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Additions were, however, made to the. area in 1844 and 1846, and these added about
73,000 to the population, but apart from such additions the population increased
between 1841 and 1851 by more than 400,000. In each of the two following decennia
the rate of increase was about the same, but between 1871 and 1881 the rate of growth
was more rapid, the addition in this period being 562,223. Thereafter, the rate
of inter-censal growth began to diminish, being about 400,000 between 1881 and
1891, 300,000 from 1891 to 1901, while in the ten years 1901 to 1911 (for the first
time in the period covered by the diagram), there was an inter-censal decrease,
amounting to about 15,000. Broadly speaking, it may be said that the population
in London increased steadily from 1841 to 1901 and has since remained practically
stationary.
The population has grown by immigration, and by excess of births over deaths,
and both factors have a disturbing effect upon age-constitution. Immigration
involves the addition to the London population of young adults of both sexes; these
throughout the period are in excess of what would be found in a community growing
only by natural increase, that is, by excess of births over deaths. The changes in
the birth-rate are apparent from the diagram on page 13. The rapid decline of
the rate in recent years has resulted in a marked diminution of the child population
relatively to the total population of the County. There were, in 1851, rather less
than 300,000 children under five years of age in London and, in each successive
census, the number increased until in 1891 it exceeded 500,000. Thereafter, it
declined with the declining birth-rate and, at the last census (1921), the number
was 376,055. It follows from these changes in the population that diseases which
are mainly fatal among children will, apart from any change of incidence or fatality,
show an increase in number up to 1891 and, thereafter a decrease, greatly accentuated
since 1911. This circumstance must be borne in mind in considering the contours
in the diagram, especially that relating to convulsions, the deaths from which are
almost entirely limited to the first two years of life and also, though to a less extent,
to diseases of the brain and nervous system, this latter group including simple and
tubercular meningitis which are both more largely incident upon the early years
of life.
The population in 1841 over 65 years of age numbered less than 70,000, but
there was a continuous increase throughout the 80 years to 1921, when this agegroup
numbered nearly 260,000. This increase is principally due to increase in
the birth-rate during the first half of the last century, though the excess of immigration
over emigration has also played some part. It is worthy of note here that the
short life-tables for London referred to in the annual report of the Medical Officer
of Health for 1923, page 10, show that of the 371,776 persons aged 5 to 15 living
in London in 1841, there would have survived in 1911, 44,921 persons, whose ages
then were 75 to 85. The actual number of persons at this age enumerated in the
census was 52,352, the excess over the expected number representing, approximately,
increase due to the excess of immigration over emigration in the intervening years.
It will necessarily follow from the continuous increase in the population at high
ages that diseases which are mainly fatal in later life will show an increased number
of deaths, while the death-rate per thousand of the population at risk may actually
not have increased or may even have decreased.
In the case of bronchitis, which is largely incident upon persons over
55 years of age, it will be seen that there is a fall in the deaths in the past 30
years, notwithstanding the increase in the population at risk. Deaths from diseases
of the heart and circulatory system, however, show a continued increase and actually
the rate of increase is, in some periods, greater than the rate of increase of the population.
At the ages chiefly involved, the increase in deaths from heart diseases is,
however, dependent upon other circumstances than either increase of population
at risk or increase in the incidence of diseases of the heart; more exact certification