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9
in mind if we would draw sound conclusions. What I mean can
be best explained by an illustration or two founded on our own
local observations within the last two years. Thus Measles was very
fatal in 1878: the deaths were far above the average. It was, so
to speak, the zymotic disease of the year. In 1879, on the other
hand, the deaths from measles were below the average; but the reduced
mortality, which means the diminished prevalence of the disease,
was almost the corollary of the excessive prevalence and fatality
of the malady in the previous year-. In saying this, I do not, of course,
ignore the fact that one epidemic of a zymotic disease may be mor-e
severe than another; still less am I forgetful of the fact that the
fatality of an epidemic is largely influenced by the means taken, or
the neglect to take means, to limit the spread of infection. Diarrhoea
may be cited as an illustration of quite another kind. The mortality
from this disease among infants was excessive in 1877: the
mortality in 1878 was far below the average; but the diminished
mortality in the second year had no relation to the excessive mortality
in the first: the conditions were altogether different. The summer
season, 1878, was cold and wet: in a cold and wet summer the
mortality from infantile diarrhoea is always low, just as it is always
high when the summer is hot and dry. But the conditions that were
so favourable to infantile life in respect of diarrhoea were very unfavourable
to life, both in the young and in the aged, in respect of
another class of diseases, viz., those of the respiratory organs, the
mortality from which throughout the year wras excessive, as it always
is in cold and wet seasons.
These and like circumstances must be kept steadily in view if we
would draw sound conclusions from a high or a low rate of prevalence
of this or that disease, or class of diseases, especially in relation to the
sanitary condition of a district.
Subject to corrections for climatic conditions, and for high
rates in previous years, the concurrence of a low general death-rate
with a low zymotic rate furnishes just grounds for satisfaction; and as
the general and the zymotic rates were both below the average in
1879, to that satisfaction we are fairly entitled.
It need hardly be said that a persistently high rate of mortality
from zymotic diseases is always a subject for serious consideration;
but, as we shall see in due course, Kensington has hitherto been in the