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who would probably, similarly, incline to the view that women nowadays, make better mothers, "in
spite of their having enjoyed the advantages of elementary education." It is quite clear that the
establishment of a first milk depot, in 1904, and following upon that of a first school for mothers, in
1907, cannot have been responsible for the marked decline in mortality under one year of age, which
actually dates from 1900 and potentially, of course, from long before that year. Doubtless the influence
of schools for mothers and infant welfare centres is just beginning to be felt, and it is to be hoped this
influence will steadily grow; but it should be recognised that so far as schools can be said to have any
effect in producing the decline in infant mortality of the last 16 or 17 years, it is the schools established
under the Education Act of 1870, and not the schools for mothers which date from 3 or 4 years ago, that
are in question. The decline has, moreover, as already stated, been markedly favoured by the present
cycle of cool seasons and by the amount of attention increasingly devoted to home environment and
to limitation of spread of infectious disease and to sanitary circumstances generally, particularly during
the last 15 or 20 years.
Smallpox.
Infectious diseases.
Although limited outbreaks of smallpox occurred during the year in various parts of the country,
156 cases having been notified in all, mostly in the Northern Counties and Wales, London was comparatively
free from the disease, only two cases having been notified. The first was that of a soldier
in one of the London military hospitals. He was seen on the 12th April by Sir Shirley Murphy and
Dr. Cameron, who were both of the opinion that the diagnosis of smallpox was open to considerable
doubt. The patient was removed to North Wharf, where he was kept under observation. The diagnosis
of smallpox was not confirmed.
The second case was that of a Belgian at Earl's Court Refugee Camp, who was removed to the
Western Hospital on 2nd May, suffering from chickenpox. The case was subsequently diagnosed as
smallpox and was removed to North Wharf. The patient was one of a party returning from Russia,
who were landed at Newcastle on 24th April, and were brought the same day to the camp. The infection
was therefore contracted abroad. All precautions were taken at the camp under the direction
of the Local Government Board, and no further cases occurred.
The Council's smallpox experts were called in for consultation purposes in nine cases in which
smallpox was suspected, but in each case the diagnosis of smallpox was excluded.
In a number of instances during the course of the year, vessels arrived in the Thames from
foreign ports with cases of smallpox on board. In every such case the names and addresses of passengers
and crew, proceeding to destinations in London, were forwarded to the borough medical officers concerned
and to the county medical officer, in order that the persons might be kept under observation.
In only one instance was there failure to notify the arrival of contacts in London. The circumstances
were briefly as follows: The s.s. Dover Castle arrived at Southampton on 30th March from Port
Said with a large complement of wounded soldiers. On the afternoon of the arrival, one of the soldiers
sickened, and was thought to have measles. The case was later diagnosed as smallpox, and the patient
died on the 4th April. Meanwhile the other soldiers on board were distributed to various hospitals
throughout the country, and a number of officers left for unknown destinations. In all, 103 men were
sent to various military hospitals in London. It was not ascertained by the Council's Public Health
Department until 5th April, and then only accidentally, that these men had been in contact with smallpox.
The Local Government Board was apprised of the facts and enquiries were immediately made. As a
result steps were taken to secure more effective co.operation between the military and civil authorities
in the future.
Measles,
scarlet fever,
diphtheria,
and whooping.cough.
The civilian deaths from measles in London during 1916, numbered 822, as compared with 2,286
in 1915 and 1,376 in 1914. Since 1st January, 1916, the notification of measles and German measles
has been compulsory and in the County of London the number of cases notified was 47,470.
The civilian cases of scarlet fever notified in London during 1916 (52 weeks) numbered 8,746,
as compared with 16,974 in 1915 and 25,015 in 1914. There were fewer cases in 1916 than in any year
since 1891, when notification first became compulsory.
The diphtheria cases notified among the London civil population in 1916 (52 weeks) numbered
8,743 as compared with 9,094 in 1915 and 9,118 in 1914. This is the first year in which the diphtheria
cases have exceeded the scarlet fever cases.
There were 802 deaths from whooping.cough in London during 1916, as compared with 1,158 in
1915 and 921 in 1914. Cases of whooping.cough were notifiable in Holborn, Lambeth and Greenwich
during the year.
Typhus fever
One case of typhus occurred during the year. The patient, a woman aged 50 years, was taken
ill about the 21st December, and the rash appeared about the 25th or 26th December. There was
considerable difference of opinion as to the diagnosis, but ultimately the occurrence of a crisis excluded
typhoid fever, the original and tentative diagnosis of typhus fever first made was reverted to and the
case was notified accordingly. The patient lived with her husband, who was a cobbler, in two rooms
of an eight.roomed tenement house in Stepney. The patient recovered. In a second case notified
from Bermondsey, the diagnosis was not confirmed.
Typhoid
fever.
During 1916, 461 cases of typhoid fever were notified, as compared with 789 in 1914 and 607 in
1915. The figures are not quite strictly comparable, as the practice relating to inclusion of military
cases was not the same in 1916 as in the two preceding years. There were, however, only nine deaths
in London of soldiers in 1916, thus it is clear that there was a distinct lowering of the case.rate, and the
statement holds good even when allowance is made for the absence of men of military age on war
service. The number of cases among men aged 20.45 was, in 1915 and 1916, in contrast with pre.war
experience, much lower than that in women of those ages.