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and hydrocephalus were not specifically divided into tubercular and non-tubercular
brain disease it was necessary to include both in this group throughout the period.
Other causes of death of importance comprised in the group are paralysis and
insanity.
Dealing first with simple and tubercular meningitis, both are mainly fatal
among children under five years of age and the course of mortality from these and
other orain diseases at these ages is found to be very similar to that from convulsions,
there being some tendency to increase up to the "eighties," owing to the increase
of the population under five years of age, while subsequently, partly as a result
or reduction in the births and partly owing to diminution in the incidence of
meningitis, both simple and tubercular, the curve shows a sharp decline.
A comparison of the movement of the mortality from diseases of the brain and
nervous system at ages under five years with that of deaths over five years of age
shows that, in the first 30 years of the period covered by the diagram, during which
an increase occurred in the deaths over five years of age, there was practically no
change in the deaths under five years. In subsequent years the figures for the
two age groups are similar until about 15 years ago, when the deaths under five
years of age began to fall more rapidly.
With regard to paralysis and insanity, these two headings were retained unaltered
in the List of Causes of Death from 1841 to 1880, but in 1881 radical changes
were made so far as the different diseases which were comprised under these two
headings are concerned. Thus, general paralysis of the insane becomes classed with
insanity, while diseases included under the heading of " paralysis " were distributed
to various stated causes of death. The group includes diseases, the syphilitic origin
of which was not at the time recognised, which form a considerable portion of the
deaths among the insane. There can be little doubt that progressive improvement
in the certification of deaths among inmates of asylums occurred in the course of
the period from 1841 to 1925. The Lunacy Commissioners were appointed in 1847
and gave place to the Board of Control in 1914. In 1844 only about 20 per cent.
of insane persons were accommodated in County asylums; in 1869 about 43 per
cent. were so provided for, while in 1924 there were nearly 80 per cent. thus accommodated.
The development in municipal provision for the insane has undoubtedly
been accompanied by improved certification of deaths, and this in conjunction with
the changes in methods of classification referred to above makes it a matter of doubt
as to how far the curve for brain and nervous diseases in the diagram can be regarded
as representing the actual changes in the incidence of these diseases.
It may be added that from 1841 to 1857 delirium tremens was included among
diseases of the nervous system, and the deaths from this cause are not included
in the figures upon which the diagram is based. The number of deaths attributed
to delirium tremens and intemperance varied little from 1841 to 1880, and as the
population during this period increased considerably, the death-rates per thousand
living had actually declined. There was, however, no decrease in the amount of
alcohol consumed per head of population, and it is, therefore, doubtful how far
reliance can be placed upon the mortality rates as an index of the effects of alcoholic
excess upon mortality. From 1881 the heading "delirium tremens and intemperance
" was replaced by "alcoholism," and from thence onwards to 1901 there
was a rapid increase in the number of deaths under this new heading, the deaths
being more than trebled in the twenty years. There is, during this period, no
corresponding increase, either in the proceedings for drunkenness or in the amount
of alcoholic liquor consumed per head of the population and the increased mortality
classed to alcoholism must rather be due to better certification than to any considerable
increase in deaths from this cause.
Among the diseases directly associated with alcoholism, cirrhosis of the liver
takes a prominent place (see Annual Report of the Registrar-General, 1911, page