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London County Council.
PHYSICAL DETERIORATION.
Report by the medical officer on the resolutions of the Inter-Departmental
Committee on Physical Deterioration which have been referred by the
Council to the Public Health Committee for consideration.
(Printed by order of the Public Health Committee, 2nd November, 1905.)
I propose to deal seriatim with the several recommendations of the Physical Deterioration
Committee referred to me for report.
(2) Register of sickness.
The Committee report that it appears to them " in the highest degree desirable that a register
of sickness not confined to infectious diseases should be established and maintained." They suggest
utilisation of the official returns of poor law medical officers, and of the records of sickness kept by
hospitals, and other charitable institutions throughout the country.
The fact that a national system of registration of sickness is needed has, during the last two hundred
years, become gradually more and more obvious. Already in the early part of the 18th century,
it appears, proposals to establish such a system were made, and Dr. Rumsey in 1844, Dr. Liddlo
in 1848, Dr. B.W. Richardson in the early fifties and the Metropolitan Association of Medical
Officers of Health in 1857 attempted to construct schemes of the kind upon a practical basis.
The returns of the association last referred to related to both outdoor and indoor cases treated
by poor law medical officers, and the circulation of the tables was undertaken by the General
Board of Health. The information obtained was never of a very complete character, and the
returns were not continued for much more than a year. Still as Dr. Newsholme remarks in
referring (in a paper read before the Statistical Society in 1896) to this effort, it is a " significant
fact that nearly 40 years ago a department of the government was actively engaged in collating
and circulating information as to various kinds of sickness in the metropolis."
An attempt of a similar kind to the above was made in Manchester in 1860 by the Sanitary
Association of Manchester and Salford, and weekly returns with quarterly and annual reports were
published for 20 years, the observations extending to an area occupied by a population of nearly 400,000
persons. Moreover, from 1859 onwards, owing mainly to the exertions of Dr. Rumsey and Dr.
Ransome the subject of the registration of sickness was frequently reported upon by Committees of
the Social Science Association and the British Medical Association.
In 1857, Sir John Simon, then medical officer of the Privy Council, urged that " certain broad
information ought periodically to be given as to the quantities and kinds of sickness treated by the
several destitution authorities and by the several medical charities of the country."
It was arranged in 1868 that returns, which were then made in five towns and in the district of
Marylebone, should be compiled upon a uniform plan.
Mr. Goschen, in receiving a deputation of the British Medical Association in 1870, said
that the arguments in favour of the registration of disease were very clear and strong
and that everyone must accept them, and the report of the Royal Sanitary Commission
in the following year shows that the importance of sickness returns was fully recognised
by the Commissioners. One outcome of the Commissioners' report was the compulsory appointment
of medical officers of health, and this, as Mr. C. E. Paget remarks in his " Wasted Records of
Disease," was " the first kind of positive recognition given by any Government in this country to the
need for reliable registration of disease." The annual reports of medical officers of health were to be
transmitted from all parts of the country to the central authority, and provision was thus made for
furnishing this first instalment towards the keeping of a record of prevailing diseases.
The need for further information was apparent however; for instance, Dr. Farr in his 35th
report, while noting the value of annual reports of medical officers of health, urged that weekly
returns of sickness should be procured from every district. He said " the thing to aim at ultimately
is a return of the cases of sickness in the civil population as complete as is now procured from the
army in England. It will," he adds, " be an invaluable contribution to therapeutics as well as to
hygiene."
j.t.s—1000—29-11-06.
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