View report page

ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR
THE YEAR 1919.
PART I.—GENERAL.
Introductory Note.
In a year following upon five years of war it would seem appropriate that a review should be
made of the lessons learnt under the exceptional strain and stress experienced; but hard upon the
armistice followed the great influenza of November-December, 1918, to be succeeded a few months
later in February-March, 1919, both by a further prevalence of influenza and the threat of smallpox ;
and throughout the year the menace of typhus, dysentery and smallpox widely disseminated on the
Continent and more especially in eastern Europe, has been felt to constitute a serious source of danger.
So far as epidemic diseases concerned it is, as has often been urged, the post-war period rather than
that of the war itself that threatens the safety of civilian populations not actually living within the
area of hostilities. For five years and more the emigration from and immigration into this country of
civilians practically ceased, and this fact has materially influenced the extent of risk ; it is only now,
indeed, nearly eighteen months after the cessation of hostilities, that there is any prospect of the
resumption on a considerable scale of the pre-war movement of emigrants passing through London and
other ports on the way westward.
There have been, moreover, during the past 18 months, apart from questions of the spread of
epidemic disease, pressing problems closely concerning the public health, which have engaged the
attention of Committees of the Council (Education, Public Health, Housing, Main Drainage) and
thrown much work upon the public health department. An attempt, however, is, despite the difficulties
in question, made in the succeeding pages to review some of the lessons learnt with regard
to typhoid, influenza, tuberculosis and measles.
The year 1919 was one of exceptionally low mortality, although there was considerable increase
in the number of deaths from influenza and allied causes in its first quarter. Save for a fortnight of cold
and inclement weather during February, the conditions were favourable to health.
The rainfall and the number of rainy days were about the average for the year as a whole, the
winter rainfall being somewhat above, while that of the summer and of the autumn were below the
normal. The temperature was below the average. February, July, October and November were cold
months, and July especially so, this being a month of much cloud and northerly winds.
The year was essentially a period of transition from the war conditions of 1918 to almost normal
conditions towards the end of 1919. The majority of the war refugees were repatriated early in the
year, and with the return of American and Colonial troops, and the demobilisation of the British forces,
there resulted, by the middle of the year, a net addition of over 400,000 to the London population.
It is, therefore, gratifying to be able to record the fact that the deaths in the latter half of 1919 were
lower than in any corresponding period for many years.
The number of marriages registered increased somewhat, the estimated marriage rate being 22 Marriages,
per 1,000 living as against 19 in 1918.
The Registrar-General estimates the birth-rate in 1919 to have been 18'2 per 1,000 as compared Births,
with 16'0 in 1918. A rapid increase in the births registered occurred in the latter half of the year, and
in the closing weeks the registrations far exceeded even pre-war figures.
The death rate among civilians is estimated by the Registrar-General to have been 13'6 as Deaths,
compared with 19'2 in 1918. Epidemic influenza was a direct or contributory cause of about 5,000
deaths in the prevalence of February-March, but the total of deaths in the year, 59,114, was nevertheless
below that of any previous year since 1856. The mortality among infants under one year per 1,000
births was 85 in 1919, as compared with 108 in 1918, and is the lowest rate ever recorded in London.
The exceptionally low prevalence of notifiable infectious disease recorded during the past two infectious
or three years was not generally maintained in 1919; the total number of cases notified was, however, disease
still below the average. Several cases of small-pox occurred, but fortunately isolation of the cases and
contacts proved successful in limiting the spread of infection. Diphtheria showed increased prevalence,
the cases notified being, indeed, in excess of any year since 1902. Scarlet fever, which had fallen to a
minimum incidence in 1917, has since then steadily increased, not only in London, but in the country
generally, and there is every appearance of the approach of another period of greater prevalence.
Typhus fever was epidemic in many parts of Europe in 1919, but only two cases were notified in
London. Dysentery caused 86 deaths, as against 313 in 1918. Typhoid fever showed still further
decline upon the remarkably low rates of recent years. The low incidence of typhoid fever is the more
remarkable in that the population of London was, owing to demobilisation, increased for a time
by 400,000 persons drawn from all parts of Europe. While the civilian population has escaped
thus lightly, there was still unusual prevalence of typhoid fever in certain of the London mental hospitals,
though the total number of cases (90) was much less than the number (170) in 1918. The remarkable
freedom of the army from the disease as compared with earlier military experiences has been widely
ascribed to preventive inoculation. Whatever the conclusion may be with regard to the soldiers it is
clear, however, that such an explanation cannot hold with regard to typhoid in the civilian population
55580