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London County Council.
Report of the Public Health Committee submitting the report ot the
Medical Officer of Health of the County of London for
the year 1903.
In submitting the medical officer's report for 1903, we are glad to state that the London death
rate from all causes per 1,000 living has further declined to 15'2, the lowest on record. The medical
officer points out that the remarkably low death rate for that year was not peculiar to London, and
that it appears probable that some general cause, such as favourable meteorological conditions, was
largely responsible for the phenomenon.
The infant mortality rate has also declined, and both in the period 1893—1902 and in 1903
was lower in London than in any of the principal English towns except Bristol. The rate is, however,
unfortunately, far higher than it ought to be, and we are giving the subject our anxious consideration.
The number of marriages in London in 1903 was 40,215, giving an annual rate of persons
married of 17*4 per persons living, a slight decrease in the rate (17"8) for 1902. The steady decline
in the birth rate has continued, that for 1903 being 28'4 per 1,000 living, the lowest rate recorded in
London since the institution of civil registration.
The number of cases of small-pox noticed in London in 1903 was 416 as compared with 7,796
in 1902, and 1,700 in 1901, the deaths from this disease in these three years being respectively 13, 1,314,
and 229. It will thus be seen that, although the severe epidemic with which London was visited
in the last few months of 1901 and the early part of 1902 was practically at an end at the
close of August, 1902, a number of cases have since been from time to time reported. We have
continued our efforts to minimise the spread of the disease in common lodging houses and seamen's
lodging houses, and, when requisite, such houses have been visited daily by a medical expert
specially employed for the purpose. In some instances it has been necessary for the Council,
as on past occasions, to pay for the board and lodging of destitute occupants of such houses who
had been in contact with cases of this disease, this course being taken in order that these " contacts
" might be kept under observation.
Measles still continues the cause of deplorable mortality, no fewer than 2,046 deaths in London
being attributed to this disease in 1903. The Council has, on our advice, made an order,
which came into operation on 1st April, 1903, applying to measles certain sections of
the Public Health (London) Act, 1891. This order has the effect, while not making the disease
notifiable, of placing it on a level in other respects with the dangerous infectious diseases
specified in the Act. It is too early yet to gauge the results of the order, but we hope it
will have a good effect in impressing upon those charged with the custody of children the necessity of
taking proper precautions against the spread of the disease, especially having regard to the fatal effects
which often ensue from the exposure of sufferers from this malady before they have fully recovered
from it.
We are pleased to observe that in 1903 there was a considerable reduction in the number of
cases of scarlet fever, diphtheria, and enteric fever in London, as compared with the preceding year.
The case mortality from diphtheria also showed a progressive decline during the preceding ten years. The
result of investigations made by Dr. Hamer into exceptional prevalences of enteric fever in London at
the close of 1903 pointed to infected fish as the source of the outbreaks in question (Appendix I.)
T he deaths from influenza and bronchitis were also considerably below the annual average of the
preceding ten years. The medical officer points out the rapidity with which influenza may increase
from small to epidemic proportions and calls attention to the fact that the mortality from this disease
has usually attained its maximum in the late autumn and winter months.
Phthisis was the cause of 7,124 deaths in London in 1903, as against 7,424 in 1902. The
deaths registered under the heading " Cancer " still increase. 4,695 deaths were ascribed to this cause in
1903, the annual average of the preceding ten years being 3,964.
There were no cases of bubonic plague in London in 1903, but the Council's arrangements for
dealing, in case of necessity, with " contacts" have been maintained, and prompt action was taken
with regard to suspected cases.
The spread of enteric fever from the consumption of oysters and other shell fish which have
been exposed to sewage contamination has been the subject of reports which we have from time to
time made to the Council, and the fourth report of the Royal Commission on Sewage Disposal suggests
measures which should be adopted with a view to minimising this danger. The Council has, on our
advice, urged the Local Government Board to promote legislation to give effect to these recommendations
of the Royal Commission.
Watercress has also been held to be a source of danger when gathered from polluted sources,
and we are now engaged in making a thorough investigation into this subject.
The question of the purity of the milk supply of London has recently excited public attention,
and we think it right to remind the Council that in 1902 it made an unsuccessful attempt to obtain
from Parliament powers to deal more effectively with milk which had been exposed to infection.
The Council has, on our recommendation, decided to make a further attempt in the session of 1905
to obtain these powers, which we think are urgently needed in the interests of the London
public.