View report page

12
hope of throwing some light (inter alia) on this perverse and pessimistic point of view
a chart has been prepared, with the help of Mr. B. E. Spear (p. 18), showing year
by year for the London population the fluctuations in the number of deaths from
particular accredited causes.
When due allowance has been made for disturbing influences, and especially
for the altering age-constitution of the population, it transpires that certain apparent
increases of mortality—those from cancer, pneumonia and influenza—are mainly
if not entirely attributable, on the one hand to change of fashion in nomenclature,
or on the other to greater accuracy of diagnosis. Their importance is in any case
seen to be dwarfed into small proportions in comparison with the marvellous decreases
observed. The conspicuous decline in phthisis is, undoubtedly, in part due to better
housing and feeding and in part to migration of population, though this latter factor
became much less extensively operative some 15 or 20 years ago. The most remarkable
contour, of course, is that for zymotic diseases, which bears eloquent testimony
to the value of the public health effort of the last 40 or 50 years, which has brought
about the practical extinction or conspicuous decline in prevalence of the chief
zymotics. The contours, however, which, perhaps, present features most deserving
of special study at the moment are those of bronchitis and of diseases of the brain
and nervous system, in both of which, despite the increase in the populations at
risk, there is an unexpectedly pronounced decline; altered age-constitution has
doubtless operated here, and there has probably, too, been some transference to
other categories (to pneumonia and heart disease in the case of bronchitis ; and to
influenza and other headings, from both bronchitis and diseases of the brain and
nervous system); but these explanations are not adequate to account for an outstanding
and as yet unexplained decline under the two last named headings.
In so far as the extreme ages (old age and infancy) are concerned, it is doubtless the
greatly increased care for the very old and very young (one of the conspicuous developments
of modern civilisation) which must be held to be largely accountable ; but
it may be suspected also that some of the improvement at all ages under the headings
referred to must be ascribed to decided falling away in the maleficent influence
of those close allies "alcoholism " and "venereal disease," both of which, while
making but little parade at any time in registered causes of deaths, have notoriously
had their power for evil greatly curtailed in the last half and particularly in the last
quarter of a century.
It comes as a special surprise, however, in an age which is reputed to be one of
"nerve strain," "brain fag" and "overpressure," and in which much has recently
been heard about the " epidemic diseases of the central nervous system," to find
that diseases of the nervous system make so little impression upon records of
mortality nowadays, as compared with the far away "sixties " and "seventies."
In face of the vast improvements brought about as regards mortality statistics
in the period which has been reviewed, no share in which can possibly be ascribed
to restrictions upon liberty of "well persons," such as are now being advocated by
the extremists, the conclusion is obvious that some evidence of the utility and
practicability of the proposed new methods will have to be forthcoming before they
can meet with general approval.
Population.
Vital Statistics.
The population of the County of London at the census of 20th June, 1921, was
4.484,523, including members of the armed forces in London, but excluding Londoners
on active service elsewhere. It is estimated by the Registrar-General that
the population with residence in London at the date of the census was about
4,524,000, allowance being made in this estimate for persons absent on holiday
when the census was taken. The Registrar-General estimates the total population
in the middle of 1925 to have been 4,612.000, including 10,000 non-civilians. The