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London County Council.
ANNUAL REPORT OF THE COUNCIL, 1913.
CHAPTER XXXII.
REPORT OF COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL
OFFICER (Dr. W. H. Hamer) for the year 1913.
Part I.—General.
Introduction.
The population of the County of London in the middle of the year 1913, as estimated by the
Registrar-General, was 4,518,191 persons. The loss of population resulting from outward movement
in recent years, which was commented upon in last year's report, is referred to in greater detail this
year on page 2.
The marriage rate fell slightly, to 18.3, but with the exception of the rate for 1912, is the highest
since 1899.
The birth rate was the same as in 1912, namely 24.5, and thus for the first time in ten years
no decline is recorded. This fact might be attributed to the effect of certain provisions in the National
Insurance Act, but it is worthy of note that a similar pause in the decline of the birth rate in 1913,
is observed in certain of the foreign capital towns, such as Paris, Amsterdam and Stockholm. In
England and Wales, as a whole, the birth rate increased from 23.8 in 1912 to 23.9 in 1913.
The death rate, which was 136 in 1912, increased to 14.2 owing to the higher infantile mortality,
which rose from 91 to 105. The death rate was nevertheless below the average of the decennium 19011910,
and as compared with that period the lower rate of 1913, resulted in a gain of 7,847 lives, or
387,897 years of life. The death rates from the principal epidemic diseases, namely, measles, whooping
cough, scarlet fever, diphtheria and typhoid fever showed marked decrease on the average of the preceding
five years. There were no deaths from smallpox or typhus. Eight cases of typhus, of suspected
typhus, were reported during the year, and are described in detail on page 30; certain of them are
of special interest as illustrating the difficulty sometimes experienced in determining whether a case
is in point of fact one of typhus or of typhoid fever.
In last year's report reference was made to experience gained in the campaign against typhoid
fever in South-west Germany in recent years; in the present report a discussion will be found at page
31, of the very important researches of Dr. Houston, Director of Water Examinations, Metropolitan
Water Board, concerning the possibility of detecting organisms resembling the typhoid bacillus
in raw river water.
An increase occurred in the number of cases of scarlet fever, diphtheria and erysipelas, notified
during the year, while on the other hand, the number of cases of smallpox, typhoid fever and puerperal
fever declined. In some sixteen instances more than one case of puerperal fever occurred in the practice
of the same midwife, and the results of investigation into these multiple cases are given in detail
at page 39.
The phthisis death rate was 1.30 per 1,000 living, as compared with 1.35 in 1912. The extent
to which London residents suffering from phthisis die outside the area of Greater London is discussed at
page 41. The age incidence of tuberculosis mortality in England and Wales is compared with that in
Ireland, Prussia, and the registration area of the United States (see diagram U), and the results of
an analysis of the figures relating to differences in age-incidence observed in the countries named will
be found at page 42.
The notification of all forms of tuberculosis became compulsory on the 1st February, 1913, and
the resulting data for the County of London as a whole are exhibited and discussed at page 47.
One case of human glanders was notified in 1913 and references were found in medical literature
to certain other suspected cases ; details relating to these cases are given on pages 51 to 53.
In the administrative section of the report a continued decrease has to be recorded in the number of
premises requiring to be annually licensed by the Council, including cowsheds, slaughterhouses, offensive
trade premises and common lodging houses. Seamen's lodging houses show a slight increase, though
there are now only half as many as were in use prior to licensing powers being obtained.
A considerable amount of work under the Housing, Town Planning Act, has been done throughout
London, especially under the Inspection Regulations. Generally, the defects found have been remedied
under the Public Health (London) Act, but owing to the absence of particulars in some of the reports it is
impossible to tabulate in a complete form the results of the action taken. In one or two of the reports,
too, no information is given as to the work carried out under the regulations made under Section 94 of
the Public Health (London) Act, relating to houses let in lodgings. Many of the reports of medical officers
of health contain references to the cleansing of verminous persons, houses, and clothing, and it is evident
that this important work is receiving an increasing amount of attention. Facing page 70 is included a
diagram showing the seasonal prevalence of three kinds of vermin during the five years in which observations
with regard to this point have been made. The five years' record shows that distinct improvement
has been brought about.
Two censuses of homeless persons were made during the year—in February and late October.
The figures on both occasions show a large reduction on those previously obtained, and indeed the number
of persons enumerated in February last year (649) was less than one-quarter of the number reported in
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