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7
death, and, as from 1940, accepted the principal cause of death as shown on the
medical certificate. In addition, the International List of Causes of Death, which was
revised in 1938, was applied in 1940, in accordance with international agreement.

•Based on the dual classification of deaths for England and Wales, 1939.
The second cause affecting the statistics was the outbreak of war. A young and
healthy section of the population was, from September, 1939, excluded from the
mortality statistics, which henceforth related only to civilians. This selective factor
was bound to inflate the death rates, since the population in respect of which they
were calculated was now on the average older and less healthy.
In so far as the slopes of the curves before and after 1940 are more important than
absolute figures, it is possible to consider the diagram as a whole and to observe the
continuity in trend. To reduce the confusing effect of the large scale reclassification
of deaths, heart diseases and bronchitis have been combined.
The death-rate from all causes, which, with the increasing age of the population,
had been slowly rising before the war, rose sharply in 1940. This rise was partly a
feature of the war-time statistical basis as explained above, but the heavy toll of air
raids was an important contributory factor. The rate for 1949, at 11.7, is slightly
higher than in 1948, but it must be borne in mind that 1948 was an exceptional year
with low respiratory mortality and low mortality from heart disease. There are, of
course, ups and downs even in a general descending trend.
Tuberculosis
Another cause of the rise in the death rate, notably in 1941, was the increase
in deaths from tuberculosis. This rise was only temporary and measured the effect
of war conditions in hastening the death of those with advanced disease. Recent
experience in both mortality and morbidity is more fully discussed in a later
paragraph.
Bronchitis
and heart
disease
The death-rate for the bronchitic and heart disease group has followed a similar
trend to that of the rate for "all causes" of which it forms a large part. Figures for
the component diseases are shown in Table 3 (p. 120). Mortality from heart disease
and bronchitis, after reaching a higher level in the early years of the war, subsequently
declined. The 1947 figure is an upward fluctuation in this general trend and reflects
the severe winter. The 1948 fall was a compensatory downward swing. The rate
for 1949 (4.21 per 1,000) is once more an upward swing but is not out of keeping with
the general downward post-war trend.
Other
circulatory
disease
The death-rate from circulatory disease other than heart disease was 0.65 per
1,000 compared with 0.55 in 1948 and 0.56 in 1947. This is a sharp rise, the cause of
which is unknown.
Cerebral
haemorrhage
The death-rate from intracranial vascular lesions in 1949 was 1.07 per 1,000
compared with 1.01 in 1948. The average rate for 1941-45 was 1.15 but a large
proportion of the apparent reduction is due to the increase in the civil population
upon demobilisation, a purely "statistical" effect.
Nephritis
For nephritis the death-rate in 1949 amounted to 0.18 per 1,000 compared with
0.21 in 1948 and an average of 0.36 over the decade 1931-40.