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London County Council
Report of the Public Health Committee, submitting the report of
the Medical Officer of Health of the County of London for
the year 1908.
The year 1908 has, for London, been a very exceptional one from the point of view of vital
statistics, for the marriage-rate, birth-rate and death-rate are the lowest ever recorded. The deathrate
has shown a decline for the past 40 years and a decided and an almost uninterrupted decline year
by year for the past 10 years, while in the case of the birth-rate the fall year by year has been almost
uninterrupted for some 30 years. The decline in the death-rate since 1904 was commented upon in
last year's report, where it was stated that in 1905 the death-rate was 15*1, lower than ever before ;
in 1906 it was again 15*1; in 1907 it fell to 14 6, and now in 1908 we have to record a further fall to
13*8. The Mcdical Officer points out, however, that these very low rates are obtained by applying
the recorded deaths to estimates of population, and the correctness of these estimates is open to
criticism, inasmuch as seven years have now elapsed since the census of 1901. It appears, for
example, that in some of the London boroughs the death-rates would be raised or reduced by nearly
10 per cent., and in two instances by more than 10 per cent., if instead of using the Registrar-General's
Annual Summary estimates of population, his estimates for the purposes of the Equalisation of Rates
Act, based upon the number of rated houses in each borough, were employed. While the differences
in individual boroughs are thus considerable, the death-rate of the County of London as a whole is but
little affected by using one or other of the two estimates of population of the Registrar-General. Both
estimates it must, however, be admitted may prove to be somewhat wide of the mark.
Infant mortality.—The figure which gives the number of deaths per 1,000 births is the lowest
ever recorded in London. The infant mortality rate is, moreover, lower in London for the last
decennium than in all save one of the 13 other large English towns, and London has a lower figure
for 1908 than any of those towns. This, as the Medical Officer says, is a matter for congratulation,
though, as he adds, it needs to be remembered that the infant mortality rate is liable to considerable
fluctuation owing to climatic conditions and varying degrees of prevalence of epidemic maladies.
There are notable differences between the rates of infant mortality in districts well and badly circumstanced
socially, a fact which sufficiently indicates the results which might be obtained if the
infants of the less favoured districts had extended to them the same care as that bestowed upon
infants of the better favoured districts. The Notification of Births Act, 1907, had been adopted in
1908 in all but eight boroughs, and the houses in which births had taken place were being visited by
women sanitary inspectors or health visitors. In some districts this work was supplemented by
that of a staff supplied by local health societies ; and in this connection " consultative centres " have
been instituted in Paddington, Fulhain, Westminster, Hampstead, St. Pancras, Finsbury and Poplar.
To these centres mothers bring babies who need special attention, and advice is given as to their
treatment, the progress of the child being watched and tested by weighing.
The London County Council (General Powers) Act, 1908, section 6, provides for the appointment
of health visitors and enables the Council to contribute to their salaries.
Epidemic diseases.—Here, again, there is for 1908 a lowest recorded death-rate per 1,000. No
death occurred from smallpox, and the deaths from measles, whooping cough, diphtheria, enteric
fever, diarrhoea and phthisis were below the average of the last 10 years, but those from influenza
and scarlet fever were above the average. In connection with enteric fever reference is made by the
Medical Officer to two localised prevalencies occurring in poor populations in 1908, one in Bethnal
Green, the other in Shoreditch, and to the investigations made into the causes of the outbreaks by the
Medical Officers of Health. A report by Dr. Hamer on the subject of these outbreaks is appended
to the Medical Officer's Report (Appendix I.).
The mortality from puerperal fever shows a distinct diminution, as was the case also last year
In dealing with phthisis the Medical Officer comments upon the work done in connection with
the voluntary notification system in operation in 21 London boroughs in 1908, and he refers to the
operation of the Order of the Local Government Board requiring the notification of cases of phthisis
in London occurring in poor law practice, which came into force on 1st January, 1909. London is,
as the Medical Officer points out, but very imperfectly provided with the opportunities which are needed
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