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nounced. It would be rash, however, to build too much hope of
any lessening of mortality either on the above figures or on the
means taken which are mentioned above. Experience has often
shown that two or three years of a diminished mortality are often
followed by a sudden increase.
The fatal forms of alcoholism certified as such, are one more
than last year; but as the effects of this form of poisoning are
to be found in so many other diseases it is not possible to draw
any conclusions.
Enteric fever caused 5 deaths both in 1912 and 1913; but the
disease last year had a higher case mortality, for there were only
23 persons attacked compared with 33 in 1912. North Camberwell
still continues to supply the greater number of notifications, but all
the sub-districts provided their quota. Nineteen patients were
removed to hospital, and there were no circumstances which would
seem to point to a common cause for the disease.
There were the same number as last year of babies reported
to us (29) as suffering from ophthalmia. The infants were visited
as soon as possible, but it was usually found that they were
already being treated by their own medical attendants or more
usually had been taken to one of the eye hospitals.
There were only 3 fatal cases of puerperal fever, against 9 last
year. These were all absolutely independent of one another, and
their fewness may be reasonably claimed as a proof of the increased
skill and care of the nurses and midwives and the extra vigilance
of the bodies who control these workers.
The deaths from erysipelas were one less than last year, and,
as usual, the majority occurred in the infirmary. During the year a
letter was received from the Stepney Borough Council asking for
support in approaching the Local Government Board for the removal
of this disease from the list of those that are notifiable. For some
time it has been our custom neither to carry out disinfection nor to
advise exclusion from the schools, unless the circumstances were
altogether out of the ordinary. Its inclusion in the list was no
doubt an advantage when the Public Health Act was drafted, but
the benefit has long since passed away, and the comparatively few
cases we now get are from the infirmaries and among persons of
advanced age.
Pleurisy caused four deaths, being three less than last year;
whether these should now be classed under tuberculous diseases
is not decided, but there is no question that many cases of phthisis,
especially among men, have originated in an attack of pleurisy, from
which they have often recovered more or less completely before the
symptoms of the subsequent disease have appeared.
The deaths from cancer, which were 311 in 1912, declined in
1913 to 279, but in the present state of our knowledge it is futile to
hope that this means a permanent decrease. Its local occurrence
has been ascribed to constant irritation, and among the agents which
induce this, tobacco smoking and excessive alcoholism have been
mentioned as possible agents. It is inferred that the increased