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Diseases of the circulatory system are currently the leading cause of mortality among Australians, being responsible for almost one-third of all deaths in 2010 (ABS, 2012). As with cancer, circulatory system diseases seemed to have considerably less impact on colonial Australians, although they claimed a growing proportion of deaths as the nineteenth century drew to a close.

Circulatory system deaths were returned under a number of nosological headings, including ‘endocarditis’, ‘pericarditis’, ‘aneurism’, ‘heart disease’, ‘angina pectoris’, ‘syncope’, ‘embolism’ and ‘thrombosis’. Current nomenclatures such as ‘heart attack’, ‘infarction’, ‘ischaemic heart disease’ and ‘cerebrovascular disease’ were absent.

Deaths from ‘apoplexy’, ‘paralysis’, ‘congestion and haemorrhage of the brain’ and ‘softening of the brain’—terms which are analogous to stroke—were generally included under Diseases of the Nervous System. These, plus other selected Constitutional and Local Diseases are here included among diseases of the circulatory system (see Table 5.4).

‘Valvular disease’ was returned as a Disease of the Circulatory System. ‘Rheumatic fever’, ‘rheumatism of the heart’ and ‘infective endocarditis’ were inconsistently coded, appearing variously under the headings Zymotic Diseases, Constitutional Diseases or General Diseases (see Appendix 4). These conditions might be expected to make an important contribution to circulatory disease deaths although misclassification compromised accurate attribution. Much circulatory disease was misdiagnosed or went undiagnosed. Its pathology was not well understood until the 1880s and effective diagnostic procedures were largely absent, with the poor being especially affected (Smith, 1979, p.325; Morley et al., 2006). By 1906, New South Wales Government Statistician W. H. Hall felt that at least some of the apparent increase in circulatory disease deaths

‘…is due to a better acquaintance with the action of the heart, and to the fact that many deaths which were formerly attributed to old age are now referred to some form of heart disease’ (Hall, 1906, p.683).

Diagnosis also improved, so that

‘…a more definite description by medical practitioners of these causes of death is noticeable in recent years, proportionately fewer were certified as syncope and “heart disease,” and a larger number as endocarditis and valvular diseases’ (Drake, 1908, p.364).

Figure 6.29: Mortality rates for diseases of circulatory system, by colony, 1853–1906

Note: Mortality rates are age-standardised to the 1881 total Australian census population.

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 New South Wales

CDR ASR Deaths per 100,000 population

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 Victoria CDR ASR Deaths per 100,000 population

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 Queensland CDR ASR Deaths per 100,000 population

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 Western Australia CDR ASR Deaths per 100,000 population

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 South Australia CDR ASR Deaths per 100,000 population

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 Tasmania CDR ASR Deaths per 100,000 population

The statistics of the colonies show differing patterns—circulatory disease mortality declined somewhat after 1870 in New South Wales, Victoria and perhaps Western Australia, whereas it showed little net change in Queensland, South Australia and Tasmania (Figure 6.29). New South Wales Statistician Coghlan thought that higher rates in Victoria and South Australia in 1901–03 existed because they ‘contain the largest number of persons of middle and old age who are most prone to this order of disease’ (Coghlan, 1904).

Taken as a whole, Australian mortality from diseases of the circulatory system fell from around 140 deaths per 100,000 in the mid-1870s to 120 in the mid- 1900s. Rates plateaued somewhat between 1890 and 1900 (Figure 6.30).

Figure 6.30: Mortality rate for diseases of the circulatory system, Australia, 1856–1906

Note: Mortality rates are age-standardised to the 1881 total Australian census population.

0 50 100 150 200 1850 1860 1870 1880 1890 1900 1910 CDR ASR

Deaths per 100,000 population

0.0 0.5 1.0 1.5 2.0 2.5 1850 1870 1890 1910

Male:Female rate ratio

0 5 10 15 20 25 1850 1870 1890 1910

Male rates were higher, especially in the years to 1870. Referring obliquely to the greater prevalence of circulatory disease risk factors among males, the New South Wales Statistician felt that the elevated rates were ‘probably due to the greater risks and shocks to which males are exposed’ (Hall, 1906, p.683).

Circulatory disease deaths comprised a growing proportion of total mortality from around five per cent in the mid-1860s to over ten per cent by 1906, by which time it had assumed the status of a leading cause of death.

Mortality increased rapidly after age 40 (Figure 6.31). Deaths among the elderly were increasingly returned as circulatory disease; 13 per cent of all deaths among persons aged 75 and over in 1875–79, rising to 21 per cent in 1900–04. Figure 6.31: Age-specific mortality rates for diseases of the circulatory system, Australia, 1875–79 and 1900–04

In reviewing the status of circulatory disease at the end of the nineteenth century, one commentator anticipated better days ahead;

‘May we not hope that wiser and quieter conditions of life will yet arrest the modern tendency to heart disease...Who will venture to say that, in view of these many cases of needless dying, the moral and intellectual progress of the race will not yet achieve an enormous saving of human life? Perhaps the coming century will multiply by ten the proportion of mankind that reaches the full span of years.’ (Brisbane Courier, 19 Sep. 1898, p.4)

They could not possibly foresee the impact that the disease would have during the course of the twentieth century.

0 500 1,000 1,500 2,000 2,500 3,000 0 1- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- Age group (years)

1875-79 1900-04 Deaths per 100,000 population