The Health of the People J UDICIOUS students of vital statistics
look upon Sir George Newman's annual Report as one of the most fascinating publications of the year. It is always readable, because Sir George moves easily among figures, and detects and expounds tendencies. The Report of this Chief Medical Officer of the Ministry of Health deals, of course, only with England and Wales, but that means that it deals with a population of thirty- nine and a half millions out of a total population of about forty-four and a half millions.
He tells us that the year 1928 was not only an excep- tionally healthy year, but was perhaps the healthiest on record. Better organization of health, longer life, and reduced birth-rate are having notable and visible effects upon the " age constitution" of the nation. For more than a generation the proportion of children has been decreasing, and the proportion of persons past the prime of life has been increasing. The Registrar- General in 1928 estimated that the population contained 8.1 per cent, of children under five, but 15.8 per cent, of persons over 55. Amongst the latter the women out- numbered the men by more than half a million.
It is expected that by the year 1941, only 7.5 per cent, of the population will be children, and that more than 19 per cent, will be persons over 55. When it is remem- bered that at the beginning of the twentieth century children outnumbered those in late middle age and old age, the remarkable character of the change will be appreciated.
In 1928 the birth-rate exceeded the death-rate by only five per thousand. In 1901 the excess of births over deaths was 11.6 per thousand. "We are almost," says Sir George, "within sight of a stationary population." A generation ago such a prospect would have caused consternation. Sociologists conventionally looked upon a rising birth-rate as a pledge of the future industrial capacity of the nation. The slightest downward wavering in the rate caused them to predict a national decline. A falling birth-rate was a sinister portent to be viewed as gravely as prophecies about the exhaustion of the coal-seams of Great Britain. We know now that our coal is not likely to be exhausted within any period that we need trouble about, and that by the date of exhaus- tion coal would in any case probably be no longer neces- sary as a source of energy. Thus also does the birth-rate cease to affect us with its old hauntings. It is recognized to-day that England and Wales are already about closely populated as is possible for- reasonable main-, tenance. At all events, a- new balance Will have to be struck between urban and rural populations if the numbers are to be safely increased. The actual number of children born in 1928 was 660,267—an increase of 6,095 over the 'previous year—but the figure of that year was the lowest on record. The deaths in 1928 weie 460,389, which was 24,220 fewer than in 1927.
The figures of infant mortality continually improve, but it is a strange and disturbing fact that they are accompanied by an increase in the maternal death-rate. The deaths of infants under one year old in 1928 numbered 42,960. In 1910 the figure was 94,579. In other words, infant mortality has been more than halved in eighteen years. The maternal death-rate for 1928, on the other hand, reached 4.42 per thousand, and was the highest recorded since 1911. Sir George suggests that it is useless to talk merely about improving the conditions in maternal institutions, as he is convinced that the majority of births will continue to take place in the "homes of the people." An improvement in domestic midwifery, therefore, is the real objective.
One further comment. Sir George puts in its proper perspective the alarm about post-vaccinal nervous disease. He shows that nervous disease was an extremely small group, and that it was by no means peculiar to vaccination. It followed attacks of influenza, measles, whooping cough and chicken-pox. "Vaccination," he adds, "is our sheet-anchor against smallpox."
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