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out last year, in contradistinction to anything that may have happened in the Army abroad, it cannot
be claimed that protective inoculation has had any appreciable influence in maintaining during the
war the remarkably low level of typhoid fever reached 14 or 15 years ago in the civilian population.
At the end of the year a group of cases among consumers of a certain batch of oysters was recorded.
Some increase in the number of deaths registered from phthisis has been apparent for 5 or 6
years past and the reasons for this are considered on p. 6.
Towards the end of 1917 and in 1918 there was a new development which has special interest in
connection with observations made in London in the last four years with regard to influenza and cerebrospinal
fever. It should be premised that in the Annual Reports of 1914, 1915 and 1916, statistical
evidence to the effect that epidemics of there two diseases occur concurrently and also in a certain
sequence to one another was adduced. Reference was also made to the relationship between poliomyelitis,
cerebrospinal fever, and influenza. In 1916 there was a considerable outbreak of poliomyelitis in New
York, and in London in that year and again in 1917 there was synchronised prevalence of cerebrospinal
fever and of influenza.
The recent
"obscure
disease with
cerebral
symptoms."
At the close of 1917, however, a distinct change of type was manifested. In December, and in
the early months of 1918, cases of illness with pulmonary, gastro-intestinal or cerebral symptoms
were prevalent, and it soon afterwards became apparent that a special epidemics inference was at work
At first the suspicion of some observers fell upon focd, and "botulism" and "solanism" were invoked
as the sources of the trouble, but no evidence of this was forthcoming, and it was then agreed that,
most of the illnesses with obscure cerebral symptoms must be regarded as cares of polioencephalitis due
to special epidemic influence. In Paris, M. Netter described similar cases, and he pointed out that like,
prevalences had been noted following immediately upon the pandemic influenza of 1889-90 ; in these
epidemics,which appeared in Italy and Hungary, lethargy was a striking symptom, just as here in London
the outbreak was described under the title of "epidemic stupor" ; M. Netter also referred to similar
prevalences in Austria in 1916-17 of a disease known as "Schlafkrankheit."
Polioencephalitis was, moreover, found during the spring of 1918 to be prevalent in epidemic
form in other parts of the world, e.g., Germany and South Africa; it further transpired that influenza
was raging in Spain and a " new disease " in Sweden.
Probable
nature of
the outbreak.
The phenomena of the particular epidemic constitution of 1917-18 arc considered on pp. 7-10; it
must suffice here to state that just as encephalitis, febrile cerebritis, influenza and sweats prevailed in
Europe 400 years ago and have periodically done so since that time, so, history repeating itself, they
have again recently spread widely in the old and new worlds. Thus it would appear that the events
of the past few months once more strikingly illustrate the "posting character," the unexpected manifestations
and the protean behaviour of "influenza" ; and incidentally, the close connection between
polioencephalitis, poliomyelitis, cerebrospinal meningitis and influenza now seems to be established.
Often out of a great evil a great good is born, says the proverb, and it may be that recent events will
place a limit upon the too exacting claims of causal organisms, and lead to some exercise of the recognised
principle known as the Law of Parsimony in considering additions to the list of new diseases. The want
of such recognition during the last four years has made the work of administration difficult, and during
the past few months there has been quite an outbreak of ephemeral new diseases which, on enquiry,
have turned out to be old foes, with faces new only to those not versed in the. history of epidemics.
As these pages are passing through the press numerous groups of cases of influenza have been
reported from various parts of London, the type of disease now manifested being similar to that observed
in the pandemic of 1889-90; the provisional diagnosis above made may be said therefore to be now
definitely confirmed.
Administration.
The tuberculosis scheme adopted by the Council in May, 1914, was continued in operation and was
extended during 1917. At the end of the year, arrangements had been made for the use of 231 children's
beds and 100 beds for adults in voluntary institutions and in addition beds were available in the institutions
of the Metropolitan Asylums Board. As regards children, these numbers were increased to 300
in May, 1918. The number of cases receiving treatment during 1917 included 670 adults and 933
children. Treatment in 37 dispensaries is provided under the borough council schemes.
The Invalid Children's Aid Association by agreement with the Council provides some 400 beds
for convalescent cases. They assist in supplying surgical instruments and arrange the after care of
children treated. There arc 29 interim care committees and one borough committee (Chelsea) supervising
the home life of the patients and obtaining for them extra nourishment and suitable employment.
On 1st January, 1917, the scheme for the diagnosis and treatment of venereal disease came into
force, and during the ensuing twelve months over 12,000 London patients were seen at the London clinics.
The administrative work under Part I. of the Children Act, 1908, was transferred to the public health
department as from 1st April, 1917, and an account of the work done is given on page 15. Mention was
made in last year's annual report (page 3) of depletion of sanitary staffs, and it. was recorded that the
assistance of the Local Government. Board had been asked for in this matter. During 1917 it was found
necessary again to call attention to delay in the removal of house refuse, and later, improvement was
effected. Statements appear on page 16 with regard to the work of the chemical branch of the department
and on page 14 on the administration of the Mental Deficiency and Midwives Acts. It. may also be
here mentioned that a census in February, 1917, revealed only 24 homeless persons as compared with 370
in the February preceding the outbreak of war.
Population.
A.—Vital Statistics.
The population of London County at the census of the 3rd April, 1911, was 4,521,685, and it was
estimated by the Registrar-General from the records of births and deaths to have decreased to 4,518,021