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ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR THI
YEAR 1917.
Part I.—General.
Introduction.
The health of London during the year compares not unfavourably with that of 1916, itself a
year of low mortality. The long period of very cold, though dry, weather early in 1917 took its toll
among the aged, but on the other hand, wet weather in July and August and the consequent absence
of high temperatures, was favourable to infant life, the mortality from summer diarrhoea being low.
In the autumn also, except during the closing weeks of the year, the conditions were favourable, the
mortality from respiratory diseases and influenza being below the quarterly average. Thus, once again,
the elements were on the whole, propitious.
In last year's Annual Report (p. 36) the question of the possible relation of gunfire on the westerr
front to rainfall in South East England, and indirectly to the comparative freedom from scarlet fever
prevalence in London was referred to. The subject has been much debated by meteorologists in the
last few months, and the view taken has been summarised as follows:— "Much stress has been laid or
the relative wetness of the years 1915 and 1916 in the South East of England, but this fact must be
considered in connection with the fact that 1917, when the war was at its intensest phase, was a year ol
nearly normal fall."* Mr. Fredk. J. Brodie in an analysis of the records (loc cit. December, 1917)
writes as follows:— "It may be after all a mere coincidence that the repeated discharge on a wholly
unprecedented scale of vast quantities of the most violent explosives ever known to mankind, should
have been accompanied in this country by an excess of rain which was far more pronounced in
districts lying-contiguous to the seat of war than in any other part of the United Kingdom." . . .
"In 1914-17 England, S.E., stands out boldly as the wettest part of the country, with an excess of
rainfall amounting to no less than 26 per cent." ..."There can be no question that for so
extended a period as three years, an excess of rainfall amounting to as much as 26 per cent, is
extremely large and it seems to me very doubtful whether it would be possible to find its equal in the
records for any consecutive period of thirty-six months." The relation of rainfall to disease has for
long been a subject of great interest, and the phenomenal wetness in South East England since the
outbreak of war, whether due or not to gunfire, is unquestionably in part responsible for some of the
comparatively low death rates of London during the past three years.
The number of marriages registered was somewhat below that for 1916; the marriage-rate is
estimated to have been 17 per 1,000, as compared with 19 0 in 1916.
The Registrar-General estimates the birth-rate in 1917 at 17 9 per thousand, as compared with
21.5 in 1916. Part of the decline in the rate must be attributed to the sudden fall in the marriage-rate
after the first quarter of 1916, a reaction following upon the abnormal increase in 1915. An increase
in the proportion of births occurring in institutions is noted, and undoubtedly a change in this direction
connotes a diminution in childbirth fatalities both to the mothers and their offspring.
Deaths.
The death-rate among civilians in 1917 is estimated by the Registrar-General to have been 15.7
per thousand, the corresponding figure for 1916 being 14.6. The higher death-rate of 1917 is accounted
for mainly by the high mortality among children between one and five years of age, resulting from the
prevalence of measles during the winter and the late autumn.
The infant mortality in 1917 was 104 per 1,000 born, as compared with 89 in 1916. The rate was
considerably above the average in the first quarter and again at the close of the year, the cause in each
case being the adverse climatic conditions. Some comments upon the suggestion which has been made
that atmospheric pollution is a prominent if not predominant factor in the causation of infant
mortality, are submitted. The Teasons for the fluctuations in infant mortality during the last 50 years
are also considered (pp. 3-4).
Infectious
diseases.
The prevalence of the notifiable infectious diseases was, generally speaking, remarkably low in
1917, the only exceptions being diphtheria and cerebrospinal fever, each of which, however, showed a
slight decline upon last year's incidence. The number of cases of scarlet fever notified in 1916 and in
1917 was far below any previous annual record since 1890, the first year of notification.
It is noteworthy, t hat despite the exceptional circumstances of war there was no serious outbreak
in London of smallpox, typhus or typhoid fevers. Early in 1918 smallpox obtained for a time just a
footing, but up to May it had not succecded in establishing itself. Only one case of typhus was notified
in London, but early in 1918 a small prevalence of this disease was reported among gypsies in Surrey
and Sussex. The behaviour of dysentery was carefully watched and two small groups of cases were
noted among children in Chelsea and in South Islington; isolated cases were reported, moreover, in
various parts of the town, but there was no serious spread of the disease.
Upon typhoid fever attention was of course specially focussed. Small outbreaks occurred in
asvlum populations drawing patients from London, and certain more extensive asylum outbreaks were
recorded in other parts of the country. The prevalence of intestinal diseases and the raised general
death-rate among the insane throughout the country, seemed to indicate that in this section of the
population the effect of war conditions was being felt. Typhoid fever in the population of London as a
whole, remained at the low level of the preceding year, itself low in comparison with 1915. As pointed
* Symons' Meteorological Magazine, Feb., 1918.
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