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London Coming Council.
ANNUAL REPORT OF THE COUNCIL, 1920.
CHAPTER XXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR
THE YEAR 1920.
PART I.—GENERAL.
Introductory Note.
The Vital Statistics of London for 1920 arrest attention. The marriage rate remains, it is true,
the same as last year; but the birth rate has risen from 18.2 to 26.4; the death rate has fallen to 12.6,
the lowest London rate ever registered, and the infant mortality has dropped to 76, also a record, lower
even than the 80 of England and Wales as a whole, and comparing favourably with the 85 of the other
great aggregation of population, that of New York.
These phenomenal general and infantile death rates, relating as they do to so large a population
as that of the County of London, must give pause to those who advocate, at any rate on grounds of
health alone, a "return to the land," and cause hope to spring in the breast of even the most gloomy
and pessimistic of the 4½ millions of human beings, whose avocations compel them to live or work within
a few miles of St. Paul's. A death rate of 12.6 if it were possible to maintain it at that level for a
scries of years, would entail an average duration of life of the fourscore years deemed some thousands
of years ago to be attainable only " by reason of strength," and far exceeding the expectation of life of
the first Life Table of William Farr and of all the later Life Tables too.
But the critic may object that 1920 was an exceptional year, coming as it did after five years of
war, in which appalling losses were sustained ; following, moreover, upon the great influenzas of 1918
and 1919, in which such heavy toll was taken of the weak and infirm as to leave the survivors by comparison
resistant to the ill-effects of disease. Again, it may be urged by the critic, the rising birth rate
in itself may have tended to influence favourably the rate of infant mortality. In reply, it may be well
" differentiating and drawing within an inner circle," to limit the argument, as a recent Chadwick
lecturer has done, to comparison between the rates of mortality of fevers in, say, the four years 1847-50
(during which the first great Public Health Act was passed) and 1916-19. In the latter the rate of
mortality in England and Wales from typhus, typhoid, cholera, small-pox, scarlet fever, diphtheria, and
whooping-cough was only in the proportion of about 1 to 8 of that in the earlier period ; while the death
rate in a single year, 1849, was 18 times as great as in 1919. Again a comparison of the corresponding
London figures for 1920 and for 1849 shows a closely similar proportion between the earlier and the later
rates. Of course 1849, as well as being a heavy cholera and fever year, was an influenza year; and
while 1920 was comparatively free from influenza, two years before, in 1918, a very high death rate
from influenza was registered in London. Still, even in the year 1918, the total London death rate was
only rather more than half that of 1849, the earlier year of exceptionally heavy mortality.
The high marriage rate of the previous year was maintained in 1920, being 22 per 1,000 of the Marriage
estimated population.
The Registrar-General estimates the birth rate to have been 26.4 per 1,000, as compared with Births.
18.2 in 1919. In the first quarter of the year the birth rate was 31.4, but thereafter it declined, and in
the fourth quarter it had fallen to 22.9, a figure somewhat below the pre-war average for this quarter.
The death rate among civilians is estimated by the Registrar-General to have been 12/6, as Deaths.
compared with 13.6 in 1919. There were relatively few military deaths in the year, and the number
belonging to London cannot be ascertained ; but even allowing for these deaths, and for the uncertainty
as to the true population, there seems little doubt that the mortality was well below any previous record
in London. The mortality among infants under one year of age per 1,000 births was 76 in 1920, which
is considerably below any London rate previously recorded.
Comment was made in the report for 1919 upon the fact that certain notifiable infectious diseases infections
were showing increase upon the low rates of prevalence of the preceding two or three years. This upward disease.
movement continued last year so far as scarlet fever, diphtheria, erysipelas and puerperal fever were
concerned, and the high incidence of the two first-named diseases in 1920 is referred to in detail in the
second part of this report. The case-mortality happily continued to be far lower than that of earlier
experience, as has now been the case for the last forty or fifty, and very notably so during the last twenty
or twenty-five, years. Smallpox did not establish itself in 1920, though several imported cases naturally
gave rise to apprehension. Typhus, though widespread in some parts of the Continent, particularly
Poland and Russia, obtained no footing here. The special efforts made to minimise risk of spread of
typhus in London by a more systematic delousing campaign in the elementary schools, are described in
the second part of this report. The urgent need for taking these steps was emphasised by the revival of
the transmigrant traffic between Europe and the New World, to which reference is made on p. 33.
Dysentery, which had declined in 1919 as compared with 1918, showed further decline in 1920.
The behaviour of typhoid fever in the years preceding the war, during the war years and subsequently,
is one of the most noteworthy epidemiological phenomena of the time. So much misapprehension
exists on this subject that it was thought desirable in last year's report to review the whole position so
far as the decline of typhoid fever in the last fifty, and particularly in the last twenty, years is concerned.
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