View report page

The changes which have taken place in the incidence of phthisis in London
during the past ten or twelve years, are the result of a complexity of causes; and
although it may be possible to some extent to disentangle and define them, the
share which each has had in producing the changes which have occurred cannot be
ascertained owing to want of the necessary data.
The apparent arrest of the downward trend of the phthisis death-rate which
occurred about 1911 has been discussed in earlier Reports, and is associated with
decrease in emigration of phthisical persons and with the transfer to London of
deaths of London residents takine place elsewhere in England and Wales.
Sex-incidence
during the
war.
The changes which were brought about by the European war were, however,
of quite a special nature, and affected the two sexes differently. Towards the end of
1914 the female population of London was considerably increased by the influx
of refugees. Later, more women were absorbed both by munitions work and in taking
the place of men on active service. In the autumn of 1917 an opposite movement
occurred: the air raids caused a number of people to leave London, and in 1918
in addition to this factor, the shortage in agricultural labour led to the enlistment
of women in farm labour. The influence of these movements upon the notifications
of phthisis is very apparent, there being up to 1917 less decline in cases at ages 15-25
than at all other ages. After 1917 the effect of the outward movement of population
on the phthisis notifications is masked by the increasing effect of food shortage,
and, later, by the influenza pandemics, tending to increase the cases.
Among males the movement was of a different character. The male civil population
declined progressively, with the result that the notifications of phthisis continued
to fall sharply until 1916. In 1916 and 1917 recruitment became so general that by
the end of the latter year most of the male population of ages 20-35 had had to pass
through the hands of the medical examiners, and, if found phthisical, had been
notified. Consequently the notifications of males of military age, which had fallen
relatively far more than females of the same ages, in 1917 increased to a height in
excess of even the figure of 1913. In 1918 the notifications were higher still, for in
addition to the result of medical examination en masse there came the influenza
pandemics, and the aftermath of the food shortage in 1917 prior to the rationing of
the food supply.
Fluctuations in the mortality rates corresponding to those shown in the notifications
naturally did not occur, so far as the earlier war years are concerned, but
such changes as did occur later were far more marked at the ages 20-35 among males
and 15-25 among females, showing that the causes mentioned as influencing the
notifications had also been the source of the increased phthisis mortality, especially
in 1917 and 1918.
Influenza.
Influenza was epidemic in the closing weeks of 1921 and in the beginning of
1922 and the epidemic is dealt with in the last Annual Report (vol. III., p. 14). There
were 2,000 deaths in 1922, and of these 1,423 were among females. In the outbreaks
of 1918 the observed incidence was much greater upon females than males, as might
be expected in view of the number of males on military service in that year. In
the epidemics of the nineties the difference in sex-mortality is not marked, nor does