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18
rates of England and Wales and London for the past sixty years run much the
same course, except at times of exceptional prevalence (both of influenza and
diphtheria) such as those of the nineties and those of the past five or six years.
In enumerating the various factors determining the form of the epidemic waves
of infectious throat maladies, no reference has thus far been made to the question of
possible long period changes in virulence of the causal germ, or to the possible
existence of an intermediate or definitive insect host. The appeal to the operation
of factors such as these has, however, been advocated partly on the ground of
certain correspondences in geographical distribution and of seasonal prevalence in
the case, at any rate, of the curves for fleas and scarlet fever ; and partly for the
reason that the resultant of all the forces previously enumerated does not seem to
have such magnitude and direction as to account for the decided downward
movement in the mortality from throat epidemics during the last hundred or
hundred and fifty years.
Thus increased aggregation of susceptible units has to a large extent been countered
by stricter employment of isolation and disinfection; the use of antitoxin,
since 1894, has been followed by great reduction in case-mortality from diphtheria;
but, as Sir Shirley Murphy pointed out in 1898, it has also been followed by great
reduction in the case-mortality from scarlet fever; the towns with their more complete
measures of bacteriological control and of general hygiene have, over a long
series of years, been able to run neck and neck with the rural areas (which are so
much more advantageously circumstanced than they in other respects) save at
recurring intervals of some thirty years or thereabouts, when the towns have been
apparently temporarily handicapped owing to pandemic prevalences of influenza.
Those who have been occupied in gauging the respective chances, on one side or the
other, in the tug of war between the favourable and adverse factors, must have
felt doubt as to the outcome, and yet the result has been beyond all expectation.
The death toll exacted by both diphtheria and scarlet fever in civilised countries
has very notably diminished. This alteration, wherever manifested, has been
accompanied by the devotion of a vastly greater amount of attention to personal
hygiene, and there maybe something more than mere coincidence in this correlation.
Tuberculosis.
The deaths from tuberculosis of the respiratory system in London during 1924
numbered 4.486, giving a death-rate of .98 per thousand, the corresponding figures
for 1923 being 4,432 and .97 respectively. Deaths from other forms of tuberculosis
numbered 834, as against 853 in the preceding year, the death-rate being .18 per
thousand of population. The deaths and death-rates from tuberculosis of the
respiratory system by sexes annually since the war have been as follows:—
Year.
Deaths.
Approximate death-rates.
Males.
Females.
Total.
Males.
Females.
Total.
1919 2,945 2,252 5,197 1.47 0.94 1.18
1920 2,675 2,000 4,675 1.29 0.82 1.04
1921 2,737 2,076 4,813 1.32 0.85 1.07
1922 2,841 2,047 4,888 1.35 0.84 1.08
1923 2,586 1,846 4,432 1.23 0.75 0.97
1924 2,629 1,857 4,486 1.24 0.75 0.98
The increase in mortality in 1924 over 1923 is almost entirely confined to ages
20-25 and 45-55.
Notifications
of tuberculosis.
The number of notifications of tuberculosis in London during 1924 (53 weeks)
was 11,917, as against 12,175 in 1923 (52 weeks) Of these 9,388 were pulmonary
and 2,529 other forms of tuberculosis. These figures compare with those published
in these reports prior to 1921. Further correction of the figures by the exclusion
of cases notified as primary, but eventually found to have been previously notified,
brings the total number of pulmonary cases down to 7,406 and other cases to 2,207
the corresponding figures for last year being 7,561 and 2.221.