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97
It will be seen that in the 20 years the London mortality from the common
infectious diseases is below that for England and Wales as regards typhoid fever,
scarlet fever and diphtheria, but that whooping cough is more fatal in London,
The tuberculosis death rate is only slightly higher in London than in England
and Wales, but there is a marked excess in the London mortality from heart disease.
In the county boroughs of England and Wales the frequency with which heart
disease is returned as the cause of death at school age is about twice that of the rural
districts. A higher proportion of deaths from this cause appears, therefore, to be
normally associated with urban conditions. Greater accuracy of diagnosis in large
towns may, however, play some part in the difference observed.
With regard to diseases of the respiratory system, it is remarkable that London,
with its fogs and dust, should have a lower mortality rate than England and Wales
as a whole. It will be noted that the deaths caused by vehicles have nearly doubled
in the 20 years covered by the figures. The increase is attributable to the introduction
of mechanical traction. The deaths in London among children aged 5-15
caused by vehicles and horses in 1923 numbered 107 as compared with 123 in
1922 and 91 in 1921.
The diphtheria attack-rate in London during 1923 was 2.3 per thousand of
population; in 1922 the rate was 3.4 and in 1921 it was 3.6, while for the ten years
1911-20 the average was 2.0. Notwithstanding the marked decline in the London
prevalence of diphtheria in 1923 upon that of the immediately preceding years,
the attack-rate was still considerably greater than the corresponding rate in the
rest of England and Wales (0.9 per 1,000 living).
Of the total number of cases of diphtheria notified in 1923, numbering 10,301
(52 weeks), 4,699 or 46 per cent, were among children aged 5-15 years, of whom 224
or 4.8 per cent. died. The corresponding percentages for 1922 were 4.8 per cent,
and 5.7 per cent, respectively.
The scarlet fever attack-rate in London during 1923 was 2.2 per thousand of
population as compared with 3.8 in 1922. In the rest of England and Wales the
corresponding figures were 2.2 and 2.7 respectively.
Of the total of 10,047 cases of scarlet fever notified in 1923 (52 weeks), 5,597
(56 per cent.) were of ages 5-15, of whom 86 (1.5 per cent.) died. The corresponding
percentages for 1922 were 60 and 0.8 per cent, respectively.
Whooping-cough and measles were not prevalent in 1923, and the deaths at ages
5-15 were only 9 and 11 respectively.
Two diagrams ha ve been prepared to show the progress of the measles and whooping-cough
mortality in London and the various metropolitan boroughs during the last
13 years (see pp. 98-99). The black columns indicate that the mortality was above
the average, each column being proportional in height to the mortality in a given
quarter, the average for that quarter in the whole period being taken as 100. For
instance, in Hackney the measles mortality in the first quarter of 1915 was equal to
131 as compared with the average of the first quarters taken as 100, while in the last
quarter of 1914 it was, in terms of the average for the fourth quarteis, 761. The
diagram shows clearly the marked decline in mortality which has occurred since