[Report of the Medical Officer of Health for London County Council]

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The distribution of the deaths by ages in 1918 and the five preceding years is shown in the following table .—

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The following is an analysis of the cases notified in London in 1918 (52 weeks).

Form of tuberculosis notified.	Sex	Notifications on Form A. (Total of primary notifications received in London boroughs, other than elementary school cases, infra).
Form of tuberculosis notified.	Sex	0—	1—	5—	10-	15—	20—	25—	35 —	45 —	55—	65 +	Age not stated.	Total.

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Form of tuberculosis notified.	Sex.	Notifications on Form B. (Primary notifications of cases discovered through medical inspection in elementary schools).					Notifications on Form C. (Secondary notifications from institutions receiving cases).
Form of tuberculosis notified.	Sex.	0—	5—	10—	15+	Total.	Poor law.	Other.

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The ages mainly affected by the migration which the decline in population implies will be seen from the following figures quoted from the censes of 1911 (Vol. VII., p xxiv.),Showing the number of persons in various age-group in Cornwell compared with England and Wales taken as 100.-

Sex	Age-group
Sex	15-	20-	25-	30-	35-	40-	45-	50-	55-	60-	65-	70-	75-	80-	85-	90-

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Of the 265 cases, 31 proved ultimately not to be cere brospinal fever. The monthly distribution is shown

Month.	Jan.	Feb.	Mar.	April	May.	June.	July.	Aug.	Sept.	Oct.	Nov.	Dec.

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The age distribution was as follows:—

Age.	Under 3.	3—5.	5—10.	10—20.	20—30.	30—40.	40—50.	50—60.	Over 60

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recorded since these diseases were made notifiable in 1911, viz., 53 in each of the two years. The following table shows the number of notified cases each year since 1911 :—

	1911, from 1st Sept	1912.	1913.	1914.	1915.	1916.	1917.	1918.

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Month	Jan.	Feb.	Mar.	April	May.	June.	July.	Aug.	Sept.	Oct	Nov	Dec.

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The subjoined table shows the age incidence .—

Age	Under 3	3—5.	5—10.	10—20.	20—30.	30—40.	40—50.	50—60.	Over 60.

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for comparison. It will be noticed that owing largely to conditions brought about by the war, these provisions have not been utilised to any great extent during recent years.

Metropolitan borough.	No. of representations.					No. of closing orders.					No. of houses demolished.
Metropolitan borough.	1014.	1015.	1016.	1017.	1918.	1314.	1015.	1916.	1917.	1918.	1914.	1915.	1916.	1917.	1918.

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The subjoined table indicates the numbers, inclusive of advanced cases, under treatment in residential institutions during the year :—

	Men.	Women.	Total.	Children.
	Men.	Women.	Total.	Boys.	Girls.	Total.

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During the year 361 cases were examined with the following results .—

	Males.	Females	Totals.		Males.	Females	Totals.

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In the following table will be seen the number of houses, the authorised number of lodgers, the number of convictions, with the penalties inflicted and other particulars, during each year since the outbreak of war :—

Year.	No. of houses licensed.	Authorised number of lodgers.	No. of day visits by inspectors.	No. of night visits.	No. of prosecutions.	No. of convictions.	Penalties and costs.			No. of cases of infectious disease.

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In the following table will be seen the number of houses, the authorised number of lodgers, the number of convictions, with the penalties inflicted and other particulars, during each year since these houses were licensed by the Council.—

Year.	No. of licensed houses.	Authorised number of lodgers.	No. of day visits.	No. of night visits	No. of prosecutions.	No. of convictions.	Penalties and costs.			No. of cases of infectious diseases.

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TABLE I. COUNTY OF LONDON. Vital statistics for the several metropolitan boroughs and the County of London in the year 1918. (Rates per 1,000 of civil population).

Metropolitan borough. (In topographical order).		Estimated civil population. 1918.	Births.	Deaths.	Infant mortality (per 1.000 births).	Measles.	Scarlet lever.	Diphtheria.	Whooping-cough.	Typhoid fever.	Diarrhœa and Enteritis age 0-2 (per 1,000 Dirths).	Phthisis.	Cancer.	Cases of notifiable infectious disease.
Metropolitan borough. (In topographical order).		Estimated civil population. 1918.	Births.	Deaths.	Infant mortality (per 1.000 births).	Measles.	Scarlet lever.	Diphtheria.	Whooping-cough.	Typhoid fever.	Diarrhœa and Enteritis age 0-2 (per 1,000 Dirths).	Phthisis.	Cancer.	Smallpox.	Scarlet fever.	Diphtheria.	Typhoid fever.	Erysipelas.	Puerperal fever (per 1,000 births).	Cerebrospinal fever.

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TABLE II. COUNTY OF LONDON. Statistics of the administrative work carried out during the year 1918.

Sanitary Authority.	Cowsheds.		Slaughterhouses.		Offensive Trades.		Smoke nuisances.			Underground rooms.		Overcrowding.		Houses let in lodgings.			Common lodging houses.		Cleansing of persons and rooms.			Water supply.	Milk-shops.		lce cream premises.		Other food places.
Sanitary Authority.	No. licensed.	No. of inspections.	No. licensed	No. of inspections.	No. licensed.	No. of Inspections.	Observations.	Complaints.	Notices.	No. illegally occupicd.	No.closed or otherwise remedied.	Instances found.	No. remedied.	No. on register.	No. of inspections.	Prosecutions.	Houses licensed.	Authorised lodgers.	Adults.	Children.	Premises or rooms.	Tenement houses extra supply.	No. on register.	No. of inspections.	No. on register.	No. of inspections.	No. of places.	No. of inspections.

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TABLE III Tuberculosis Dispensaries-Analysis of Returns, Jan.-Dec., 1918.

1 Borough.	2 Examined for the first time					3 No. included under (2). Suffering from Pulmonary Tuberculosis.					4 No. included under (2). Suffering from Non-Pulmonary Tuberculosis.					5 No. included under (2). Found to be Non-Tuberculous.					6 No. included under 2 when Diagnosis Doubtful.					7 Total Attendances at Dispensary, including those under column 2.		8 Attendances included in column 7 at which systematic examination and records were made.		9 Visits to homes made by Dispensary Medical Officers.		10 Visits to homes made by Dispensary Nurses.		11 Referred to hospital to which Dispensary affiliated.		12 Specimens of sputum examined.
	Insured.		Unisured			Insured.		Uninsured.			Insured.		Uninsured.			Insured.		Uninsured.			Insured.		Uninsured.			Insured.	Uninsured	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.
	M.	F.	M	F	Chldn.	M.	F.	M.	F.	Chldn.	M.	F.	M.	F.	Chldn.	M.	F.	M.	F.	Chldn.	M.	F.	M.	F.	Chldn.	Insured.	Uninsured	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.	Insured.	Uninsured.

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ENTRANT INFANTS.

	Clothing and Footgear.			Nutrition.			Cleanliness (Body).			Cleanliness (Head).
Year.	Good.	Fair.	Poor.	Excellent	normal.	Subnormal.	Clean.	Nits.	Verminous.	Clean.	Dirty.	Verminous.

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INTERMEDIATE AGE GROUP (aged 8).

	Clothing and Footgear.			Nutrition.			Cleanliness (Head).				Cleanliness (Body).
Year.	Good.	Fair.	Poor.	Excellent	Normal.	Subnormal.	Clean.	Nits.		Verminous.	Clean.	Dirty.	Verminous.

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The treatment results obtained in the last term of 1918 in the selected schools, compared with London for the whole year, may be stated as follows:—

	London, per cent.	Selected schools, per cent.

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The facts as to scarlet fever incidence may, therefore, now be set out (in a form slightly modified from that given in the 1914 report) as follows; the sign + signifying excessive incidence and the sign— abnormally low incidence.

	Under school age.	School age.	Over school age.

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The following statement shows the nature of the conditions found among the children certified suitable for admission to physically defective schools at the admission examinations during the year:—

Morbid Condition.	Boys.	Girls.	Total.	Certified.	Boys.	Girls.	Total.

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The following return shows the numbers of exceptional children recorded on 31st December, 1918:—

	Blind and partially blind	Deaf and hard of hearing.	M.D., excluding imbeciles and idiots.	Physically defective.

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Special Class of Physical Exercises at Moreland-street (G.)

1917.	1918.

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TABLE A. Table showing the results of medical inspection in London Elementary and Special Schools.

	Entrants.		Intermediate.		Leavers.		Total in Age Groups.	Special cases.		Special schools.
	Boys. Girls.		Boys.	Girls.	Boys.	Girls.	Boys and Girls.	Boys.	Girls.	Children in schools for the mentally defective.	Deaf.	Myope.

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TABLE B. Number and percentage of children in each age group classified as regards clothing, nutrition, cleanliness, condition of teeth, visual acuity and mental capacity.

		Clothing and Footgear. a			Nutrition. b				Cleanliness of Head. c			Cleanliness of Body. d			Condition of Teeth. e			Visual Acuity. f			Mental Condition. g
		1	2	3	1	2	3	4	1	2	3	1	2	3	1	2	3	1	2	3	1	2	3

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TABLE C. Result of re-inspections carried out during 1918. Percentages in italics. 1st Re-inspections.

	Treatment Provided.						Not Treated.
	By doctor.		Under Council's scheme.		At other hospitals.		Treatment no longer necessary	Requiring observation only	Treatment still required.
	Cured.	Not Cured.	Cured.	Not Cured.	Cured.	Not Cured.	Treatment no longer necessary	Requiring observation only	Treatment still required.

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2nd Re-inspections.

	Treatment Provided.						Not Treated.
	By doctor.		Under Council's scheme.		At other hospitals.		Treatment no longer necessary	Requiring observation only.	Treatment still required.
	Cured.	Not Cured.	Cured.	Not Cured.	Cured.	Not Cured.	Treatment no longer necessary	Requiring observation only.	Treatment still required.

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Cases noted as requiring observation.

	No. of cases.	Discharged as cured.		Still requiring observation, or treatment.

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TABLE D Scholars—Defects noted on medical examination.

Institutions.	No. examined.	Defects.
		Teeth.	Vision.		Throat and nose.	Bars.		Heart.	Lungs.	Anaemia.	Back.		Nutrition.	Various.
		Teeth.	Defective.	Signs of eye-strain.	Throat and nose.	Hearing.	Discharge.	Heart.	Lungs.	Anaemia.	Round.	Curvature.	Nutrition.	Various.

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(ii.) Secondary asd Trade Schools, aided but not maintained by the Council.

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LONDON, Registered Weekly Deaths from Influenza, Pneumonia and Bronchitis During 1918 and 1919.

No. of Week.	Week ended	Deaths registered.			No. of Week.	Week ended	Deaths registered.
No. of Week.	Week ended	Influenza.	Pneumonia.	Bronchitis.	No. of Week.	Week ended	Influenza.	Pneumonia.	Bronchitis

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Certified cause of death.	1918 Summer epidemic.		1918 Autumn epidemic.		1919 Winter epidemic.
Certified cause of death.	Deaths.	per cent.	Deaths.	per cent.	Deaths.	per cent.

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The actual and relative incidence of death at various ages certified as due to influenza in the periods of marked epidemic mortality were as follows:—

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A general comparison of the relative age and sex incidence in London and a group of large towns of England and Wales in the summer and autumn epidemics is shown in the following table:—

	Metropolitan Boroughs. 1				Large Towns.*				London County.
Age Group.	Summer Epidemic.		Autumn Epidemic.		Summer Epidemic.		Autumn Epidemic.		3rd Quarter, 1918.		4th Quarter, 1918.

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New York—Deaths at Ages from Influenza and Pneumonia Mid-March—Mid-April 1915-17 compared with 1918.

Causes of death.		All Ages.	0—5	5—15	15—25	25—45	45—65	65 +

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London County Council 1918

36 tables in this report

The distribution of the deaths by ages in 1918 and the five preceding years is shown in the following table .—

The following is an analysis of the cases notified in London in 1918 (52 weeks).

The ages mainly affected by the migration which the decline in population implies will be seen from the following figures quoted from the censes of 1911 (Vol. VII., p xxiv.),Showing the number of persons in various age-group in Cornwell compared with England and Wales taken as 100.-

Of the 265 cases, 31 proved ultimately not to be cere brospinal fever. The monthly distribution is shown

The age distribution was as follows:—

recorded since these diseases were made notifiable in 1911, viz., 53 in each of the two years. The following table shows the number of notified cases each year since 1911 :—

The subjoined table shows the age incidence .—

for comparison. It will be noticed that owing largely to conditions brought about by the war, these provisions have not been utilised to any great extent during recent years.

The subjoined table indicates the numbers, inclusive of advanced cases, under treatment in residential institutions during the year :—

During the year 361 cases were examined with the following results .—

In the following table will be seen the number of houses, the authorised number of lodgers, the number of convictions, with the penalties inflicted and other particulars, during each year since the outbreak of war :—

In the following table will be seen the number of houses, the authorised number of lodgers, the number of convictions, with the penalties inflicted and other particulars, during each year since these houses were licensed by the Council.—

TABLE I. COUNTY OF LONDON. Vital statistics for the several metropolitan boroughs and the County of London in the year 1918. (Rates per 1,000 of civil population).

TABLE II. COUNTY OF LONDON. Statistics of the administrative work carried out during the year 1918.

TABLE III Tuberculosis Dispensaries-Analysis of Returns, Jan.-Dec., 1918.

ENTRANT INFANTS.

INTERMEDIATE AGE GROUP (aged 8).

The treatment results obtained in the last term of 1918 in the selected schools, compared with London for the whole year, may be stated as follows:—

The facts as to scarlet fever incidence may, therefore, now be set out (in a form slightly modified from that given in the 1914 report) as follows; the sign + signifying excessive incidence and the sign— abnormally low incidence.

The following statement shows the nature of the conditions found among the children certified suitable for admission to physically defective schools at the admission examinations during the year:—

The following return shows the numbers of exceptional children recorded on 31st December, 1918:—

Special Class of Physical Exercises at Moreland-street (G.)

TABLE A. Table showing the results of medical inspection in London Elementary and Special Schools.

TABLE B. Number and percentage of children in each age group classified as regards clothing, nutrition, cleanliness, condition of teeth, visual acuity and mental capacity.

TABLE C. Result of re-inspections carried out during 1918. Percentages in italics. 1st Re-inspections.

2nd Re-inspections.

Cases noted as requiring observation.

TABLE D Scholars—Defects noted on medical examination.

(ii.) Secondary asd Trade Schools, aided but not maintained by the Council.

LONDON, Registered Weekly Deaths from Influenza, Pneumonia and Bronchitis During 1918 and 1919.

The actual and relative incidence of death at various ages certified as due to influenza in the periods of marked epidemic mortality were as follows:—

A general comparison of the relative age and sex incidence in London and a group of large towns of England and Wales in the summer and autumn epidemics is shown in the following table:—

New York—Deaths at Ages from Influenza and Pneumonia Mid-March—Mid-April 1915-17 compared with 1918.