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ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR THE
YEAR 1918.
PART I.—GENERAL.
Introductory Note.
In 1918, for flhe first time in records going back nearly a century, the deaths in London exceeded
the births. Two causes contributed to this result, namely, the reduction in berths brought about by
the war, and the heavy death-roll from the two epidemics of influenza. The deaths among civilians
alone during the??? red the births by nearly 5.000, and to this figure there must be added
a number of deaths ??? on active service. In the first week of November when the second
epidemic of influenza reached its height, the death-rate in London was 55.5 per 1,000. This is the highest
rate recorded in any week since 184.9, the cholera year, in the 36th week of which 3,183 deaths were
registered, giving a rate of over 72 per 1,000.
The weather conditions during 1918 were, generally speaking, not unfavourable. The winter
was mild, except during the early weeks in January. July and August were not marked by any periods
of high temperature, and the mortality among infants from summer diarrhoea was consequently low.
The rainfall in July was exceptionally heavy and there was also much rain in September; and owing
to the excess in these months the rainfall for the year was some five inches above the average. Except
during the course of the influenza epidemics of June and July and of October to December, the mortality
was low.
Marriages.
Ihe number ot marriages registered showed some increase, the estimated marriage rate being
19 per 1,000 living as against 17 in 1917.
Births.
The Registrar-General estimates the birth-rate in 1918 to have been 160 per 1,000 as compared
with 17.9 in 1917. The decline in the birth-rate upon the pre-war rates was evenly distributed among
the four quarters of the vear, and taking 1914 as the standard, amounted to about 35 per cent.
Deaths.
Ihe death-rate among civilians is estimated by the Kegistrar-lTeneral to ha\e been 19.2 as
compared with 15.7 in 1917. The total number of deaths, ainorg civilians only, numbered nearly 76,000
and of this total it is estimated that not fewer than 18,000 were due to the influenza epidemics.
The infant mortality in 1918 was 108, showing a slight increase upon that recorded in 1917 of
104 per 1,000 births. The increase chiefly occurred in the first quarter, when the mortality from whooping
Cough was verv high: there was also a considerable number of deaths from respiratory diseases.
Infectious
disease.
Ihe remarkably low prevalance of notifiable infectious disease in London in recent years was
maintained in 1918. Several groups of smallpox cases, however, gave cause for anxiety but happily
in each instance prompt measures of isolation were effective in limiting the mischief. Diphtheria was
less prevalent than in 1917, and while there was a slight increase in the number of cases of scarlet fever,
the total for the year was nevertheless far below the average. Only one case of typhus occurred in
London. Dysentery deaths showed an increase to 313 as compared with 290 in 1917. The increase
was in the female deaths, the male deaths showing a decline. There were no recognised outbreaks due
to importation of the disease from abroad such as occurred in two boroughs in 1917. The incidence of
typhoid fever was remarkably low. In an instance in which five members of one household were attacked
suspicion fell upon some cockles which had been brought from Southend. A considerable proportion
of the cases notified in the autumn occurred among persons recently returned to London from other
parts of the country. As in the last few years there were still manifest in 1918 high mortality rates from
tuberculosis, dysentery and typhoid fever among certain asylum populations in several parts of England,
as well as in London, and a special memorandum on the "Increased Annual Death Rate in Asylums"
was issued by the Board of Control in January, 1919. Up to the time of the armistice there was steadily
growing evidence that the prejudicial effects of war conditions were being experienced in various ways
by asylum populations. Cerebrospinal fever was less prevalent than in 1917. Polioencephalitis and
poliomyelitis were at a comparatively low ebb; there were, however, a few cases of encephalitis lethargica
which might formerly have been described as polioencephalitis.
Influenza
The three widespread and fatal influenza epidemics of 1918-19 are the subject of a special report
which will be found in the Appendix. The epidemiology of influenza is discussed in that report and
reference is made to the same question on p. 8. The "obscure disease with cerebral symptoms " which
in some places ushered in the great influenza was alluded to in last year's report and is here further
considered under the head encephalitis lethargica and in the special report on influenza.
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