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support the hypothesis that diminished migration is the reason for the change in
phthisis mortality among young women. A fact which appears definitely to dispose
of any question of migration as the particular cause in the case of young women
is that there has been a similar increase in the number of new cases of phthisis
notified in London. Phthisis was not made compulosrily notifiable until 1913, and,
in the first years of notification, "primary" cases did not all represent new cases;
but it is reasonable to assume that the excess of primary cases in the early years
relatively to later years was proportionately the same for each age-group; and in
the following Table the total primary notifications between the ages 5 and 65 are taken
as 1,000 for each group of years shown in order to enable the figures for the early
years of notification to be used. As a check upon the result shown by the notifications,
a similar procedure has been adopted with the deaths for the same period.
It will be seen that the two sets of figures show very similar results. Correction
has been made for changes in the population in each age-group from one period to
another.
Primary cases of pulmonary tuberculosis, Females. Deaths from pulmonary tuberculosis, Females.
5-15 15-25 25-15 45-65 5-65 5-15 15-25 25-45 45-65 5-65
1913-14 186 258 327 229 1,000 67 239 323 371 1,000
1915-19 173 295 328 204 1,000 77 295 324 304 1,000
1920-22 133 358 329 180 1,000 58 352 328 262 1,000
1923-25 101 394 330 175 11,000 54 378 324 244 1,000
To facilitate the consideration of this table, it may be observed that had the
incidence or mortality from phthisis decreased equally in each age period, the proportion
of cases and deaths in each age-group would have remained the same for
each of the periods shown. The Table shows that the change in the incidence and
death-rate at ages 15 to 25 have been different from that at other ages, and the
table given on the preceding page shows that this difference is due to an actual and
not a relative increase in phthisis among young women of this age-period.
It would seem, therefore, to be clear that we are confronted with an actual
increase in the incidence of phthisis among young women, and it will be inferred
from the Table given on page 26 that the causes to which this increase is due
commenced to operate before the War, while the percentages in the Table on page 22
appear to indicate that the change even dates back as far as the 'nineties. In this
connection, it is noteworthy that it was about this time that women began to take
up business pursuits as a means of livelihood, and, in the course of time, they have
considerably displaced men in certain occupations and thereby reduced the wageearning
power of men in certain occupations. This change appears also to have
influenced to some extent their early marriage. The census of 1881 shows that,
of women between the age of 20 and 25, 31.6 per cent. were married. Thereafter
the percentage falls continually up to 1911, when it was 21.8 per cent. In 1921,
however, there was an increase, as the figure then rose to 25.0 per cent. It 'will be
noticed that, after the age of 25, when a far greater proportion of women are married,
there is little evidence of increased incidence of mortality through phthisis.
It is difficult to estimate to what extent the considerable employment of women
during the Great War, together with the great loss of life amongst young men of
marriageable age, are also factors in this connection.
Cancer. There were 6,720 deaths from cancer in 1926 as compared with 6,628 in 1925,
the death-rate per thousand being 1.46 as against 1.44 in 1925, and 1.21 in the ten
years 1911 to 1920. In the Annual Report of the County Medical Officer of Health