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ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR THE
YEAR 1915.
Part I.—General.
Introduction.
The health of London during 1915 does not compare very favourably with that of quite recent
years, not so much on account of any influence of the war, as owing to increase of deaths at relatively
high ages attributable to a prevalence of influenza and respiratory diseases during the winter months.
There have been changes in the London population, both as regards the aggregate number of
residents and their distribution in the county, and it has thus become necessary to calculate mortality
rates for the year upon a population from which a deduction is made for men on active service, the
deaths being similarly reduced so as to relate only to civilians. The death-rate thus obtained is
16 8. A tabular summary of the vital statistics for London and its constituent boroughs will be
found appended to this report (page 17).
The number of marriages registered in London in 1915 was the highest ever recorded. The
calculation of a marriage-rate is attended with difficulty owing to the fact that the estimated civil
population cannot be used for the purpose. Assuming the population to be roughly four and a-half
millions, the rate, comparable with that of previous years, becomes 259, which is higher than that
in any previous year. The marriage-rate has shown a slight increase annually since 1908, but the bulk
of the increase in 1915 must be directly attributed to the war. There is reason, however, for thinking
that an abnormal number of persons whose marriage was registered in London were not London
residents.
The birth-rate, which has been falling, for a number of years past, was 23 (5 in 1915, as com-;
pared with 243 in 1914, and 25.0 in 1909 -13. The question as to the extent to which certain influences
may have contributed to the decline of the birth-rate is referred to on p. 3.
In regard to the incidence of the principal epidemic diseases in 1915,10 cases of smallpox occurred
in London, see p. 4. Despite the return to this country of convalescent soldiers and the abnormal
conditions of the time, no increase in prevalence of typhoid fever or dysentery was observed. A few
cases of typhus occurred in Stepney (see page 6). The mortality from measles was 2,286, as compared
with 1,376 in 1914. The deaths from whooping-cough somewhat exceeded those in 1914. Diarrhoea
and enteritis at ages 0-2 years fell from 3,057 in 1914 to 2,556 in 1915. Scarlet fever, erysipelas and
puerperal fever show decrease as compared with the preceding year; some decline is, moreover,
observable in diphtheria and ophthalmia neonatorum: on the other hand, cerebro-spinal fever
showed increased prevalence, there being 627 civilian cases during last year, as compared with 73 in
the general population in 1914. Owing to the fact that the records in 1915 of notifiable diseases relate
mainly to the civil population, the case-rates are rendered less reliable in those diseases which are
mainly incident upon persons of military age, such as typhoid and cerebro-spinal fever. Nearly 25
per cent. of the cases of cerebro-spinal fever notified in England and Wales in 1915 occurred in
London.
In last year's report the relation between the prevalence of influenza and cerebro-spinal fever
was considered. It is now possible to make use of the entire series of figures for the year 1915, and
the opportunity has been taken to further examine that relation. It was pointed out that, during the
epidemic period February—March, 1915, the number of cases of cerebro-spinal fever, which gave a
history of influenza within a week of the onset, was in excess of expectation. A review of the cases
occurring during the rest of the year and of cases occurring in the recrudescence of the disease early in
1916 will be found at p. 9, where also reference is made to reports of the Army and Navy authorities.
The deaths from pulmonary tuberculosis in 1915 somewhat exceeded those of 1914. The
primary cases notified have exhibited each year since the introduction of notification a decline, presumably
due to the diminishing number of cases of old standing notified.
No cases or suspected cases of cholera or plague were reported during the year. Several cases of
anthrax occurred, which were associated for the first time in the history of the disease with the use of
infected shaving-brushes (see page 13).
The administrative section of the report has been of necessity considerably curtailed. The
bulk of the statistical information forthcoming in former years is, however, available, thanks to the
courtesy of medical officers of health, and is presented in a single table. War conditions have made
the maintenance of the sanitary services of London increasingly difficult, though exceptional efforts
have been made by the depleted staffs to maintain the standard of efficiency.
At the date of writing this report five medical officers of health were actually serving with the
forces of the Crown. Inquiries made in July, 1916, showed that 53 sanitary inspectors were on war
service for whom substitutes had not been engaged. There was thus a depletion of the staff of sanitary
inspectors to the extent of about 16 per cent. Some of the poorer boroughs had suffered disproportionately
in this respect, and at the time of writing this report, the Council was in communication with
the authorities concerned.
32681 A
Deaths
Marriages.
Births.
Infectious
diseases.
Administration.