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London Counts Council.
Report of the Public Health Committee submitting the report of the
Medical Officer of Health of the County of London for the
year 1905.
In submitting the report of the Medical Officer of Health of the County of London for the
year 1905 we desire to make the subjoined observations on the valuable and interesting information
contained in the report.
Death-rate.—We observe with satisfaction the continued fall in the London death-rate, the rate
for the year 1905 being the lowest on record since registration of deaths was made compulsory. We
point out that the death-rate has fallen from 21.0 to 15.1 per 1,000, or nearly 30 per cent., since the
coming into operation of the Public Health (London) Act, 1891, which brought the Council into
more direct relation with sanitary administration in London. These percentages, however, do not
themselves convey their full meaning to the majority of readers, but an easily comprehended
statement is that made by the Medical Officer that in 1905, compared with the decennial period
1891-1900, there was, as the result of the diminished death-rate, an estimated gain to the community
of 19,584 lives. The continuance of a high rate of infant mortality, while the mortality
at all ages has declined, is discussed in the report, and the Medical Officer shows reason for thinking
that this is, at any rate in some important degree, due to a more complete registration of the
death of infants which survive their birth but a brief period, for the maintenance of the high rate is
largely accounted for by extensive mortality in very young infants, and among this class the high
rate appears to be in the main explained by increase in the number of deaths registered as due
to premature birth, congenital defects, and some other headings. Important support of this view
is afforded by the fact that, while social conditions, measured by the amount of "overcrowding,"
appear to govern the degree of infant mortality in the several parts of London, this is not
observable in the mortality occurring within the first few weeks after birth—a fact probably due
in part to the less complete registration of the death of new-born infants which might, perhaps, be
expected in the most overcrowded districts, and which would presumably manifest itself by causing
fewer returns to be made under the headings above named.
Epidemic diseases.—There were only 74 notified cases of smallpox during 1905, the disease
being at a comparatively low ebb after the wave of prevalence in 1901-02. The behaviour of measles
is being watched with special interest, inasmuch as the order of the Council applying certain
provisions of the Public Health (London) Act to measles has now been in force for some years,
and, as the result of the Council's action, more endeavours have been made to prevent spread of
this malady. It is as yet too soon to speak confidently as to the effect of the order. The Medical
Officer analyses the results of the inquiries made in certain parts of London as to the effect of
aggregation of children upon the prevalence of measles, and of the experience recorded in London
schools (see Appendix II.). No conclusive result can as yet be said to have been reached in connection
with the attempt which is being made to test the value of school closure in Woolwich by
dividing the district into two parts, in one of which school closure is adopted, while in the other it
is not. Further particulars of the variations in the age incidence of measles mortality in London
are given in Appendix I., in which are also given the figures relating to some other infectious
diseases, including diphtheria.
The practicability of taking further steps for limiting the mortality from phthisis is
engaging our attention, and we note that in 19 out of the 29 sanitary districts voluntary notification
of this disease is in force. We shall be in a better position later to ascertain how far further steps
may be desirable to bring to the knowledge of the several borough medical officers of health the
existence of cases of phthisis in their districts. We note that the rate of mortality from phthisis
during the year 1905 is reduced to one-half that for the decennial period 1861-70. The deaths
recorded as being due to cancer, which in London, as in England and Wales generally, underwent
such marked increase during the last twenty years of the nineteenth century, probably
as the result of improvement in diagnosis, have, it is interesting to observe, remained practically
stationary during the last few years. The Medical Officer has examined the death-rates (corrected
for age and sex distribution) in groups of sanitary areas with varying degrees of overcrowding, and
finds in them confirmation of the conclusion already arrived at, as the result of similar inquiry
relating to the period 1901-4, that there is no evidence of relationship between cancer mortality and
social condition. In this respect cancer stands in marked contrast to phthisis.
Milk supply.—The administration of the authority, conferred on the Council by its General
Powers Act of 1904, with regard to tuberculous milk has been continued under our direction,
and the Medical Officer in his report affords details of such administration. The quantity of
milk produced in London cowsheds, however, is but a mere fraction of that which comes into the
county to supply the needs of its inhabitants, and we anxiously await the further authority,
which the Council has decided to ask Parliament to confer, with the view of securing that milk
supj)lied to the community shall be wholesome.
Removal of refuse.—The need for systematic control over the removal of offensive trade
refuse has long been evident, and we observe that in the districts of Finsbury, Greenwich,