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33
cently has been Diabetes. This disease has increased steadily in
incidence and somewhat irregularly in fatality and has shifted its
character. The irregularities in the behavour of Diabetes have
been influenced by insulin, but to suggest that insulin is responsible
for the increased incidence of diabetes is grotesque. The first obvious
results of the general use of insulin were to reduce the recorded
mortality of diabetes and to advance its age of fatality.
The latter continues; diabetics live longer than they did. The
former possibly was temporary and disappeared.
A number of causes have been at work which have in a real
sense increased the number of diabetics. During the last generation,
until the present world-wide depression occurred, there had been
a very appreciable improvement in the economic condition of all
classes of the population. Real wages increased, and with this
came an increase in the buying power of the people. On all sides,
the average man could enjoy, and did enjoy the use of more and
more food, and other comforts of life. Concomitant with the rise
in the standards of life was an increase in the use of machinery and
a greater mechanisation of industrial processes. More and more
people took to industrial employment and in such employment were
called upon to a lesser degree to use their energy in the production
of work. More food materials were taken in and less energy was
called upon to burn it up. The result may be over-feeding, and an
increase in the number of overweight persons, among whom diabetes
takes its greatest toll. On the other hand, in diabetes, again,
it is probable that the greater attention paid to diagnosis in general
and to examination of the urine in particular, especially for life
assurance and superannuation purposes, is responsible for the discovery
of a larger number of diabetics than formerly and for increased
certification of diabetes as the cause of death.
Deaths in Public Institutions.
386 deaths occurred in Public Institutions ; this number does
not include the deaths in nursing homes. I have previously commented
upon the increasing use which is made of public institutions
whenever an illness occurs. At the present time in Acton less than
one half of the deaths occur in the home.
Inquests and Coroner's Inquiries.
43 inquests were held and in 14 instances the Coroner issued
a certificate without an inquest after he had ordered a post-mortem
examination.