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the high percentage sick figures. The percentage dying and permanently unfit was higher
up to age 55 years than for any other grade of staff in this survey. The number of deaths,
six in total among 2,503 firemen, was proportionately lower than in the A.P.T. & C.
grades, so that the high percentages in this category were due to a higher rate of men retired
permanently unfit. It must be remembered that fire-fighting requires a high physical standard
and what might incapacitate a man for this activity might not impair his ability to carry
on a less strenuous activity as, say, a clerical or administrative officer.
9. Ambulance staff, section E, show high rates of sickness up to 55 years of age and
especially at younger ages—9.1 per cent. under 25 years of age or three per cent. a year.
Again, as with firemen, the average duration of each spell of sickness under two months
up to 55 years suggests earlier referral. (A survey of staff sickness for all departments
1951-53 suggested a relatively high incidence of sickness in London Ambulance Service
operative staff, especially in uncertificated sickness.) This led to more frequent referral
to the examining medical officer which may, in part, account for the higher figures. The
percentage retired unfit (there was only one death reported) was relatively high but not as
high as for firemen.
10. There is, however, a deficiency in the figure of deaths reported in these tables.
These deaths are of those in staff already referred to the examining medical officer because
of continued sickness absence and they take no account of sudden death in staff not so
referred. A separate investigation based on the year 1964 was made to ascertain the extent
of this. The results indicated that about 40 per cent. of deaths occurred in persons referred
to the examining medical officer but that this proportion varied with grade of staff and
was lowest for manual workers. Most of these sudden deaths were from heart conditions.
(b) The causes of sickness, invaliding from and death in the service
11. Table 2, sections A to E (where applicable sub-divided into males and females)
shows for the different grades of staff, by age, the causes of long-term absence on sick
leave with total figures for cases permanently unfit and dying. The causes shown are the
50 causes for tabulation of morbidity of the International Statistical Classification of
Diseases, Injuries and Causes of Death (seventh revision 1955). The ' Not stated ' category
refers to cases in which the diagnosis was not coded; these were relatively few and arose
from ‘ teething’ troubles in the early days of the scheme, the percentage figure shown in
this table excludes these 'Not stated' cases. The table is related to spells of sickness, not
persons; it would be difficult to do otherwise, because each spell of sickness can relate to
a different cause and many of such multiple referrals in the course of the three years were
of this nature.
12. For the A.P.T. & C. staff, section A, in males the principal causes were respiratory
diseases (code Nos. 28-34), psychoneurotic (No. 19), heart and circulatory diseases
(Nos. 23-27), tuberculosis (Nos. 01 and 02), accidents (No. 50) and cancer (No. 12) in
that order; for females they were psychoneurotic, diseases of the genital organs (No. 42),
heart and circulatory diseases, cancer, accidents and rheumatic diseases (No. 46). There
is, of course, an age pattern in these causes which is in line with general morbidity
experience. Cancer is very much a disease of age and assumes its greatest impact from age
55 years onwards; of the specific sites for cancer (not listed in the table), cancer of the
lung was the principal site for males and cancer of the breast for females. It is surprising
that psychoneuroses and psychoses should figure so prominently for both men and women
in the A.P.T. & C. grades, spread throughout the age range. Heart and circulatory diseases
rank third in order of importance for both men and women, again very much related to
age. Respiratory diseases were proportionately more than twice as frequent in males as
females, this difference being mainly due to bronchitis (Code No. 32), especially from age 55
years onwards. This again is a reflection of national experience. Diseases of the genital
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