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London County Council.
ANNUAL REPORT OF THE COUNCIL, 1914.
CHAPTER XXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. Hamer) for the
year 1914.
Part I.—General.
Introduction.
At the time of the census in April, 1911, the area of the administrative County of London was
74,816 acres, and the enumerated population was 4,521,685 persons. The population in the middle
of the year 1914, as estimated by the Registrar-General, was 4,518,021 persons. Reference is made
in the subsequent report to the question of movement of population, and in particular to its bearing upon
the age-constitution of the London community. This influence has undoubtedly appreciably affected
the birth, marriage and death rates, and has disturbed somewhat seriously the recorded mortality
rates for many chronic diseases. The principal vital statistics of London as a whole and of certain
large towns of England and Wales for the year 1914 and preceding periods, are shown in separate tables
at the end of this report (Tables I.—III., pages 40-42); the corresponding figures relating to the constituent
administrative districts of London are set out in the various sections of the report.
The marriage rate, which fell to a minimum (16-9 per 1,000 living) in 1908 and 1909, attained
during the year 1914 the comparatively high level of 19'2, a figure which has not been reached since
1876. The exceptional circumstances prevailing during the latter part of the year undoubtedly exercised
sonm influence in producing this result, but since 1909, even in normal years, the marriage rate has
shown a gradual recovery from the low level reached in 1908.
The birth rate, which failed in 1913 for the first time since 1903 to show a decline on the rate
of the preceding year, again showed diminution during 1914, being 24'3 per 1,000 persons living, as
compared with 245 per 1,000 in 1912 and 1913. The maximum birth rate was attained in 1876, the
year preceding the fall in the marriage rate.
The death rate (14.4 per 1,000 living) shows a slight increase on the rate for 1913. This rate
has fluctuated considerably in the last decennium, reaching as high a figure as 15'8 in 1906, and falling
as low as 13.6 in 1912, in which year the rate was the lowest ever recorded for London. The present
rate, however, compares very favourably with the rates, exceeding 20'0 per 1,000, in the years preceding
1890. The infant mortality rate (104 per 1,000 births) is slightly lower than in 1913, but exceeds considerably
the very low rate of 1912 (91 per 1,000 births). In the earlier year, it is to be observed that
the summer temperature Was below the average, whilst the rainfall, especially during the month of
August, was above the average. Probably this fact had its effect upon the mortality from diarrhoea,
for the deaths were only half as numerous in 1912 as in 1913 or 1914.
Comparing the year 1914 with 1913 as regards the principal epidemic diseases, measles shows
decreased mortality, though towards the end of 1914 it began to be increasingly prevalent; while scarlet
fever and diphtheria display an increase, the latter with a slightly raised case mortality; whooping
cough also exhibits increased mortality. The death rate from typhoid fever remains very low, but the
case mortality is slightly higher than that usually observed. Having in view the conditions prevailing
on the Continent in the latter half of jthe year, and the large number of persons arriving in this country
from abroad, the most careful scrutiny was made of all suspected or possible imported cases of epidemic
disease. Fortunately, during 1914 there was no development of mischief in London in respect of
cholera, plague, small-pox, typhus or typhoid fevers, though reference to the introduction of isolated
cases of the three last named diseases from abroad will be found under the appropriate heads.
Among the notifiable infectious diseases, scarlet fever, diphtheria, typhoid fever, and erysipelas
all showed some increase of prevalence during the year as compared with the preceding years. Reference
is made on p. 57 to the subject of possible relationship between prevalence of scarlet fever and of
certain kinds of vermin. The circumstances attending an exceptional prevalence of typhoid fever in
the early part of 1914 are analysed in some detail (p. 20) and reference to the general question
of the origin of cases of typhoid fever in London is also made. As regards pulmonary tuberculosis
16,467 primary notifications were received as compared with 19,218 during eleven months only of 1913.
For " other forms of tuberculosis " the respective figures were 3,862 and 6,436. Seventy-three cases
of cerebrospinal fever were notified as against 92 in 1913. A discussion of the relationship between
influenza and cerebro-spinal fever, as illustrated during the increased incidence of these diseases
commencing towards the end of 1914, will be found on page 34. The subject is one of no little
interest; indeed, it has occupied the attention of students of epidemic disease for many years past; the
recent outbreak has afforded a good [opportunity for making a detailed study of the whole question.
It may be stated as the outcome of this investigation that the number of instances in which sufferers
from cerebro-spinal fever have been found to have been coincidently affected by influenza, is far
higher than would have been anticipated had the association been merely a matter of chance.
Poliomyelitis also shows a decline ; some account of a very interesting group of cases of poliomyelitis
notified in East London during the summer months is given on p. 37 ; it is especially noteworthy that
the majority of these cases were reported from the London Hospital, and there is no doubt that the
careful attention given to this disease by the staff of; that hospital accounts for the fact that this
prevalence of the disease has not passed without being recorded.
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