66 The Public Health. [Jan., 



compared with almost every other city of the empire. With this divided 

 authority it is much to the credit of London that she can claim to 

 be the healthiest city in the United Kingdom. During the last ten 

 years the death-rate has been as low as 23 in the 1,000, whilst 

 during the first four months of this year, 1866, the death-rate was 

 lower than any of the thirteen cities whose death-rate was published 

 weekly by the Registrar-General. The average death-rate of these 

 four months was 25 in the 1,000. Since that time the death-rate 

 of London has been up as high as 35 in the 1,000, but that was 

 during the month of August when the Cholera was raging in the 

 East. Even during that sad month the mortality of Newcastle- 

 upon-Tyne was as high, and that of Liverpool much higher, without 

 any outbreak of Cholera in the former. 



But London is not one city ; it is a congeries of cities. The whole 

 death-rate may be low, but there are spots where it is excessive. 

 Taking as an instance the parish of St. James's, Westminster, we 

 find the death-rate here during the past ten years to have been 20 

 in the 1,000; but on examination it will be found that in one 

 district the death-rate has been as low as 12 in the 1,000, whilst in 

 another it has been as high as 25 in the 1,000. So in many of the 

 parishes of London, when the bills of mortality are low, there are 

 plague-spots which present for a few hundreds or thousands of people 

 a mortality as great as that to be found in any other town through- 

 out the country. 



The health of London has undoubtedly been benefited by 

 the general Act passed in 1855 under the name of the Metro- 

 politan Management Act. This Act gave to the various Local 

 Boards of Works or Vestries the power of electing a central body, 

 the Metropolitan Board of Works, in whom the management, 

 making, and repairing the sewers of London was vested. One of 

 the great acts of this body has been the construction of sewers, by 

 which the whole of the sewage of London is carried several miles 

 beyond its boundaries, and emptied into the river Thames. It is 

 worthy of note that this great work is now nearly completed, and 

 that the only locality not connected with the new Main Drainage 

 Works, is that district in the East End of London which has lately 

 been the seat of the ravages of Cholera. 



Another great good effected by the Metropolitan Management 

 Act was, that it made it compulsory on the Vestries to elect Medical 

 Officers of Health. To these officers was committed the duty of 

 superintending the health of the district to which they were 

 appointed. Under this Act forty-six Medical Officers of Health 

 were elected in the various parishes of London. In some in- 

 stances these gentlemen have been supported by the Vestries 

 who appointed them, and material sanitary improvements have 

 ta&en place as the consequence. But in a large number of instances 



