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9
The death-rates from all causes for each metropolitan borough and for London
as a whole will be found in the table on p. 57 ; and the annual death-rates in London
since 1840 in relation to the mean of the rates for the 83 years are shown in the
diagram on p. 6.
There were 61 deaths per thousand births in 1923 as compared with the previous
lowest rate of 75 in 1922 and with 81 in 1921. In the following table the deaths
per thousand births from the principal causes of infant mortality are shown for 1923
and preceding periods :—
1911
Cause of Death. to 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923.
1914.
Measles 3.40 4.81 1.74 4.92 3.89 0.67 2.02 0.67 3.30 0.96
Whooping-cough 3.63 4.72 3.54 2.51 7.02 0.87 2.89 2.34 3.92 2.23
Influenza 0.27 0.31 0.16 0.27 3.65 1.38 0.46 0.26 1.12 0.20
Tuberculosis 3.40 3.48 2.81 3.88 2.65 1.66 1.52 1.45 1.43 1.21
Bronchitis 6.41 7.60 5.29 6.96 7.02 5.10 5.65 2.89 4.05 2.43
Pneumonia 12.28 16.10 11.69 15.28 16.78 10.25 12.62 11.54 16.00 9.07
Diarrhœa 24.28 20.82 13.89 16.03 13.67 14.75 8.98 18.63 6.26 9.07
Premature birth 18.16 17.60 16.40 17.22 18.47 20.42 15.32 16.17 16.10 14.66
Congenital defects 14.69 15.18 13.86 15.22 14.39 12.70 11.53 11.53 9.30 8.80
All causes 108 112 89 104 108 85 76 81 75 61
Infant
mortality.
The most noteworthy feature of the infant mortality in 1923 is the low deathrate
from diseases of the respiratory system, due to the absence of epidemic influenza
and a mild winter. Some increase in deaths from diarrhoea resulted from two
short periods of high temperature in the summer. The deaths from premature
birth and, more especially, from congenital defects, show remarkable decline.
The infant mortality in each metropolitan borough and in London as a whole
in 1923 will be found in the table on p. 57 ; and the annual mortality among infanta
under one year of age per thousand births in London since 1840 is shown in the
diagram facing p. 7.
Reference has been made in earlier reports to the remarkable decline in the rate
of infant mortality since 1900 in London, and the part which has been played by
administrative efforts directed both to the care of the newly born and to the health
of expectant and nursing mothers. The influence exerted by elementary education
upon this decline has been briefly considered in earlier reports, and is further discussed
on p. 60. The effect of restriction of the sale of intoxicants upon infant mortality
from overlaying and prematurity has been specially considered by Dr. C. R. Gibson,
Medical Officer of North Riding Combined Districts, who in an article in Public
Health (May, 1924), suggests that " alcoholic indulgence, or the domestic neglect
which it may entail, is one of the leading causes of avoidable infant mortality." He
finds in Denmark a correlation of .7 ±.2 between alcohol consumption per head
and non-diarrhœal mortality : yet during the war, when the effect of reduced consumption
of alcohol is clearly shown in the diminished deaths in adults from
alcoholism and cirrhosis in England, there was no corresponding decline in infant
mortality. Dr. Gibson makes a point of the fact that during 1915 to 1918 onefourth
of the convictions for drunkenness were among women, in place of the usual
one-fifth : but some such variation in the sex-ratio of convictions was to be
expected at a time when an army of men was being maintained abroad.
The decline of infant mortality since 1900 is found not only in London, and
England and Wales, but in most European countries. In some—notably those in
eastern Europe where specially high infantile mortalities have been recorded—it is
a continuation of a decline which commenced many years earlier. On the other
hand in the western countries of Europe, with generally much lower rates of infantile
mortality, the decrease from 1900 onwards follows a more or less prolonged period
of practically unchanged mortality rate.