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taken an upward step. North Wales improves ; Shropshire joins Herefordshire ;
Dorset remains as before, but its north and north-eastward extensions show further
development, and even throw down an outlier through Surrey to join Sussex.
Hampshire, with the Isle of Wight, still compares badly with the surrounding
counties.
In the decade 1911.20, further and very marked general improvement is manifested,
all the counties save four showing rates of less than 50 per million. Northumberland,
after assuming, comparatively speaking, a better relative position, has
lapsed, and is joined again with Durham, Yorkshire and Lancashire. Lincolnshire
has taken two steps forward and is now on the roll of honour among counties with
less than 50 per million deaths from typhoid fever.
The location of the place of origin of the added cause already spoken of, in the
review of the decade 1871-80, was held, on the showing of the typhoid rates for
1891-1900, to be somewhere in Yorkshire. In the decade 1901-10 Lincolnshire took its
place by the side of Yorkshire qua typhoid rates, and then in 1911-20 once more stood
aside from it, joining with counties exhibiting less typhoid. This behaviour of
Lincolnshire would be explicable, if during the decades 1891.1900 and 1901.10 the
area of origin of the superadded cause covered for a time both sides of the estuary of
the Humber. The phenomena are, in fact, in accord with the sequence of events
described in the Annual Report for 1916, p. 7. There was from about the early nineties
occasional resort to, and then gradually lessened use by, the Humber ports (as a
source of supply of small plaice) of that part of the A, area which includes the mouth
of the Elbe. These events have been seen to correspond in point of time with rise
of typhoid prevalence in London in 1891.00 with heightened autumnal prevalences,
and with gradual fall (1901-10) followed just after the close of that decade with
complete disappearance of autumnal excesses of prevalence. These phenomena are
observable, too, in the counties surrounding London and in the northern and some
of the midland counties. Moreover, London is known, subsequent to the eighties,
to have become increasingly dependent upon the North.Eastern fishing ports for
its supply of small plaice. It appears, therefore, that there is here explanation of
the parallelism in the behaviour of London and other counties, qua prevalence in
general and autumnal prevalence in particular, with occasional supply and later
discontinuance of supply of fish from the A3 area—the use commencing in the
early nineties, the disuse gradually coming about some years later, and the supply
ceasing after 1911.
There were 6,346 deaths from cancer in 1923 as compared with 6,044 in the Cancer,
previous year. There has been a continuous increase in the mortality since the
earliest years of death registration. The rate in London is slightly higher throughout
than in England and Wales as a whole, but, as will be seen from the following figures,
the difference is small:—
Cancer death-rate.
Period. London. England and Wales.
1851.60 0.42 0.32
1901.10 0.98 0.90
1911.20 1.21 112
1921 1.33 1.21
1922 1 33 1.23
1923 1.39 1.27
The mortality occurs principally amongst persons of high age and the cancer
death-rate in any given population is largely governed by the proportion of aged
persons in that population. The progress over long periods is. therefore, most
accurately shown by figures relating to age-groups, the sexes being separately
considered. In the following table the mortality from cancer in London is shown
for each age and sex for the principal age-groups affected, for three-year periods
to which each successive census in and since 1851 is central:-