View report page

22
ASSIGNED CAUSES OF DEATH.
Class I.—Specific Febrile or Zymotic Diseases.*—
The "Class" of diseases called Zymotic, comprises, in the
Registrar-General.s arrangement of the "causes of death," six
"Orders." The first and second Orders ("Miasmatic" and
"Diarrhœal") include the diseases which the RegistrarGeneral
describes as "the seven principal diseases of the
zymotic class," grouping as he does, under the generic term
"Fever," the three distinct fevers,named "Typhus," "Enteric,.
and "Simple Continued."
These zymotic diseases have a special interest for sanitarians, being of a more
or less preventable character ; the absence or the prevalence of certain of them
therefore, is regarded as a test of the sanitary condition of a district. But, without
under rating the importance of this test, it must be said that there are limitations to
its applicability necessary to be borne in mind in drawing inferences from mere
numbers. What I mean may be best explained by illustrations, founded on our
own local experience within the last few years. Thus, Afeasles was very prevalent
in 1888 and 1890, the deaths being considerably above the average. In 1889 and
1891, on the other hand, the deaths from measles were greatly below the average:
*
but the lowered mortality, regarded as evidence of the diminished prevalence of the
disease, was the natural consequence of an excessive prevalence and fatality in the
preceding years. In saying this, I must not be thought to ignore the fact that one
epidemic of a zymotic disease may be more severe than another ; or that the
severity of an epidemic may be influenced by the measures taken, or the neglect to
take measures, to check the spread of infection. Again, the number of deaths from
]Yhooping-cough in 1889 was the lowest on record; it is not surprising to find,
therefore, that in the immediately preceding and succeeding years this disease was
fatal above the average : the large total of 185 deaths in 1878, moreover, followed
the then minimum return of 34 in the previous year. Diarrhaa may be cited as
an illustration of quite another kind. The mortality from this disease amongst
* The classification of the causes of death in the Weekly Returns and Annual
Summary of the Registrar-General, was considerably modified in 1882. The list of
causes, in its new form, is an abbreviation of the more detailed list used in the
Annual Reports of Births, Deaths and Marriages in England. Table III. in my
reports prior to 1882, was framed upon the lines of the abridged list of the causes
in the Annual Summary, and was the basis of some of the other Tables. It being
desirable that Table III. should accord with the new list used in the Annual
Report, the Society of Medical Officers of Health revised certain Tables framed, at
my instance, for uniformity, in 1872, and settled the lorms of Tables I—V as they
appear in the Appendix.