observation. The epidemic diseases which are required to be thus reported are: Cerebro-spinal meningitis. Scarlet-fever. Diphtheria and croup. catarrh. Puerperal fever. intestinal Tonsillary angina. Varicella. Mumps. Röthein. Epidemic conjunctivitis. jaundice. stomatitis. Influenza. The returns must state the age, sex, and nature of the illness of each patient. No fee is paid to the practitioner for notifying. Similar returns are required from the medical officers of all hospitals. Sweden.-All cases of infectious diseases in towns must be notified on a plan somewhat similar to that in force in Denmark. All cases of sickness occurring among the poor have been notified and tabulated ever since 1851. The cases of sickness occurring in the hospitals of Stockholm are notified weekly to Dr. Linroth, the health officer of that city. This applies to the State and Communal hospitals. There are also a few private hospitals; these are required to send a report yearly, including a statement of the nature of the illness of patients. Norway. There is a system of immediate compulsory notification of certain diseases, and a monthly notification of certain other diseases. In July, 1895, the diseases required to be notified daily (which may be varied from time to time) included, I was informed by Dr. Bentzen, the health officer, small-pox, measles, scarlet-fever, typhus fever, enteric fever, erysipelas, diphtheria, puerperal fever, and cholera. Weekly returns of these cases are tabulated, along with particulars of the mortality in Christiania, in a weekly bulletin issued by Dr. Bentzen. Cases of influenza have been required to be notified weekly. The following is the form (anglicised) for the monthly list of cases in each doctor's practice : Return of New Cases of Epidemic Diseases observed in Christiania. This form must be filled up and sent to the office of the Sundheds-kommission before the third day of the month. The doctor is not paid for notifying cases or for filling up the monthly returns; but the forms and postcards for notifications are supplied gratuitously. For failure to notify he is liable to a fine of from 8 to 800 krone. Returns of hospital cases must be made by their medical officers daily or monthly like private cases. Some indication of the value of sickness returns may be gathered from the accompanying curves, based on the notifications of rheumatic fever in Christiania since 1861, and in the whole of Norway since 1863, stated in proportion to population, and expressed as a deviation from the mean case-rate for the whole period. The value and instructiveness of the curves is evident, notwithstanding the fact that in the first half of the period most of the curve is below the mean line, and in the second half of the period is above the mean line. This is probably owing to the fact that in the earlier years medical attendants were fewer and less available, and notification was less strictly carried out. The deficiency of the earlier data does not, however, conceal the main lessons of the curves. This deficiency would be gradually and fairly steadily removed, not by fits and starts. Hence the peaks and valleys of the curves express real facts, and correspond with years in which rheumatic fever was or was not epidemically prevalent in Christiania and Norway. The illustration is of value in another sense: rheumatic fever, like many other diseases of great importance, very seldom kills during the attack of fever, but chiefly by the heart disease, which may prove fatal years later. Hence curves of the annual deaths from rheumatic fever are of comparatively little value unless for very large communities; and, if we judged from them, or from the figures from which they are constructed, we should conclude that rheumatic fever is a disease of slight importance, instead of being, as it is almost, the most important disease in our midst. I have elsewhere estimated that in this country at least four persons in every thousand are on an average attacked annually by rheumatic fever." The Scope of Preventive Medicine. Having completed our sketch of the history of the attempts to establish a national system of registration of disease in this country, noted the progress already made towards this consummation, and compared that with the advanced condition of registration of sickness in some continental countries, we are in a position to consider the lines in which further progress may and ought to be made. To contend that preventive medicine is limited in its scope by the so called zymotic diseases, a very common view among those imperfectly acquainted with its principles, is to rob it of its most important and promising field of work. Zymotic diseases in the year 1893 caused a death-rate of 3,165 per million living. In the "Milroy Lectures," 1895. 9 • Including small-pox, measles, scarlet-fever, typhus, enteric and continued fever, whooping-cough, influenza, cholera, diarrhoea, malaria, hydrophobia, and other zoogenous diseases, venereal diseases, erysipelas, puerperal fever, and other septic diseases. |