DISEASE CAUSES CLIMATIC MORTALITY 39 



results obtained, and to justify the expenditure 

 incurred. 



The first step to take is to try to find out the 

 common diseases present in the town, and their in- 

 dividual prevalence. The best person to do this is 

 the local health officer, if there is one. The medical 

 officer of health of a town must be already conver- 

 sant with the diseases that cause the death-rate. 

 He is in touch with all the local medical practitioners, 

 and has regular access to the death registers and 

 examines the death certificates, if there are any. 



But health officers, especially in warm climates, 

 very frequently suffer from the belief that their 

 duties consist solely in preventing and dealing with 

 epidemics, and they are often inclined to ignore those 

 endemic diseases which may and frequently do cause, 

 both directly and indirectly, the high death-rate. A 

 hot climate, in itself, does not produce an excessive 

 mortality ; it is always due to disease. For instance, 

 since mosquitos have been abolished the mortality 

 at Rio is the same as that of Liverpool. There is 

 another example. The Health Departments in Egypt 

 have spent 249,000 during the past few years on the 

 " prevention " of plague by an out-of-date method. 

 About 900 cases of that disease occur in a few 

 scattered villages every year ; but in spite of the 

 so-called prevention, the disease continues as before. 

 On the other hand, some thousands of children die of 

 the effects of measles in the cities of that country 

 annually. And yet for this disease the Health De- 

 partment has not spent a penny ; and in January 



