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ber of deaths. The natural conclusion would be that many more
cases are occurring than did in the past. We do not have exact
data on this matter, such as notification in the case of persons suffering
from Tuberculosis gives us ; if we did we should not be in the
dark as to the increase and its extent.
The increase in the incidence of some diseases is compounded
of many factors, and part of it only may be called a real increase.
The number of cases which are recognised has grown rapidly
through the expansion of medical facilities, improvements in the
technique of diagnosis and the increased use of these techniques.
Not only are sick people more thoroughly examined, but early cases
are picked out in greater numbers through an examination of supposedly
healthy persons. In this an increase in the examination
for life assurance has played a prominent part.
All the improvements in medical facilities and in early discovery
through more thorough and frequent examination of persons
both in health and sickness had not really added a single case
to the number of persons suffering from these diseases. It has
merely enabled us to identify more cases than before, and when
death occurred these deaths have been registered as due to these
diseases, whereas in the past many of these cases were not diagnosed
and the deaths were registered as due to other causes.
In the case of heart disease, it is generally recognised that
within recent years there has been a great advance in our knowledge
of cardiac disorders, and an entirely different conception now
exists as to the fundamental causes of heart failure. Formerly,
it was considered that the important causation of death from heart
disease was always an affection of the valves of the heart, and unless
a murmer was heard the death was attributed to some cause
other than heart diseass. It is now recognised that the essential
cause of cardiac failure lies in the heart muscle and is due to changes
in the heart muscle which render it unable to maintain an efficient
circulation. This change of view has resulted in an enormous addition
to the number of deaths attributed to heart disease, but the
increase is most noticeable in the deaths of old people. Of the 148
deaths which occurred last year, 106 of them were in persons over
65 years of age. I have taken at random the deaths in one month
last year and in each case the death certificate stated that death
was due to—(a) Myocarditis and (b) Senility. The ages of these
persons were 90 years, 86 years, 85 years and 78 years respectively.
Because the doctors happened to have stated that the immediate