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ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR THE
YEAR 1916.
Part I.—General.
Introduction.
The health of London during the year compares favourably with that of 1915. The year 1916
was one in which, in a literal and perhaps in a metaphorical sense also, more water than ever before
known, flowed under London Bridge. The present type of distribution of rainfall has prevailed since
1909, i.e., for seven years; 1912 was especially remarkable for amount of rain; the floods of the early
part of 1915 were the highest since November, 1894, and there followed, in 1916, a flow of water in the
Thames (875 thousand million gallons), exceeding even that of 1915 and actually the highest since 1883,
when the present system of keeping records was first instituted. The phenomenal weather conditions
have unquestionably exercised considerable influence upon the public health, and are doubtless in far
larger degree accountable for the reduction in the mortality of infants, of that from epidemic throat
diseases and from typhoid fever and epidemic diarrhœa, and also for a freedom from the ordinary
nuisances prejudicial to health, than is generally realised. The early workers in epidemiology attached
great, perhaps undue, importance to meteorology, and certainly the suspicion came to be entertained
twenty or thirty years ago, that there had been too much "talking about the weather." The recent
rapid extension of enquiry into regions hitherto unexplored, and the growing importance attached to
laboratory methods, has led to some neglect of the knowledge which had been carefully and laboriously
acquired in earlier days. Thus, there is now a marked tendency to attribute falling mortality rates
to causes such as stimulation of the activities of phagocytes and exploitation of newly discovered
antibodies, rather than to obvious elemental agencies the influence of which was apparent to our
forefathers.
Deaths
The study of the death and sickness rates for 1916 is, however, complicated not only by abnormal
weather conditions, but by the many disturbances incidental to the great European war. The
threatened dangers of famine and of the introduction of formidable epidemic diseases, have so far
not materialised; the general condition as regards nutrition of the mass of the people has probably
rarely, if ever, been better, and there has been freedom beyond the most sanguine anticipation from
most of the war diseases.
It needs to be realised, however, how much has been due to the absence of trying seasons, to the
restrictions upon freedom of communication and traffic, especially with countries abroad, which the war
has brought about, and to the gradually accumulated effect of the code of sanitary precautions worked
out during the last 60 or 70 years by the health service of the country. The trying seasons will come
in due course, the termination of the war will favour spread of infectious disease, and the need for the
maintenance of the sanitary service is becoming increasingly apparent as the months pass by. In
particular, depletion of sanitary staffs constitutes at the present time, a source of serious danger; it
is further most regrettable that public opinion, while tolerating a ready acceptance of new and comparatively
untried measures for combating disease, is not strong enough to secure that reasonable
protection against smallpox should be afforded to the child population; the fact is the more remarkable
when it is appreciated that the original vaccination is not only directed against the most formidable
of the scourges of the human race, but also that it has withstood for more than a century all critical
assaults.
In making comparisons of this year's rates with those of previous years, it has to be borne
in mind that the estimates of population upon which the rates are calculated are still less to
be relied upon than were the similar figures for 1915. When the National Register was compiled in the
summer of 1915, the marked local changes of population which the war has caused, were only just
beginning, and that Register, originally not absolutely reliable, does not, of course, record the subsequent
movements of the population.
Marriages.
The number of marriages registered in 1916 fell considerably short of the abnormal record of
1915, but still compares favourably with the previous figures. The Registrar.General estimates the
marriage.rate at 19.0 per 1,000. The marriages registered, of course, include marriages of members
of the forces, and for that reason the rate cannot be calculated on the civil population. If the population
be taken roundly at four and a half.millions, the rate would be 19.4 per 1,000, comparing with 25.9
similarly calculated for 1915. The average rate during the five years 1909.1913 was 17.8.
Births.
The Registrar.General estimates the birth.rate in 1916 at 21.5 per 1,000, as compared with 22.6
in 1915, and 25.0 in the period 1909.13. It is obvious that the birth.rate calculated on published
population estimates (23.4), does not compare with pre.war figures. The abnormally high marriage.rate
since the war commenced, must have tended to augment the birth.rate, and thus have pro vided a
set.off against the decline associated with war.
The London death.rate in 1916, is calculated by the Registrar.General at 14.7 per 1,000 among
the civil population, as compared with the corresponding figure for 1915 of 16.8. The decrease in the
death.rate is greatest at the extremes of life, and is, generally speaking, the result of the more favourable
climatic conditions which prevailed as well in the winter as in the summer months.
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