentBoard, but, as Mr. Harris says, no authority insists that itshould be taken.As to the causation, this is pretty generally known. A

special inquiry was made as to the feeding of the 201 infantswho died under one year. Only 19 were breast-fed ; that is,182, or 90 per cent., were hand-fed, a circumstance whichthrows a ghastly light on the cause of the mortality. Now,investigations that have been made in several towns-e.g.,Derby-show that, speaking generally, from 60 to 80 percent. of the infants born are breast-fed, so that it is

only from 20 to 40 per cent. of the mothers that require to beinduced to suckle their children ; in Islington Mr. Harrisestimates that the proportion is not more than 30 per cent. ;these are the people to be got hold of and instructed. He

believes that they are mostly in good health and capable of

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nursing their infants ; from irquiries made it appeared thatof the mothers of the infants that peri&hed, 63 per cent. werein robust health and 14 per cent. moderately strong, so that77 per cent. might have nursed their infants, if they hadwished, unless obliged to go out to work ; only 45, how-ever, of the 201 mothers had any occupation away from theirown houses.The excessive infant mortality this year has been in

marked contrast with the healthiness of the third quarterof last year, when the rate in Islington was only 67 per 1000births. This was on account of the very moderate tempera-ture, the comparative freedom from dust, and the absence offlies that marked the summer of 1910. In 1911 the conditionshave been very different ; the mean temperature was 5’ 1° andthe highest daily temperature 7’ 9° above the decennial mean ;the rainfall was 3’ 42 inches below the mean, and the registeredsunshine 284 hours in excess. This last element, however,in the meteorological conditions Mr. Harris calls " thesaving factor of the quarter," as it doubtless destroyedmuch bacterial life. To complain of unprecedented heat ina report which also contains praise of excessive sunshine is,of course, only an apparent contradiction, for while sunshinehas heat for one of its results, it has other effects, and thegermicidal quality must be sought in these, not in the heat.

The Remedy Proposed.The remedy advocated by the medical officer, by which

this excessive infant mortality may be checked, is the

employment of health visitors ; there is now a large body oftestimony as to the value of their work from several points ofview. Mr. Harris earnestly recommends that at least threeshould be appointed to deal with infant sickness and toassist in other directions on points of personal hygiene.We regret to learn that the health committee of the

borough council has not taken its medical officer’s advice,though it was so far impressed by the statistics furnished,and the facts laid before it, as to instruct him to prepare amemorandum on the dangers of artificial infant feeding andon the extreme importance of breast feeding, this memo-randum to be forwarded to the mother of every newly bornchild. This is better than nothing, but we do not considerit as in any way a satisfactory substitute for the first-handinstruction and personal influence of the health officer.

BRITISH MEDICAL ASSOCIATION:SPECIAL MEETING OF REPRESENTATIVES.

. A SPECIAL meeting of the Representative Body of theBritish Medical Association was held on Thursday, Nov. 23rd,and Friday, Nov. 24th, in London at the Connaught Rooms,to consider the report of the Council on the NationalInsurance Bill as amended in Committee of the House ofCommons, and to discuss the future action of the Associa-tion during the last stages of the Bill and thereafter.The meeting of the Representative Body was not open to

the press, and we are much indebted to the executive of theAssociation for courteous permission to publish the followingaccount of what took place at this important meeting fromthe pen of one of our editorial staff to whom admission was

granted.The representatives sat from 10 A. until 8 P M. on

Thursday, and from 9.30 A M. until 5 P.M. on Friday, andevery point received the closest attention of all present. Itwas generally recognised that the decisions arrived at duringthis meeting would have the most far-reaching consequence tothe medical profession, and the gravity of the position wasobviously plain to an assembly imbued with a sense of theimportance of the occasion and conversant with the detailsof the measure under discussion.

PROCEEDINGS IN COMMITTEHI.

Shortly after the disposal of the more formal items on theagenda paper on Thursday morning the meeting resolveditself into committee, and the deputy chairman of represen-tative meetings, Dr. R. C. Buist, was called to the chair inorder that the chairman, Dr. E. J. Maclean, might be freeto speak and to move official resolutions. Dr. Buist provedhimself to be an admirable chairman in circumstancesrequiring a high degree of tact, discernment, and know-ledge.

It was well known beforehand that a number of representa-tives, particularly those from the northern counties, had

been instructed by their divisions to advocate the rejection ofthe Bill in its present form by the medical profession, and toadvise the immediate cessation of all further negotiations bythe Council of the Association. This attitude was reflectedin many speeches and proposed amendments. But the

general sense of the meeting-largely guided by temperate-counsels from the leaders of the Association-was againstpremature and violent action. It was pointed out that

everything was to be lost and nothing to be gained by utilis-ing the " strike weapon " at the present moment, whilst theBill is still under consideration by Parliament, and before theprofession has tried its utmost to shape it into a satisfactoryform.Although there was this wide difference of opinion upon

the action that should be taken by the Association, it wasquite obvious that all the representatives were agreed thatthe Bill in its present form was entirely unsatisfactory to themedical profession. From the beginning of the meeting dis-cussion centred itself around the difficult question of imme-diate action: whether the profession should refuse service-under the Bill forthwith, or whether the Association shouldcontinue its efforts to amend the Bill up to the last moment.The business on Thursday included the reception of the

Council’s report to the divisions upon the position of the pro-fession under the amended Bill. The report of the actjomtaken by the Council since the annual representative meetingin July at Birmingham was also considered, and importantcorrespondence with the Chancellor of the Exchequer arisingout of this report was read.

CORRESPONDENCE WITH THE CHANCELLOR.In reply to representations of the Association that the

recent increase in size of the Local Insurance Committees,without provision for any corresponding increase in thenumber of medical members of such committees, was pre-judicial to a friendly reception of the National Insurance Billby the medical profession, the Chancellor stated that underthe Bill the Commissioners have full power to nominate alarger number of medical men where circumstances renderit expedient. He further stated that in the case of thelarge committees it was intended to exceed the number whichthe Bill at present obliged the Commissioners to appoint.The Chancellor considered that the Bill provided for medicalrepresentation on the Auxiliary Committees, and stated thatthe powers given would be used.The Chancellor promised to amend the Bill in such a way

as to facilitate the supply by medical men of medicinesand aDDliances.

It having been represented to the Chancellor that combina-tions might be made under the Bill whereby medical menmight be employed at a lower rate than that locally paid byan Insurance Committee to practitioners on the local panel,the Chancellor considered that the temptation for makingsuch combinations did not exist under the Bill, inasmuch asany saving effected out of the apportioned moneys would becredited to the Insurance Committees and not to suchcombinations.To a submission from the Association that provision should

be made for compensation to medical practitioners who maybe proved to incur loss in the value of their practices throughthe operation of the Bill the Chancellor made no reply.

Mr. Lloyd George said that he would propose an amend-ment to secure that in each case at least one InsuranceCommissioner for Scotland, Ireland, and Wales should be amedical man, as is provided in the case of the EnglishCommissioners.

In the leading article on the National Insurance Bill in thelast issue of TiiE LANCET it was assumed that the proceed-ings of the Representative Meeting would be arduous, pro-tracted, and important. This forecast was fully justified. Itwas based as much upon the direct indications which hadreached us of the feelings and intentions of the varioussections of the profession as upon our knowledge of theCouncil’s report and of the recommendations which it pro-posed to lay before the Representative Body. For the greaterpart of both Thursday and Friday the Representative Meetirgremained in committee. The committee stage concluded onFriday at luncheon-time, and the Representative Meetingthen resumed and adopted in quick succession variousimportant resolutions which had been passed by the membersin committee.

THE RESOLUTIONS ADOPTED.These resolutions, among other points, reaffirmed the

Association’s insistence upon the six cardinal principles of