'I have the honour to submit the 58th annual report on the marriages, births and deaths registered in Ireland during the year 1921 . . . The number of deaths registered in 1921 amounted to 63,838, a number equivalent to 14.2 per 1,000 of the estimated population, which is the lowest rate recorded for Ireland."
This was the proud introduction of Earnan De Blaghd, Minister for Local Government, to the registrar-general's annual report for 1921. Due to the imminent political changes involving partition, it was to be the last all- Ireland report until 2001. Eighty years later, the Institute of Public Health, an all-island body set up under the Good Friday Agreement, published "Inequalities in Mortality 1989-1998: A Report on All-Ireland Mortality Data".
How has the health of the nation changed as we move into the 21st century? The most striking difference is in the number of deaths from tuberculosis. More than 7,000 people died from the dreaded "consumption" in 1921, compared with 70 in the late 1990s. What was a rate of 157.3 deaths per 100,000 population is now 1.3, reflecting the introduction of effective antibiotic treatment and a huge improvement in living conditions and sanitation.
A county-by-county analysis of TB deaths in 1921 showed a particularly high rate for Dublin city and county. While Cork, Belfast and Limerick each had similar rates in the region of 160 per 100,000, Dublin experienced a rate of 275 deaths per 100,000.
James Plunkett, in his great novel Strumpet City, gives a graphic account of living conditions in the capital during the early 1900s. Tenement living, adults forsaking food so as to feed their children, and a Poor Law approach to medical care - all contributed to the spread of Mycobacterium tuberculosis, the bug which causes TB. The hacking and expectoration created perfect conditions for the contagion, which is carried by droplets in the air.
TB was a horrible way to die, as the following contemporary account illustrates: "There is shortness of breath, pains in the breast, profuse sweats during sleep, spitting of blood and matter. Shivers succeeded by hot fits, with flushing of the face and burning of the hands and feet, and, in the last stages of the illness, a diarrhoea that helps to waste what little remains of flesh and strength."
The rate of infant mortality is regarded as a particularly sensitive measurement of a region's health. In 1921, the rate for Belfast and Dublin compared unfavourably with that of London. The UK capital had an infant mortality rate of 80 deaths per 1,000 live births; Dublin's infant mortality was 134 per 1,000, suggesting a sizable gap in the overall health of the two capital cities.
Eighty years later, the all-Ireland infant mortality rate - at 6.1 per 1,000 births - is little different from that of the UK. Regional differences have also been eliminated, although unequal access to health services undoubtedly continues in certain parts of the inner city.
There were 2,760 violent deaths on the whole island in 1921. This high number reflected ongoing political disagreements, with armed conflict between those in favour of partition and those committed to a united Ireland. Twelve hundred deaths were the result of homicide, about 1,100 of which were caused by gunshot wounds. Another sign of the times were the 21 deaths caused by execution following legal sentencing.
The 2001 report shows a higher death rate from homicide in Northern Ireland than in the Republic, which again illustrates ongoing paramilitary activity. Most violent deaths involve young men; in the Republic, road traffic accidents are now the main killer of young males.
Cancer is regarded by many as a modern disease. In this regard, it is interesting to note the 3,895 deaths from all cancers on the island in 1921. There are now almost 11,000 cancer deaths a year, according to the Institute for Public Health report. These figures are due partly to better overall medical detection as well as to more accurate diagnosis. Nevertheless, the crude death rate for cancer in 1998 was two and a half times that of 1921.
Diabetes is most definitely on the increase - a product of a more affluent lifestyle and less exercise - a fact confirmed by the higher death rate from the disease in the late 1990s than in 1921.
Apart from TB, other infectious diseases were very much a matter of life and death in the 1920s. In 1921, there were 40 deaths from tetanus, a disease which is almost unheard of today thanks to the primary immunisation scheme administered by the State. Whooping cough claimed 582 souls, while the number of deaths from diphtheria that year was the highest since records began in 1864.
The publication of the 2001 Mortality Report was a hugely symbolic event and further evidence of the value of cross-Border co-operation in health planning. But it is interesting to make the 80-year comparison and to get a feel for the different challenges we now face. While violence and infection were once the main killers, we must now do battle with cancer, heart disease and diabetes in an ongoing drive for longevity.