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The improvement in the death rate of schoolchildren is largely a history of the
overcoming of mortality from the infective diseases: the death rate in this group is
now only 44 deaths per 100,000 population or one death for every 2,300 children, and
violence accounts for one-third of them for boys in this age group.
With young adults (15-24 years) the reduction in the death rate is again largely
due to the almost complete disappearance of infective disease; tuberculosis, which is
treated outside the description of 'infective disease' in this context, now occupies
second instead of first place in this age group though the death rate from this cause is
only 13 per cent. of what it was in 1901 (tuberculosis is dealt with in detail in pages
25 to 49). Cancer appears currently in this age group as a major cause of death for the
first time although it has increased only slightly (from 5 to 6 per 100,000 population
over the fifty years) ; it appears now because of the great reduction in mortality from
other causes. Deaths from pregnancy and childbirth in young women are now only a
tiny fraction of what they were and are too insignificant to warrant separate mention.
Violence now accounts for nearly one-half of male deaths in this age group.
At adult ages of 25-44 years tuberculosis has disappeared as a major cause of death
and cancer now occupies first place in this age group, though its contribution to
mortality remains the same as in 1901 (46 per 100,000 population compared with
45 in 1951). Deaths from pregnancy and childbirth in women at these ages, despite
their decline from 48 to 6 per 100,000 population still occupy eighth place in the list
because of the very great decline in deaths from other causes. Alcoholism, which figures
in the list for 1901, has virtually disappeared as a cause of death. Violence still occupies
a prominent place in deaths of males in this age group.
The mention of violence in current mortality in each of the three foregoing age
groups is noteworthy, especially as a cause of death in males.
At 'middle age' (45-64 years) the sex differential in the death rate has been commented
on earlier and this difference between the sexes, which has increased, is readily
seen from the difference in length of the black (male) and hatched (female) lines;
thus in cancer, which shows an absolute increase over the period, the male death-rate
is now one and a half times that of the female rate whereas in 1901 the female rate was
one seventh higher than that for males. Pneumonia and bronchitis, which took a heavy
toll in lives at these ages at the beginning of the century are still major causes of death
though the statistical change in 1940 referred to in the footnote on page 154 applies in
this context; the death-rate for males from these causes is three times that of females.
Deaths from tuberculosis at these ages show a marked decline but again the sex differential
has increased over the fifty years to the disadvantage of men. As with the previous
age group, alcoholism, which was of some importance as a cause of death in 1901
(53 per 100,000 population) has disappeared. This is the first age group in which syphilis
and its sequelae receives mention in each of the three years—no doubt this is a reflection
of the increase in facilities for treatment which received such an impetus in the first
world war, younger age groups have received effective treatment whereas for persons
of this generation adequate treatment probably came too late to save them from the
late effects of syphilis and babies are now protected by ante-natal care. Throughout this
age group the important feature is the higher male death-rate, a sex differentiation
which has increased over this century and which, with two exceptions (vascular lesions
of nervous system and diabetes), persists in every one of the causes of death Listed.
At the extreme end of life, 65 years and over, the pattern of death remains similar
over the fifty years with, perhaps, more specificity in the certification of death, e.g.,
'old age' in 1901. The main causes of death in each of the years is from degenerative
causes—heart disease, other circulatory disease, vascular lesions, nephritis and bronchitis.
The big difference in scale for each of the three years should be borne in mind when
making comparisons at these ages.
The outstanding feature of this review is the great reduction in mortality from the
infective and respiratory diseases and from tuberculosis. Diseases in which he the
greatest scope for further prevention of death are certain causes of neo-natal mortality
(prematurity, post-natal asphyxia, etc.), violence in young people and cancer in the
middle-aged.
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