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ii.
Evidence is adduced in the report that no inconsiderable proportion of the reduction
in the infantile mortality has been due to causes other than the absence of epidemics of
infantile (summer) diarrhoea during the last five years. That fact, taken in conjunction with
the statistics given in Appendix B, favours the view that the special work undertaken in connection
with health visiting has been not unsuccessful. The greater part of such work has
been performed by the visitors of the Health Society as has been made manifest by the figures
given in these reports. That Society has maintained a paid Visitor in addition to securing
the co-operation of numerous voluntary workers (principally district visitors). The work of
the Women Inspectors has of late years been mainly in connection with the (so called) minor
infectious diseases reported by the schools, and the demands on their time for such work is
likely to increase rather than diminish. But for the help of the Health Society it would have
been necessary to increase the number of Women Inspectors, and even with such help the
date is not far distant when some increase will have to be made, if certain branches of work
now being done, are not to be abandoned.
Without early information of births the work referred to in the preceding paragraphs is
impossible. It is, therefore, satisfactory to note the increased (and increasing) proportion of
births reported under the Notification of Births Act, 1907.
At the present time births within the Metropolitan area have to be notified within
thirty-six hours, and registered within forty-two days. Such requirements appear to me to be
cumbersome and while the information received through notification is too early for
immediate use, that received through registration, is usually too late. Amendment of the
law is, I think, necessary and could be effected without detriment to "health visiting" by
requiring the registration of births to be effected within five days—the period prescribed for
the registration of deaths. Notification would then be unnecessary. If, however, it were
desired to retain notification with an extension of the present prescribed limit of thirtv-six
hours, registration of the birth should be effected by the medical officer of health, the official
to whom the notification is addressed—following the practice prevailing in many European
countries. Both methods would impose a single obligation on the public, but the first
mentioned is, to my mind, the better method of the two.
Although, by reason of the over-estimate of the popoulation, the mortality from
consumption (pulmonary tuberculosis) is understated in the report—the rate for last year
should be 0.89 instead of 0.83—yet the fall in the number of deaths from 161 in 1909 to 127
last year represents a satisfactory decrease in the mortality from this manifestation of
tuberculosis. In 1909 there were 72 deaths among 801 patients whose cases were reported
during life, which (for the present purpose) may be described as a case fatality of 9 per cent.
Last year the known cases of this disease totalled 1,259, and the deaths from consumption among
them, 71 (case fatality 5.5 per cent.). The deaths among the reported cases were equal to
56 per cent. of the total number of deaths from this cause, whereas in the previous year they
formed only 44 per cent., so that the proportions of fatal cases known and unknown in life in
the two years were exactly reversed.
Some reference should be made to the voluntary work which has been undertaken in
connection with this disease. The "Dispensary," the opening of which was recorded in the
last report, has continued to discharge its functions without any decline in activity or signs of
any diminution in public interest. Last year 813 new patients residing in Paddington
attended the Dispensary, pulmonary tuberculosis being definitely diagnosed in 248 of
them, while 265 other patients were found to be suffering from other forms of tubercu-