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23
xliii.,and similar tables in later reports). Cirrhosis of the liver was not separately
stated as a cause of death until 1881, and although the number of deaths so certified
increased in the course of the next 20 years the increase was small, and in fact,
negligible in comparison with that noted under the heading of alcoholism in the
same period. From about the end of "the nineties" the deaths registered as due
to alcoholism declined rapidly and, as a decrease is also apparent in the deaths from
cirrhosis, it is clear that the reduced consumption of alcohol has been the cause
since then of the reduction in mortality from alcoholic excess.
It has been shown that there is a want of correlation between the recorded
deaths from alcoholism and the extent of alcoholic excess as shewn by the consumption
of alcohol per head of the population ; and it is the general opinion that
the deaths recorded as due to venereal disease afford no real indication either of the
extent of venereal affections or of the variations in their prevalence since 1840.
The deaths directly attributed to venereal disease show decrease since about 1900,
and there is strong reason for believing that there has been a notable decline in the
mortality caused directly or indirectly by venereal disease. It will be readily
understood that while a decrease in the incidence of venereal disease and in diseases
resulting from alcoholic excess might not immediately affect the deaths registered
as due to syphilis and alcoholism, it would have a material influence upon the deaths
in later life from diseases known to result from these causes. Some part of the
decrease shown to have occurred in the mortality from diseases of the nervous
system and from bronchitis may perhaps be looked for here.
There has, it will be observed, been but little change in the number of deaths
from diseases of the digestive system, notwithstanding the increase in the population
at risk. The deaths recorded in this group have undoubtedly been reduced as the
result of improved diagnosis and certification, for it includes several headings, such
as ascites, teething, stricture of the intestines, etc., which are of an indefinite
character. Not much, therefore, can be concluded from the curve, but it is of
interest to note that, although the use of preservatives in food has been assigned
as the cause of certain diseases of the stomach and intestines, there is little evidence
of any increase in diseases of the digestive system as a whole in recent years.
Ill-defined
and nonspecified
causes of
death.
A curve showing the mortality from ill-defined and non-specified causes of
death is included in the diagram on page 18. The group consists largely of deaths
among infants from ill-defined causes associated with premature birth, and the
movement of the mortality recorded in this group is, therefore, governed more by
changes in the birth-rate than by improved diagnosis and certification; this will
be clear from the close similarity of this contour to that of convulsions.
All causes.
On reference to the diagram on page 18, it will be seen that during the twenty
years, 1841-1860, the death-rate from all causes in London showed no tendency
to decline. Thereafter there was a steady decrease, the rate of decline being accentuated
in the last twenty years. On comparing the course of the London mortality
with that of European countries generally since 1840, much the same movement
in the mortality is found to have occurred, as is shown by a French Government
publication, " Statistique Internationale du Mouvement de la Population, 19011910"
(volume 2, page 119). In this volume a diagram is shown of decennial
mortality in the principal European countries and, while broadly speaking, there
was not much change in the decennial mortality rates from 1841-1850 to 1871-80,
some countries showing increase and some decrease, after 1871-1880 there was no
exception to the rapid decline of the death-rate, though the decrease was small
in Ireland. Generally speaking the amount of the decrease is greatest in the countries
which had the highest rate in the "seventies."
It is of course not practicable to deal here in detail with all the changes which
have played a part in reducing the deaths from all causes in London since 1840,
and from what has been said in regard to the similarity of the general movement