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Sickness.
13
out, among other matters, the complete absence of any legal definition of the term. In various
countries such terms as "born dead," "born without signs of life," &c., have been enacted by the
registration laws, but in none of them is there anything approaching a "definition.'' The report
contains a suggested reasoned definition. This country and such of its dependencies as have
based their registration laws on the English model stand apart in the absence of legal requirement
for the registration of still-births. It is much to be hoped that that defect will be remedied
at no distant date.*
SICKNESS: Morbidity.
The diseases scheduled by Section 55 of the Public Health (London) Act, 1891, for notification
were small-pox, diphtheria, membranous croup, erysipelas, cholera, and the fevers known
as scarlet, enteric (typhoid), typhus, relapsing, continued, and puerperal. To that list there have
been added from time to time, by Orders made under Section 56 of the Act, the following—
bubonic plague, cerebro-spinal fever, acute poliomyelitis, hydrophobia, glanders, anthrax, and
ophthalmia neonatorum. Varicella (chickenpox) has been temporarily on the list at times when
smallpox has been prevalent. In certain parts of the Metropolis the following diseases have
been, and some still are, notifiable—epidemic (zymotic) enteritis, measles, and whooping cough.
The notification of pulmonary tuberculosis, and more recently of tuberculosis generally, being
enacted by Orders under an Act other than the Public Health (London) Act, will be dealt with
separately. Only the diseases which occur practically every year have been included in the
tables given in this section. Other diseases will be dealt with under their appropriate
headings.
The returns for the Borough (Table 6, page 14) relate to the number of cases certified, irrespective
of corrections for ultimate diagnosis, but corrected for repeated notifications of the same
case. Compared with the previous year, there were increases in the notified cases of diphtheria
(increase, 81 cases, or 49 6 of the total for 1911), scarlet fever (increase, 46, or 20.3 per cent.), and
puerperal fever (increase, 4 cases, or 57.1 per cent.). There was a notable dccline in the reported
number of cases of enteric fever (decrease, 22 cases, or 59.4 per cent.). The difference between the
estimated numbers of the population for the two years is so slight that what has been said of the
actual numbers applies equally to the rates for the two years. As compared with the quinquennial
averages the rates for last year show notable decreases with regard to scarlet fever (rate, 1912,
1.91; mean, 3.32) and enteric fever (rate, 1912, 0.10; mean, 0.24). Increases have to be
reported in all the other diseases for which quinquennial means can be determined.
Charts showing the equivalent annual morbidity rates based on the numbers of cases of
scarlet fever and of diphtheria reported in each week in the Borough and the Metropolis will be
found opposite page 16. Two curves are given in each case, viz., one of rates for the past year
—hard black line—and one of average rates (1902-11)—broken line.
Scarlet Fever.—The London curve for 1912 was well below that of the averages throughout
the year. The dip in the curve associated with the summer holidays is well shown in the curve
of averages, but does not appear in that for 1912 until the last week of those holidays. The
autumnal rise is very apparent in the curve of averages, but not so in that for the last year.
There is not so much distance between the Paddington curves as was noted in the London,
and in several weeks last year's curve rose above that of the averages. The dip during the
summer holidays is very marked in the curve of averages, but last year there was a considerable
ascent in the curve in the earlier weeks of the holidays followed by an unusually deep dip, and
for some weeks after the holidays the curve ran at a much lower level. Except in the 44th and
45th weeks the autumnal increase was very slight.
*The report referred to above, entitled "Report of the Special Committee on Infantile Mortality," was
issued by the Society as a separate document in August of last year. It has been reprinted, together with a
discussion on the contents thereof, in the Journal of the Society for December, 1912.