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than at the school ages ; doubtless Infant and Child Welfare work may claim some
credit for this.
It is interesting to compare the school-age figures for London with those for
the whole of England and Wales. For a proper appreciation of the lessons to be
learnt it is necessary, however, to digress for a moment by referring to a comparison
between rural and urban mortality rates made, as long ago as 1857, by Dr. William
Farr. He says, " the mortality of the English people is very variable, but generally
under favourable conditions does not exceed 17 in 1,000 . . . The deaths of
17 persons in 1,000 may, therefore, be considered in our present imperfect state
natural deaths ; and all the deaths above that number may be referred to artificial
causes . . . But it may be said that this standard cannot fairly be applied to
determine the excessive mortality of large towns, which can never become so healthy
as the country. How healthy the towns may become we do not know." Dr.
Farr scarcely anticipated that the ideal, supposed in 1857 to be unattainable for
large towns, viz., 17, would be far surpassed by a record rate of 11.4 in London
last year. Dealing with the London deaths (1838-44) under 5 years of age, Dr.
Farr calculated that out of 139,612 deaths, the " excess of deaths in London among
children," comparing London with a healthy area, was 58,980. And later, he
observed, " The diseases chiefly incidental to children are twice as fatal in the
town districts as they are in the country."
The Table on pp. 95-96 will enable the figures relating to England and Wales
to be compared with those for London for the last six decades.
At ages 5-9, in males, London starts, in 1861-70 at a considerable disadvantage,
but draws level in 1901-10 and only just loses pride of place in 1911-20. In females
London passes England and Wales in 1901-10, but just falls behind again in 1911—
1920.
At ages 10-14 less precise conclusions can be drawn and probably migration
is an obscuring influence here. In males, London stands in better case in the earlier
decades, but gives way to England and Wales in 1891-1900 and 1911-20. At
ages 10-14, in females, London leads in each decade with the exception of 1911-20.
The higher mortality in London in 1911-20 is partly attributable to epidemic
disease (and especially to influenza), and partly to the more correct allocation of
transferable deaths which has been made by the Registrar-General since 1911.
The striking phenomenon that London, at these school ages in recent decades,
either holds a better record, or else runs the rest of the country very close, seems
to indicate that there have been special efforts made in London which have, as it
were, more than compensated for ill effects associated with the great growth in
size of the Metropolis. These influences have presumably in the main been exerted
through London's education service and services affiliated thereto, both directly
upon the scholars, and in the later decades also indirectly, by reason of the fact
that parents, who having themselves been through the schools, have been made
more ready to act upon advice and to welcome assistance in regard to health
questions generally.
Even more noteworthy, however, than the figures relating to the general
death-rate at school ages, is the statistical evidence now available with regard to
verminous conditions and infectious disease. The results of the delousing work
undertaken in London have been set out year by year. Sir George Newman quoted
the figures in his last annual report (p. 38) as " typical of those received from the
country generally, though the London scheme of cleansing is more complete."
Still more striking is the record of seasonal flea prevalence, which has been obtained
by examination of London school children during the last twelve years. The
chait printed on page 90 shows reduction in the percentage of flea-marked school
children from an annual mean of about 28 per cent. in 1913, to 7 per cent. in 1923 ;
here is, therefore, precise statistical confirmation of a phenomenon which must have
been brought under the notice of many Londoners. The altered death rates from
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