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11
The difference between the crude and standardised rates fur London, which lost a
large proportion of its population (more young than old) by evacuation would doubtless
be larger but "standardisation" in London cannot be carried out until regular
age group population estimates are once more available.
Up to 1948 for England and Wales, the comparative mortality index for females
had fallen to 0.941 (1938=1.000) while the male index has risen to 1.057.
In London, for both sexes combined the long-term trend of cancer mortality
can be seen from Table 3 (p. 120). The increase there shown between 1891 and
1940 is due partly to the increasing age of the population, and partly to improved
diagnosis, but some part is attributable to increased incidence e.g. lung cancer.
The important changes in mortality in London between 1931-33 and 1947-49
in relation to certain specific sites are summarised below.

There has been a considerable improvement in the mortality from cancer of the
buccal cavity especially in males. It is evident that the increase in respiratory
cancer, however it may be accentuated by improved diagnosis, overshadows all other
changes for both sexes. The increase since 1931 in male mortality from cancer of
the digestive system has been substantial, but in the last three years the death-rates
for males per 1,000 have been 1.063, 1.057, 1.055; and the increase now appears to
be halted. For females the death-rates have been 0.818, 0.868, 0.860; and the
increase, which had been progressive up to 1948, has at least suffered a temporary
pause. The increase in cancer of the genito-urinary organs in males has been large
and can hardly be attributed to diagnostic advances. Deaths in the last five years
have been 372, 441, 433, 456 and 470.
Digestive
The mortality from digestive diseases (other than diarrhoea under two years of
age and cancer) was 0.42 per 1,000, the same as in 1948. Within this group the
death-rate from ulcer of the stomach or duodenum fell from 0.17 to 0.15 per 1,000.
The death-rate from appendicitis was 0.032 per 1,000) in 1949, compared with 0.033
in 1948.
Road
accidents
Deaths from road accidents in 1949 amounted to 257, compared with 248 in
1948, and 319 in 1947. While the addition to the death-rate caused by road accidents
is small the public should be reminded that each year a heavier toll is taken by the
roads than by any poliomyelitis outbreak so far experienced and more die in street
accidents than succumb to diabetes.