The Twentieth Annual Report of the Chief Medical Officer of the Ministry of Health, Sir Arthur MacNalty, for the year 1938, begins with a review of the nature of progress and the application of the conception to questions of health. Life in primitive society is not so healthy as is sometimes supposed, and the true condition is cloaked by the law of survival of the fittest. Civilisation has its cost; certain diseases follow in its train, e.g., tuberculosis. Besides the “new humanity” of the eighteenth century improvements in public health began to appear, and the population increased rapidly. Then came the progress of the Industrial Revolution, accompanied by new problems, especially in the domain of health. It can be concluded, however, that the growth of the health services, and the proof of their effectiveness as shown by the improvement of the nation's vital statistics, is real evidence of progress. In 1938 there was a rise of 10,647 births over the number registered in 1937, representing a birth rate of 15·1 per 1,000 living—a slight improvement on the rate of 14·9 for 1937. It is 0·7 above the rate for 1933, which was the lowest recorded. The infant mortality rate is 53 per 1,000 births as against 58 for 1937, and is now the lowest on record. The deaths in 1938 were 478,829, as compared with 509,574 in 1937, a decrease of 30,745. The five principal killing diseases remain the same as for many years past and occur in the same order, viz.:— (1) Diseases of the heart and circulatory system; (2) cancer—malignant disease; (3) bronchitis, pneumonia and other respiratory diseases; (4) diseases of the nervous system; (5) all forms of tuberculosis. If, however, the diseases are re‐arranged to show the principal killing diseases operating during the years of working life—15–65—then tuberculosis takes the third place instead of the fifth, and diseases of the nervous system occupy the fifth place.
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