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1914 births, while in the aggregate for Hampstead, Lew is ham and Wandsworth the decline was 32 per
cent. The reduction in births registered also varies, however, with the decrease in civil population
resulting from enlistment and migration ; thus in the Metropolitan Borough of Woolwich, where the
civil population in 1918 is estimated bv the Registrar-General to exceed the total population in 1914,
the decline in the birth-rate is only 10 per cent., considerably below that found in any other borough.
The greatest decrease, 49 per cent, occurred in Shorediteh.
Deaths.
The deaths among the civil population of London during 1918 numbered 75,928 as compared
with 63,406 in 1917. The Registrar-General gives the death-rate as 19'2, the rates during the years
1915-17 being 16-8, 14 6 and 15'7 respectively.

Infant
mortality.
The excessive mortality in 1918 shown in this table is almost entirely due to the two influenza
epidemics; they are dealt with in a separate report, which is appended. During the course of these
epidemics the deaths from pneumonia, bronchitis, diseases of the heart and circulatory system, and
phthisis were considerably increased. Of other causes of death not affected by influenza mention must
be made of whooping-cough, the mortality from which, allowing for the decrease in child population,
was higher than in any year since 1896. The deaths from diseases of the respiratory system in the first
quarter of the year were also high. The reduction in the mortality from cirrhosis and alcoholism is
remarkable; it will be recollected that a decline was recorded in 1917 and was associated with the control
of the liquor traffic.
The death rate among infants under one year of age was 108 per 1,000 births, the corresponding
rates in 1915-17 being 112, 89 and 104 respectively. Influenza caused 259 deaths, and there are indications
of an increase in the number of premature births during the course of the influenza epidemics; but the
cause principally responsible for the somewhat higher infant mortality Was whooping-cough, from which
499 deaths were recorded.
The reduction in mortality from overlying commented upon in recent reports and associated with
decrease in drunkenness was maintained in 1918, being 93 as compared with 150 in 1917.
Smallpox.
Infectious diseases.
A small outbreak of smallpox during the Spring of 1918 is described in Part II. of this Report.!
It must be added here that between 7th December, 1918, and 31st March, 1919, 18 cases of smallpox
occurred in the Boroughs of St. Pancras (12). Islington (2), Battersea (2). Holborn (1), and Westminster
(1), which were all directly or indirectly connected. The first of the series was a man, G. N., aged 63 years,
living at 59, Red Lion-square, Holborn. A few days later, on lltli December, an Australian soldier
who attended the medical inspection room at Horseferrv-road, Westminster, was also found to have
smallpox. On making enquiries it was found that this man had stayed at 59, Red Lion-square previously
referred to ; it was ascertained that these premises were frequented by overseas soldiers, and that
smallpox had occurred among a party of soldiers who had psissed through London previously. The
Australian stayed with other friends at 40, Burton-street, St. Pancras, a night or two before reporting
for medical inspection on 11th December, with the result that three further cases occurred among the
occupants of that house between 28th December, 1918, and 6th January, 1919. The long interval gave
rise to suspicion that an intermediate unrecognised case must have occurred. The first of the St. Pancras
group of cases that of 28th December, was reported from 9, Se\erus-road, Battersea, where the patient
was staying for the Christmas holidays, and two other persons in that house developed the disease on
13th and 15th January respectively.
Concurrently with the later cases of this group another set occurred, originating in a child E. B.,
aged 13, living at 6, Dewsbury-terrace, St. Pancras, who was at first thought to be suffering from
chicken-pox in the early part of January. It was not until after her mother was removed to hospital
on 25th January that Dr. Shadick Higgins, Medical Officer of Health of St. Pancras, saw the child and
concluded that she was recovering from smallpox. The source of infection could not be discovered
and no connection with any of the cases in the group previously referred to could be traced. Although
the child had not been to school during her illness, in view of this and other possible unrecognised cases
the children attending schools in the neighbourhood were kept under close observation by the Council's
medical officers.
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