Hygiene: a manual of personal and public health.

  • Newsholme, Arthur, Sir, 1857-1943.
Date:
1902
Catalogue details

Licence: In copyright

Credit: Hygiene: a manual of personal and public health. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    Tests of the Health of a Community. i. The general death-rate is the test most commonly applied, and generally trusted. It has its limitations in this respect. It may usually be trusted in comparing a town or district for a single year with preceding years, as the age and sex distribution of a given population only changes slowly. But when comparison with other towns or districts is made, the possibility that erroneous conclusions may be drawn becomes considerable, {a) Before the death-rates of two districts can be compared, either this comparison must be made by means of death-rates for age-groups (0-5, 5-10, ... 65-75, ^^c.) or the factors of correction, the method of obtaining which is described on page 341, must be applied, {h) It must be ensured that in the two compared districts, an equal amount of correction has been made for deaths occurring in public institutions and among visitors (page 340). (c) Even when the above precautions are taken, it is conceivable that a town with a death-rate of 15 per 1,000 may really be as healthy as another with a death-rate of 12 per 1,000, though a statistical justification of this statement is a difficult task. Social conditions quite irrespective of the sanitary condition or the natural salubrity of a district have an important influence on the death-rate. Poverty and all that it connotes, necessarily involves a higher death-rate than occurs among the well-to-do. Furthermore, the domestic servants employed by the latter frequently die in districts other than those in which they are employed, without any possibility of the requisite correction being made. 2. The zymotic death-rate is frequently quoted as a test of sanitary condition. This is a death-rate based on the deaths from the seven chief zymotic diseases, small-pox, measles, whooping- cough, diphtheria, scarlet fever, fever (chiefly enteric), and diarrhoea. This death-rate should be entirely discarded, the death-rate from each infectious disease being separately stated. A high death-rate from enteric fever would be a much more serious reflection on the health of a town than a high death-rate for whooping-cough. The death-rate from each of these diseases in London and in England in 1899 was as follows :— Death-rate IN 1899 per 1,000 Living. England and Wales. London. Small-fox 005 nil Measles .. •32 ■47 Scarlet fever .. 12 •08 Diphtheria •29 •43 Typhus .. OOI nil Enteric fever .. 20 •18 Whooping cough •32 •38 Diarrhoea •94 •92 A statement of the death-rate from each of these diseases for a series of years is a much more trustworthy test than a similar statement for a single year, in which accidental causes may have caused a temporary increase, or than a statement of the average result for a series of years, which tends to conceal the epidemic variations of the