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52
The death-rate from pulmonary tuberculosis in London has been
falling with varying regularity since 1860 for females and from 1870 for
males. For Westminster rates have been worked out from 1880. These
show a steady decrease in the average death rates for pulmonary tuberculosis
from 208 to 86.9 per 100,000 of population, the rate of decrease
being considerably accelerated in the last four years.
I have pointed out in previous Reports that not only is the incidence
of the disease less among females, but the death rate is less than among
males, consequently the greater proportion of females in the population
results in a decrease in the total cases and in the number of deaths. This
would account for a small amount of the improvement, but most of it
must be attributed to the better conditions in the home and the work place.
The greater drop in the last five years, notwithstanding housing difficulties
and unemployment, points to the advantage of hospital and sanatoriun
treatment which are now available, and to the after-care bestowed upon
patients.
As regards non-pulmonary deaths, improvement in the death rates is
not manifest in London generally until the decennium 1891-1900 (The
London Public Health Act was passed in 1891). In Westminster the
average has fallen from 89 in 1881-90 to 11.7 in the last four years. Under
this heading are included deaths from tuberculosis affecting the brain
(meningitis), the abdomen, the spine and other bones and joints, glands,
and general or miliary tuberculosis. The fatality from these is chiefly
among children. I have taken out figures showing the death-rates of
children under 15 years of age in five-yearly groups since 1901-5 under
four headings, according to the site of the disease as registered, bat it
must be kept in mind that the part of the body named may not have been
the primary seat of the disease, thus meningitis may be the ultimate
cause of death but there may have been some other part of the body
previously affected. Still, when the rates are taken out for all deaths
due to tuberculosis at these ages it is evident there has been a substantial
reduction in the aggregate, whatever variations may exist in the rates from
separate sites of the disease. During the War years there was a check
in the falls which had been taking place, but in the last four years the
improvement has been very marked.