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1928
22
become better known, and people come to know of them, the
fear of consulting a doctor may cease, and we may hope that on
the development of any symptoms which may point to a
possibility of Cancer, the sufferer will at once seek medical advice.
Other diseases which show an increase are diseases of the
heart and blood vessels, and old age. But the cause of death
in all these is largely a matter of classification. In the majority
of cases of deaths from heart disease in old people the cause is
a degenerative one. In young people heart disease is usually
due to a preceding attack of acute rheumatism, but in old people
it is a degenerative change. Diseases of the arteries or arteriosclerosis
and apoplexy or cerebral hæmorrhage are also intimately
connected since arterial disease is a necessary precursor of the
rupture in the brain which constitutes the apoplexy. Old age
itself comprises a group of degenerative processes with, frequently
enough, no pronounced disease. It is naturally a very indeterminate
term.
On Table I. are given the deaths upon which an inquest
was held or the Coroner issued a certificate after a post-mortem
examination had been held. One of the deaths reported to the
Coroner, and where a post-mortem examination was made is
important, on account of the prominence which this disease has
attained and its bearing on the question of vaccination. The
cause of death was certified as acute encephalitis, and the death
occurred in a child 5 years of age who had recently been
vaccinated. The case presented symptoms which were not usual,
but the medical inspector from the Ministry of Health who
investigated the case, was, I understand, satisfied that it fell
within the category of those which have recently been reported
upon by the Committee on Vaccination. The usual onset of
Encephalitis is from the seventh to the thirteenth day after
vaccination. In this case the child was vaccinated on September
11th, and the onset of symptoms was on September 16th. A
post-mortem was made by Dr. Bronte and the cause of death
was certified to be Acute Encephalitis. The lymph used in this
instance was not Government lymph but was obtained from a
private source. Post-vaccinal encephalitis is something which
is new to us, and like encephalitis Iethargica, which is all but
new, it introduces us to new problems, and increases the
difficulties of combating Small-pox.
It has been suggested that the cases, are a variation of
infantile paralysis, but the incubation period and age distribution
are different. Moreover, we in Acton, have been particularlv
free recently both of infantile paralysis and encephalitis
Iethargica. No notification of either disease had been received
in 1928 up to and including September. On October 31st a case