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2
Infectious
diseases.
With regard to infectious diseases, the record of 1916 was in essential particulars,
not unlike that of the preceding year. There was evidence of introduction into London of
pediculosis and scabies by returned soldiers, but typhus did not obtain any footing. Smallpox was
imported from time to time and small outbreaks occurred in the north of England, but there was no
serious prevalence. Soldiers who had been in contact with a case of this disease, were brought into a
hospital in London, but the military authority did not immediately notify the civil authority.
Fortunately, no harm resulted, the Public Health Committee of the Council communicated the facts
to the Local Government Board, and steps were at once taken with a view to obviating a recurrence in
the future of such omission. In marked contrast to this instance stand the numerous cases of notifications
of the discharge from hospitals of convalescents from dysentery and typhoid; these were all systematically
transmitted to borough medical officers, and no mischief was heard of as having been traced in any
case. In a few instances, notices of the arrival in London, even of persons suffering from tuberculosis,
in one case a list of contacts of chickenpox, and in several, lists of contacts of cerebro.spinal fever or
poliomyelitis were received. In dealing with cerebrospinal fever, the difficulty has been particularly
acute, as the cases in which special restrictive measures have been urged have been numerous. The
practice adopted has been to offer facilities for bacteriological examination, to advise "positive
contacts " to be as much in the open air as possible, to examine them repeatedly, if desired, until they
could be pronounced free, to refuse to countenance restrictions being placed upon their liberty, and
when the question has been seriously pressed, to discuss each particular case with the borough medical
officer of health, who has invariably been in accord with the Council's officer as to the reasonableness of
the course recommended. The behaviour of typhoid fever in recent years has been extremely interesting,
and it is considered in detail on pp. 6.9. The prevalence of this disease is, says the Medical Officer
of the Local Government Board, perhaps the best single gauge of the sanitary condition of a community,
and he notes that the death.rate in the country in the last few years is only about one.eighth of that of
the "seventies." It is highly satisfactory to record that there has been an almost equal freedom from
the disease in the Army in France. In this connection it is customary to hear it stated that "inoculation
has done much." Upon this the criticism may be made that it cannot of course, be claimed that
inoculation has appreciably affected the civilian mortality, and that being so, there is a possibility
that some of the influences which it is agreed have proved sufficient at home, may have operated
abroad also. It is of course possible, however, that inoculation may have modified the type
of the disease observed in the Army in France, and from a bacteriological point of view, at any rate,
this would seem to have been the case.
The remarkable decline in scarlet fever is made the subject of special consideration in
Part II. of this Report under the heading Infectious Disease.
The scheme for dealing with tuberculosis has been further proceeded with; the arrangements
for institutional treatment of cases have been continued in spite of war conditions; the work of the
dispensaries has further developed; and special consideration has been devoted to after.care by the
Interim Tuberculosis Committees, which were hard at work throughout 1916.
Early in the year there appeared the Report of the Royal Commission on Venereal Diseases.
It was realised at once that an opportunity was now to hand for promoting a scheme for treatment.
The medical officers of health concerned recognised that London and the Home Counties could most
profitably avail themselves, by means of a combined scheme, of facilities offered by the large London
hospitals; after some preliminary arrangements a conference was held at the Local Government Board,
and it was then decided that negotiations with twenty.two hospitals should be conducted by Dr.
F. N. K. Menzies, on behalf of the ten participating authorities concerned; the scheme rapidly matured; it
met with the approval of the ten councils, of the medical profession generally and of the Local Government
Board, and came into operation on 1st January, 1917. The Report of the Commission appears to suggest
that the prevalence of syphilis has not lessened in recent years; such a conclusion is, however, open to
considerable question (see p. 13). The estimate accepted by the Commission that 10 per cent. of the
population of the large cities has been infected is largely based upon the Wassermann test, but the value
of this, as of most other laboratory tests, depends upon its being precisely studied and appraised in
relation to extra.laboratory observations.
Administration.
During the year the registration and regulation of lying.in homes under the Council's newly.
acquired powers, were proceeded with. In a report on maternity mortality in connection with child.
bearing, published by the medical officer of the Local Government Board in 1916, the county and
metropolitan boroughs are classed in seven groups, according to their rates of mortality from child.
bearing per 1,000 births. It is interesting to note that 10 metropolitan boroughs, including several
very poor boroughs, appear in the best group, with mortality under 3 per 1,000 births; 12 in the second
group, with mortality from 3 to 3.5 per 1,000 births; 3, 2, and 1, respectively in the next three groups;
none in any of the remaining lower groups. A comprehensive report on the provision of midwifery
service in the County of London was prepared during the year by Dr. Janet Lane Claypon, and was
published by the Local Government Board early in 1917. The Local Government Board advised that
the Council's staff of midwifery inspectors should be strengthened, and two additional inspectors were
appointed early in 1917. Reference to work done in co.operation with maternity and child.welfare
centres will be found in Part II. of this Report.
The task of dealing with seamen's lodging.houses occupied by Chinamen was attended with
some difficulty, and the help of the Local Government Board and of the Board of Trade was sought
in this connection. The Board of Trade agreed to strengthen the by.laws by altering the definition of
"a seaman."