London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1897
[Report of the Medical Officer of Health for London County Council]
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(D) Increase or decrease per cent, of death rates at each age-period in 1861-70, 1871-80, 1881-90, and 1891-96, compared with the death rates of the decade immediately preceding.
| Period. | All ages. | 0— | 1— | 2— | 3— | 4r— | 5— | 10— | 15— | 20 and upwards |
|---|---|---|---|---|---|---|---|---|---|---|
| 1861-70 with 1859-60 | — 35.2 | — 28.6 | — 17.8 | — 27.2 | — 30.8 | — 36.0 | — 46.1 | — 62.9 | — 62.8 | — 42.6 |
| 1871-80 „ 1861-70 | — 33.3 | — 40.8 | — 40.0 | — 37.4 | — 31.2 | — 26.4 | — 23.8 | — 35.6 | — 45.3 | — 37.0 |
| 1881-90 „ 1871-80 | + 0.0 | — 22.3 | — 8.1 | — 7.8 | + 4.6 | + 14.3 | + 22.0 | + 6.8 | + 5.7 | — 5.9 |
| 1891-6 „ 1881-90 | — 2.1 | — 4.2 | — 3.4 | + 2.6 | + 3.9 | + 5.5 | + 4.1 | + 6.4 | 0.0 | 0.0 |
(E) Increase or decrease per cent, of death rates at each age-period in 1859-60, 1871- 80, 1881-90, and 1891-96, compared with the death rates at each age-period in 1861-70.
| 1859-60 | + 544 | + 40.0 | + 21.6 | + 37.4 | + 44.6 | + 55.4 | + 85.5 | + 169.4 | + 168.7 | + 74.1 |
| 1871-80 | — 333 | — 40.8 | — 40.5 | — 37.4 | — 31.2 | — 26.4 | — 23.8 | — 35.6 | — 45.3 | — 37.0 |
| 1881-90 | — 333 | — 54.0 | — 45.3 | — 42.3 | — 28.0 | — 15.9 | — 7.1 | — 31.3 | — 42.2 | — 40.7 |
| 1891-6 | — 347 | — 56.0 | — 47.1 | — 40.8 | — 25.2 | — 11.3 | — 3.3 | — 26.9 | — 42.2 | — 40.7 |
Table I. (C) relating to England and Wales shows that subsequent to the period 1861-70 there has
been a continued relative increase of incidence of diphtheria mortality upon the ages 3— 4— 5— and
with trifling exception upon 10—. In the period 1861-70 compared with 1855-60 (D) the greatest
relative increases were at the ages 1— and 20—, but in all subsequent periods compared with
1861-70 (E) the greatest relative increase has been at the age 5—; also when each period subsequent
to 1861-70 is compared with the period immediately preceding, (D) this age has always had the
greatest relative increase except that in the period 1891-6 compared with 1881-90 the increases at
ages 4—5— and 10— have been nearly equal.
Table II. (C) relating to London shows also that subsequent to the period 1861-70 there has been a
similar relative increase of incidence of diphtheria mortality upon the ages 3— 4— 5— and 10—. In
the period 1861-70 compared with 1859-60 (D) the greatest relative increase has been at the age 0—, but
in all subsequent periods compared with 1861-70 (E) the greatest relative increase has been on age 5—,
except that in 1891-6, the increases on ages 5— and 10— have been practically identical; also
when each period subsequent to 1861-70 is compared with the period immediately preceding (D)
these ages have, with trifling exception, always had the greatest relative increase.
Table III., (C) relating to England and Wales, excluding London, shows that subsequent to the
period 1861-70, there has been, with trifling exception, a continued relative increase at the ages of
3—4—5— and 10—. In the period 1861-70, as compared with 1859-60, (D) the greatest relative
increase was at the age 1—, but in all subsequent periods compared with 1861-70, (E) the greatest
relative increase has been at the age of 5—; also, when each period subsequent to 1861-70 is
compared with the period immediately preceding, (D) this age has always had the greatest relative
increase, except that in the period 1891-6, compared with 1881-90, the greatest relative increases have
been at 4— and 10—.
There is, therefore, marked agreement in the behaviour of the figures supplied by England and
Wales, London, and England and Wales less London ; there has in fact been in each population, since
1861-70, a notable increase of relative incidence of diphtheria mortality on the ages of 3—4—5—
and 10—; and, so far as the figures antecedent to the period 1861-70 may be trusted, there is
observable difference in the behaviour of the figures in the period before and after that period.
Another and important behaviour of the figures deserves attention. It will be seen that the
variations in incidence are, speaking generally, such as to form a regular curve which rises from
age 0—to a maximum at ages 5— or 10—, and then gradually declines until age 20— is reached.
In considering the circumstances which may have brought about the changes in the age
incidence of diphtheria mortality, three important points have to be considered—
1. Changes due to difference in nomenclature.
2. Changes due to natural behaviour of disease.
3. Changes due to some varying social condition of the community.
1. Changes in nomenclature.—The disease mostly affected by changed nomenclature is undoubtedly
croup, deaths, which in earlier years would have been certified to be due to croup, being now
attributed to diphtheria. The addition, therefore, of the deaths attributed to croup and diphtheria is
the only safe course to adopt in considering variations in prevalence of diphtheria, or in the age
distribution of diphtheria mortality, and this course has been adopted in this report.
There may, however, have been, with improved medical knowledge, more exact diagnosis between
scarlet fever and diphtheria. If we assume that the transference has been proportionate at each age,
it is interesting to observe that owing to the different age-distribution of mortality from the two
diseases, transference from one to the other necessarily alters the age incidence of the disease to which
the transference is made.
In connection with the altered age incidence of diphtheria, transference of scarlet fever to
diphtheria alone needs consideration, as the transference of diphtheria to scarlet fever if proportionate
at each age would not affect the age incidence of diphtheria mortality. Whether this transference has
taken place in any considerable degree is difficult to determine, but the regular character of the curves
based on the percentage variations in diphtheria age-incidence (see diagram facing page 8), and which
I have already referred to, suggests that some transference has taken place.