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the mean of the local rates and the rates for the country as a
whole. The larger population upon which the London rates are
based would probably tend to reduce the high peaks shown by the
local rates in certain years. Despite this smoothing, it would
seem that the London rates do reflect the fact that, while much of
the county area is of an industrial type similar to West Ham,
other large areas are residential and commercial in nature. In
these latter parts the adverse environmental factors which serve to
raise the respiratory death rates in the industrial sections are
operative to a much smaller degree. The study of respiratory
death rates opens up a field of investigation which is of great
importance in the assessment of the effect of invironmental factors.
Reference should also be made to the notes on pneumonia,
influenza, and bronchitis in the section on infectious diseases.
DEATHS FROM CIRCULATORY DISEASES,
(a) Diseases of the heart.
This group of diseases covers pericarditis, acute and
chronic endocarditis—including all forms of valvular disease,
myocarditis, disease of coronary arteries, disordered action of the
heart, dilatation, and heart disease—ill-defined and not allocated to
some other primary condition. The group now refers to those
diseases included in headings 90 to 95 inclusive of the International
List. There have been during the course of the last fifty years
considerable changes in the method of allocating deaths due to
heart diseases. It is impracticable to give full details here, but
it may be said that in computing the number of deaths due to these
conditions I have attempted to take these changes into consideration
as much as possible.
During the year 1937 the number of deaths from heart
disease was 787, of which 384 were of males and 403 of females.
This number was a decrease of 35 persons compared with the
figure for the previous year, which incidentally showed the highest
number of deaths so far allocated to these conditions. The rate
per 1,000 of the population was 3.03 as compared with a rate of
3.09 for the previous year.
Of the total of 787 heart disease deaths registered, 558
were due to myocarditis or other diseases of the myocardium, and
124 to chronic endocarditis or valvular disease.
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