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been taken ill after landing. One had been admitted to St. George's Hospital as a case of malaria and
died a few days later ; another was found to be in St. Mary's Hospital, where he was seen by one of the
Council's medical officers, who was of opinion that the man was suffering from pernicious malaria; a
third had been admitted to hospital at Ramsgate, where he subsequently died with acute malarial fever ;
the fourth was admitted to an institution at Grimsby whilst a fifth patient was treated in the infirmary
at Dundee as a case of enteric fever. The last two cases were also reported subsequently to have
malaria. A number of deaths from malaria also occurred amongst the troops after their arrival at
Salisbury Plain. Upon further enquiry it was ascertained that the vessels had come from Sydney and
had called at Sierra Leone en route, where they stayed for four nights. These vessels and several others
which arrived about the same time carried Australian troops, in addition to munition workers who were
contracted out by the Australian Commonwealth to the Ministry of Munitions for labour in all parts of
the country. No further developments arose in the London area.
The Local Government Board later issued a memorandum for the information of medical officers
of health throughout the country, dealing with indigenous cases of malaria in England.
Tuberculosis.
Phthisis.
The number of deaths from pulmonary tuberculosis in the civil population of London during
1917 was 6,908, compared with 6,491 in 1916 and 6,875 in 1915 There has, therefore, during the course
of the war been a serious increase in the mortality from phthisis, the average annual number of deaths
during 1911-14 being only 6,286 in the total population. For nearly 50 years the phthisis mortality in
London has, with occasional years or short periods of exception, persistently fallen ; the first indication
of a pause in the decline was in 1914.
The hardship and exposure of war directly and immediately affected the mortality of males of
military age; but as there has also been an increase in the female mortality during the war period,
other causes must be looked for.
It has been pointed out in previous reports that one of the consequences of notification of tuberculosis
would be to increase the recorded death-rate, the reason being that in the case of a notified
phthisic dying from some concurrent disease, the phthisis history would be less likely to bo overlooked
in certifying the cause of death. This influence would attain a maximum effect some time after the
introduction of compulsory notification (1st Feb., 1913) and of National Insurance (15th July, 1912);
and some proportion of the recorded increase may be attributed to more accurate death-certification.
Emigration to the colonies, and resort to Continental sanatoria must largely have been arrested
on the outbreak of war, and simultaneously the great increase of sanatorium treatment in the United
Kingdom under the Insurance Acts must have led to the retention in this country of a certain number
of phthisics ; doubtless, deaths among these which before the war would have been recorded elsewhere,
are now included in London records.
Lack of food and disturbance of the normal dietary are both factors tending to increase susceptibility
to phthisical infection, but during the years 1915 and 1916, neither can have been largely
operative. In 1917, however, many articles of popular dietary were either scarce or expensive and to this
cause some share of the increased phthisis rate of that year may be attributed : at any rate, while the
increase in 1915 was undoubtedly augmented by the adverse climatic conditions and the prevalence
of pneumonia, etc., this cause did not largely affect the year 1917.
Turning to the consideration of special classes of the population it is noteworthy that there has
been a marked increase in the deaths from phthisis among inmates of lunatic asylums. The increase
is remarkable because of its great excess above that observed in the general population, for while in
the country as a whole the female deaths increased by 261 in 1916 over 1915, in asylums alone the increase
was 133. The asylums increase was greatest between 30 and 60 years of age, the female deaths at this
age period being 623 in 1915 and 719 in 1916, while in England and Wales as a whole the deaths declined
from 8,698 to 8,627. On the other hand at ages below 30 years the female deaths in asylums increased
from 196 to 230 and in England and Wales from 8,173 to 8,570.
The following paragraph appears in the Annual Report of the Board of Control for 1916, p. 13:
" The continuance throughout the year of war conditions, led to great and increasing difficulties in the
administration of asylums, mainly through the diminution of the staffs by the withdrawal of large
numbers of the most efficient officers for military service, and through the curtailment of accommodation
by the conversion of several institutions into war hospitals and consequent overcrowding of those
which remained in use as asylums."
Reference is made elsewhere in the same report (p. 60) to similar consequences of the war in
Poor Law Institutions, but "there lias been during the period a marked decrease in the ordinary workhouse
population, many of the country workhouses having very few inmates." It is possible therefore,
that the conditions have been less unfavourable in Poor Law Institutions on the whole, than in asylums,
and the absence of a correspondingly marked increase in them of the phthisis mortality may be thus
accounted for. Tuberculosis, other than pulmonary, caused 1,575 deaths among London civilians in
1917, the figures for 1916 and 1915 being 1,514 and 1,681 respectively.
The number of " primary " cases of tuberculosis notified during 1917 (52 weeks) was 18,735, as
compared with 17,631 in 1916 and 18,661 in 1915. Of these, 14,871 were pulmonary, and 3,864 other
forms of tuberculosis, the corresponding figures in 1916 being 13,547 and 4,084 respectively. These
figures, differing from those given elsewhere in this report, include cases among soldiers and sailors.
Notification
of tuberculosis