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101
1913
relatives- Considerations of his sort apply far less to institutional than to
private practice, and so it is to be expected that the proportion of deaths
returned from institutions should be higher in the case of syphilis than of
mortality in general.
" The proportion of the deaths from syphilis returned by institutions is
double that of deaths in general, and in the case of adults more than half the
total deaths ascribed to syphilis are returned from institutions. It is much
more likely that this is due to greater under statement of these deaths in
private practice than to exceptional resort to institutions by sufferers from
syphilis."
The returns of deaths from syphilis, issued by the Registrar-General,
show that whereas in 1875 their number was 2,138—equal to a death-rate of
89 per million of the population—in 1910 they numbered 1,639—equal to
a death-rate of 46 0 per million. Thus, on the surface there appears to have
been a decrease of 23 per cent. These figures are, however, fallacious, for
such diseases as locomotor ataxia, general paralysis of the insane, aneurysm,
and other diseases known to be induced by syphilis, show no similar diminution.
It is singular, however, that the number of intending recruits refused
admission to the army on account of syphilis, per 10,000 offering themselves
for enlistment, has declined from 158 in 1870 to 19 in 1911, which would seem
to show that syphilis is becoming less prevalent. The reduction is explained,
the Army Surgeons say, by the fact that candidates for the army
now know that they will be rejected if they present themselves whilst suffering
from active signs of the disease, and, therefore, they avoid doing so.
The fact, also, is to be taken into consideration that a form of syphilis known
as soft chancre was proved to be due to a different cause from syphilis, and
was probably neglected in the return which showed the cause of the rejection
of candidates on account of other non-syphilitic disease of the genital organs.
It is not proposed to follow this disease through its various ramifications,
but rather to study it from a public health point of view.
As already stated, locomotor ataxia and general paralysis of the insane
are looked upon as being entirely dependent upon syphilis; indeed, to these
two diseases Dr. Mott attributes about 40 per cent. of the male deaths at the
London County Council Claybury Asylum.