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doubt that other deaths from phthisis occur in the borough and
are wrongly entered up on the death certificates.
To take an actual example : a patient, 45 years, was examined
by three medical men in September and November, 1911, and was
notified by each one to the public health department as suffering
from phthisis. The patient died in December, 1911, and the
cause of death was entered on the death certificate as " bronchitis
" by one of the doctors who had previously notified the case
as one of phthisis.
In another case a patient, 41 years, was notified as phthisis in
February, 1911. He died the next day, and the death was certified
by the assistant of the first doctor to be due to bronchitis.
In both these instances the deaths should have been accredited
to phthisis following the rule that when a death is associated with
two or more causes—the primary cause of death—the one cause
for statistical purposes, must be the disease which has lasted
longest and the disease which has an infectious basis. In
Finsbury the number of deaths attributed to bronchitis in 1911
was 161. Now it is quite true that very young children may, and
do, die of acute bronchitis. It is very difficult sometimes in
infants to say whether the case is one of acute bronchitis or
broncho-pneumonia. But young adults rarely, if ever, die of
bronchitis, and the so-called chronic bronchitis of older people
is hardly ever the primary disease.
In both these cases a death from bronchitis very often means
that the primary cause of death has been overlooked or could not
be ascertained. The bronchitis is then due to heart disease,
phthisis, Bright's disease, gout, alcoholism, emphysema, or to
arterio-sclerosis—a disease of the blood vessels. These diseases
quite commonly produce changes and effects in the lungs which
give rise to a secondary bronchitis.
It would appear then that, out of the 161 deaths due to
bronchitis, 29 may possibly be correctly so attributed, but of the