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Are Zymotic diseases decreasing ? You say at any rate here
we ought to find some improvement, for are not sanitarians always
insisting that they are preventible diseases ? Here, again, there is
a small but certain improvement, and it is extremely satisfactory to
find it so. In 1856, 1857, 1858, 1859, the percentage of deaths in
Islington from these diseases was respectively 23.6, 22.9, 27.2, 27.9,
whilst the four last years (viz., 1872, 1873,1874, and 1875), show the
percentage of deaths to have been 23.7, 20.8, 20.2, 21.1. Of course
it may be urged that this is an accidental occurrence; but I think
there can be but little doubt that so far as zymotic diseases are
concerned, there has been of late a certain definite and noticeable
improvement, as much in the cases that recover as in the fact of a
decreased death-rate. But, inasmuch as our total death-rate remains
fixed, it is quite clear that if we have lessened the fatality of one class
of diseases, there must have been a certain compensation by an
increased fatality of another class. This is an instructive fact, and
it is no use for us to shut our own eyes to it, or to try and blind
other people's eyes. The two points I am desirous of making clear
to you are these:—1st. That so far as mortality is concerned, the
records of the past twenty years show little or no marked improvement,
and that therefore your chances of living and dying in 1876
are pretty nearly the same as they were in 1856. 2ndly. That
although we have in a measure stopped the ravages of some
diseases, still, in order to bring up the death-rate to what I may call
its normal percentage, other diseases must have, and have, increased
in a like ratio.
I do not think this state of things is much to be wondered at.
There must be some limit to the increase of the people, and nature
has, in a great measure, it appears to me, taken the matter of
population in her own hands. She would in this way (if people
would only inquire of her, and listen to her answers) render many
discussions to which we have been favoured of late as unnecessary
as they are untempting.
And another lesson I would draw, and it is this, "that," in the
language of my late lamented colleague, Dr. Letheby, "the deathrates,
as calculated in the usual way, are neither expressive of facts,
nor reliable indications of the sanitary condition of a community."
And here I should wish to guard against my meaning being