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London Country Council.
Report of the Public Health Committee submitting the report of the
Medical Officer of Health of the County of London for the
year 1904.
We submit the Medical Officer's annual report for 1904, and observe that the London
death rate, although it has risen from 152 per 1,000 in 1903 to 16.1 per 1.000 in 1904, is still
very much below the average of the last 10 years. Notwithstanding the increase of organised
effort to reduce the mortality of infants, the death rate of children under 1 year of age has
risen from 180 per 1,000 births in 1903 to 144 per 1,000 births in 1904.
The marriage rate has further declined from 17.5 per 1,000 persons living in 1903 to 17.0
per 1,000 persons living in 1904. The decrease in the birth rate has also continued, and the rate
for 1904 (27.9 for 1,000 persons living) is the lowest recorded rate since the institution of civil
registration.
489 cases of smallpox were notified in London in 1904, and 25 deaths were registered as due
to this disease, as compared with 416 cases and 13 deaths in 1903. With the object of facilitating
the detection of cases of the disease, which has frequently been incorrectly diagnosed as chickenpox,
the Council, on 29th March, 1904, again made an order rendering chickenpox a notifiable disease in
London, and this order was subsequently renewed and remained in force until 7th November, 1904.
Medical experts were also appointed by the Council for the assistance of medical practitioners in
diagnosing doubtful cases of smallpox, and special precautions were again taken to prevent as far
as possible the spread of the disease in common lodging houses and seamen's lodging houses,
frequent visits being made and all suspected cases being examined by the experts.
We regret to observe that the number of deaths from measles has increased from 2,046 in
1903 to 2,256 in 1904. In the early part of 1903 an order was made by the Council extending to
measles the more important sections of the Public Health (London) Act, 1891, except that requiring
notification, and the Medical Officer's report contains particulars of the action taken by
sanitary authorities to give effect to the order. It is too soon yet to expect that the order has
attained its object of educating the public as to the dangerous character of the disease, but it is
satisfactory to note that progress is being made in that direction.
The number of cases of scarlet fever has increased from 12,531 in 1903, to 13,439 in 1904 ;
but the number of deaths is practically the same (365 in 1904, as against 361 in 1903).
Diphtheria was reponsible for 723 deaths in 1904, as compared with 740 in 1903, the
number of notified cases having also decreased from 7,738 to 7,219. This disease proves much
more fatal to children of tender years than to older children and adults. The number of deaths
from whooping cough in 1904 was 1,495, as against 1,627 in 1903. The decline in the mortality
from this disease, which appears to have begun in the decennium 1871-80, and was conspicuous
in the decennia 1881-1900 and 1891-1900, has been since maintained.
A further substantial reduction has taken place in the number of cases of enteric fever,
and the case-mortality has also declined as compared with that in 1903. The medical officer
points out that some London districts suffer from this disease practically twice as much as others,
and he thinks this is more especially due to the fact that the habits of the population in poor
districts give more opportunity for the spread of the disease from one person to another. Shellfish,
fried fish, and watercress in a number of cases came under suspicion as the infecting agent.
It will be remembered that the result of a careful enquiry by Dr. Hamer into localised prevalences
of enteric fever in 1903 pointed to infection by fried fish.* As regards shell-fish, the Council has
urged the Local Government Board to give effect to the recommendations of the Royal Commission
on Sewage Disposal (fourth report), t The condition of watercress beds from which London iB
largely supplied has recently been the subject of a special investigation by the Council's medical
officer and chemist, and iu certain instances many causes of pollution were found. The Local
Government Board has been furnished with copies of the report containing the results of the
inquiry, as well as with details of the localities referred to therein. (Appendix II.)
The deaths attributed to influenza which in 1903 numbered 644 rose in 1904 to 709.
Bronchitis and pneumonia were together the cause of 12,982 deaths as compared with 11,066
in 1903.
7,526 persons died of phthisis in London in 1904 as against 7,124 in 1903. This increase is,
however, slight compared with the marked decline in the mortality from this disease shown when
a number of years is reviewed. There was a slight decline in the number of deaths due to cancer,
the death rate for 1904 per 1,000 persons living, being 0 92 as against 0.96 in 1903. The medical
officer points out that the incidence of cancer mortality in no way corresponds with the incidence
of phthisis mortality, which appears to be largely governed by the social condition of the population.
The arrangements made by the Council for dealing with persons coming into contact with
cases of plague have been maintained, but fortunately there were no cases or suspected cases
brought to its knowledge in 1904.
* Enteric fever.—Report by the Medical Officer of Health, presenting report by Dr. Hamer on prevalences of
Enteric Fever in London at the close of 1903 (No. 719).
† Royal Commission on Sewage Disposal (Fourth Report) (Cd. 1883-1904).
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