London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1950
[Report of the Medical Officer of Health for London County Council]
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of the mother as a result of increased emphasis upon dietary supplementation,
of more effective ante-natal care generally, and of more skilled obstetric service
had led to a sharp fall in the still-birth rate. Since that review was made the special
character of the fall between 1942 and 1943 has become more apparent; this must
have been due either to some contemporary factor such as the food priorities which
were authorised about that time or to some new factor. There is a possibility that
the higher fertility rates now obtaining may in part be due to less voluntary or
deliberate restriction of families in the middle classes, than before the war; this
would also contribute to reduction in foetal mortality.
Mortality
In addition, the International List of Causes of Death, which was revised in 1938, was applied in 1940, in accordance with international agreement. The chief movements resulting from these alterations are estimated to be :—
| Cause | Approximate change as a percentage of those formerly assigned to this cause* |
|---|---|
| + 5 ,, | |
•Based on the dual classification of deaths for England and Wales, 1939.
To take the extreme case, if the former classification had been used, the 2,368
deaths from bronchitis in 1950 would have been reduced to 1,319 and the rest would
have been classified otherwise, e.g., to heart disease or cardiovascular conditions.
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. The effect of this
factor can be judged from the following figures for England and Wales as a whole,
published in the Registrar-General's Statistical Review, 1946-47, Text, Medical.
The " total " rates exclude deaths abroad but are an approximation to the true rate.
1940 1941 1942 1943 1944 1945 1946 1947
Civilian death-rate per 1,000 civil population 14.4 13.5 12.3 13.0 12.7 12.6 12.1 12.3
"Total" death-rate per 1,000 total
population 13.9 12.8 11.5 11.9 11.6 11.4 11.5 12.0
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