u The death rate from Phthisis in Dublin is also excessive.
To this a multiplicity of causes contributes.
The conditions unfavourable to cleanliness in the home, already referred to, directly encourage the spread of the disease from person to person.
Another fafouring circumstance is the low state of vitality engendered by poverty, of which there is so much in Dublin; aided, it may be, by resort to stimulants on the part of the insufficiently fed.
The conditions, also, of many cow sheds and dairy yards in the
i city are such as to favour Tuberculosis among cattle kept in these places ; and therefore
.
to give rise to serious risk of disseminating Phthisis and other Tubercular diseases by f
means of milk.
In less degree like danger arises from the use of meat derived from
, ill-kept private slaughter-houses, of which there are not a few in Dublin.
In addition to the mortality duo to deaths among infants, as well as to Diarrhoea, : Enteric Fever and Tubercular diseases, it is desirable also to make particular reference *
to the high mortality in Dublin from Respiratory and from Nervous diseases.
The
t high death rate from Respiratory diseases may be referred in part to the lessened [ resisting power caused by insufficient food and clothing.
Partly also, however, it is attributable to the home conditions that so often, in Dublin, favour spread of infection.
For no small share of Respiratory disease follows upon attacks of Influenza and Measles; ihile Pneumonia itself, which is a large contributor to this group of diseases, is in a large proportion of cases an infectious disorder.
, The low vitality ol" a considerable section of the population is also to be reckoned as | aiding the high death rate from Nervous diseases ; to which also the injudicious use of j alcohol may contribute, although, for reasons already given, it is difficult to lay stress | on this factor.
But this excessive mortality from Nervous diseases in Dublin is more | apparent than real, inasmuch as the excess of the Dublin rate over the London rate is due to deaths from " Convulsions."
The death rate from " Convulsions " in Dublin is VH per 1,000 of tho population, while that in London is 0*41 per 1,000 of the population.
Accordingly, the mortality from Nervous diseases is not so great as would appear, since "Convulsions" is a loose expression frequently indicative of want of accurate diagnosis.
More correct diagnosis would lead to the classification of many deaths thus described in groups of disease other than Diseases of the Nervous System, Regarding the mortality in Dublin from the whole group of Zymotic diseases some comment is necessary.
From certain maladies of this group Dublin suffers less, from others more, than do other large towns.
In Dublin the necessity for hospital isolation as a means of lespening'prevalenec of those diseases is greater than in most towns, because of the relatively largo proportion of the population without satisfactory means of isolation of the infectious sick in their homes.
It appeared in evidence, indeed, that the number of beds in hospitals for infectious diseases is considerably larger in proportion to population in Dublin than elsewhere.
But it also appeared that at times these beds are not all available, as was the case in 1899.
The sufficiency of hospital accommodation for infectious sickness in Dublin would seem, therefore, to be less certain than it appears to be, although such accommodation has at no time fallen below that of other large towns.
Inadequate means of isolation of the infectious sick, it need Wdly be pointed out, constitute a grave hindrance to control of epidemic disease.
Hindrance also arises in Dublin from lack of power on the part of the Sanitary Authority to close day schools with a view to preventing spread of infectious disease, ftis measure is of undoubted utility in some circumstances, and might have proved of ^vice in checking the spread of the Measles epidemic, which, in 1899, contributed so Helyto the Dublin death rate.
The absence, too, of compulsory notification of ^eetious disease in certain of the townships, which are essentially suburbs of Dublin, ai*d in some adjoining rural districts, adds to the difficulties of the Sanitary Authority in endeavouring to cope with epidemic outbreaks of disease.
From several other diseases than those that have been particularly considered, the penality 0f Dublin is somewhat in excess of that usual in large towns, but not in such §r(-e as to call for special reference.
Measures for Improving the Health or the City» ^e now come to the second point referred to us—that is, what measures we Commend for adoption with the view of improving the health of the city.
h^t, as to "tenement houses."
Any improvements in these numerous and widely ottered insanitary dwellings must re-act favourably on the health of Dublin.
The *w1b and structural parts of many of the large houses, which were formerly the
