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15
Mortality in London from certain causes 1841-1925.
The changes which have occurred in the course of the last eighty-five years
in the London mortality from certain diseases or groups of diseases, are broadly
shown in the diagram on page 18. It must be borne clearly in mind that the contours
there given are not based upon the death-rates per thousand living but upon
the actual deaths registered in each year.
Some of the contours shown relate to groups of diseases and causes of death,
and the groups are not in some instances identical with those constituting groups
similarly designated in the Registrar-General's annual reports.
All except the first three contours are drawn to the same scale. The all-causes
deaths are shown on a scale one-fifth, the zymotic and bronchitis deaths on a scale
two-fifths of that of the remaining curves.
The heading "Zymotic Diseases" includes the principal infectious diseases,
smallpox, cholera, typhus and other fevers, diarrhcea, measles, whooping cough,
and also croup, gastritis and gastro-enteritis; but influenza is not included in this
group, being shown by a dotted line above the zymotic disease contour and also
separately. In the earlier years venereal diseases, pyaemia and puerperal fever
were included among zymotic diseases in the Registrar-General's reports, but these
have here been excluded throughout.
The group of diseases of the heart and circulatory system does not include
apoplexy. Diseases of the brain and nervous system comprise tubercular and
simple meningitis, insanity, paralysis and diseases of the ears and eyes, but the
group does not include apoplexy, epilepsy, or convulsions, deaths from the last
named being shown in a separate curve. The group of urinary diseases is the same
as that of the Registrar-General. Diseases of the digestive system are shown for
ages above five years, in order to avoid the disturbing effect upon the figures resulting
from the practice, which obtained in the nineties, of using the terms gastritis
and gastro-enteritis for deaths, which in earlier years would have been ascribed to
diarrhcea simply and thus have been included in the zymotic group of diseases.
Senile dementia was not classed with old age from 1881 to 1910, being in this period
allocated to insanity, but the number of deaths from this cause is relatively small
and insufficient to affect appreciably the contour shown in the diagram.
In regard to the classification of causes of death, it may be of interest to recall
that the Act requiring the registration of births, deaths and marriages in England
was passed in 1837. A classified list of diseases was at that time drawn up by the
Presidents of the Royal College of Physicians and the Royal College of Surgeons,
and the Master of the Society of Apothecaries,, and circulated to members of the
medical profession. This list was adopted in practice by the Registrar-General and
in 1845 it was circulated to all registrars of births and deaths in England for their
guidance in the registration of deaths. The classification of causes of death adopted
by the Registrar-General was based upon this list, and this classification remained
in force with some few alterations until 1881, when it was revised, some of the
medical terms used having become obsolete, and other changes being rendered necessary
by increased knowledge of the causation of disease. After 1881 the classification
of causes of death was revised from time to time until 1911, when the Internationl
list of Causes of Death was adopted, involving considerable changes in the classification
then in use in England. This list is subject to revision every ten years.
It may be added that, in addition to the changes brought about by the introduction
of this list, in 1911, the deaths registered in any district were allocated to the usual
place of residence of the deceased, so that the general register office became a clearing
house, as well as a registration office for deaths throughout the country.
It is necessary in considering the contours to have in view the changes which
have taken place in the population of the London registration area since 1840.
The population in 1841 of registration London, as then constituted, was 1,875,493.
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