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as a whole, for only a very small percentage of this population was inoculated and the number of cases
occurring since 1914, after correction for age and sex constitution, has shown distinct diminution. A
further remarkable feature in connection with the London typhoid has been the smoothing out of the
ordinarily observed autumnal rise of prevalence.
When the war first broke out the opinion was very generally expressed that a rise in typhoid in
this country was likely to occur, from infection by returned convalescents. In the Annual Report for
1914 (page 23) it was pointed out that this view was erroneous ; the experience of the great water outbreaks
(Maidstone, Lincoln and Worthing) was cited, following upon which no notable postepidemic
prevalences of typhoid occurred. Moreover, in Belfast" disuse of cockles was followed by a diminution
of typhoid, despite the presumable existence in the city of large numbers of bacillus carriers." It was
added that "The case of London is especially noteworthy, for in 1898, 1899 and 1900, typhoid
prevailed in considerable excess; many hundreds of carriers of typhoid bacilli must have newlv
appeared upon the scene; and to these were added, in 1900 and 1901, appreciable numbers of
returned 'carriers' from South Africa; yet in the succeeding years typhoid steadily declined."
Facts of this nature were declared to be " wholly irreconcilable with the bacillus carrier thesis."
It was concluded, therefore, that the predictions of probable spread of the disease by persons
arriving from abroad need not be too seriously regarded; but it was added that "disturbance of the
operations of the fishing fleet in the North Sea, and possible interference with the shellfish industry,
brought about by the war, afforded reason for closely watching the behaviour of typhoid fever." The
opportunity is taken (pp. 10-20) of reviewing the whole position in the light of the experience gJned
in 1914 -19, and an attempt is made to deduce such lessons as may be learnt from the facts observed.
Puerperal fever and erysipelas were more frequently notified in 1919 than during the preceding two
years. Both diseases tend to rise and fall with the scarlet fever incidence ; in the case of puerperal fever,
however, the great i ncrease in the number of births in the latter part of the year enters largely into account.
The influenza epidemic of February-March, 1919, was dealt with in conjunction with the two
epidemics of 1918, in a special report appended to the report for last year. During 1919, deaths from
influenza continued to occur, but apart from wider prevalence of a " mild type of influenza " during
the autumn, the incidence was sporadic. The high autumnal mortality from bronchitis coincided
with the appearance of the autumnal influenza referred to, and was largely attributable to it. Cerebrospinal
fever, poliomyelitis, polioencephalitis and encephalitis lethargica were but little prevalent. The
number of cases of tuberculosis notified during 1919 showed decline upon the figures of recent years.
Admisistra-tion.
There was throughout London a gradual approach towards a restoration of the pre-war standard
with regard to sanitary administration during the year, as men and women returned from war duty.
The tuberculosis scheme of May, 1914, was further extended, and the opportunity was taken to review
the progress made; Dr. F. N. K. Menzies, working in conjunction with Dr. J. E. Chapman, one of
the medical inspectors of the Ministry of Health, made a comprehensive survey of dispensary work in
London. See the Appendix to this Report. This Appendix also includes a reprint from a Memorandum
presented to the Insurance Committee by Dr. Noel D. Bardswell. The scheme for London and the Home
Counties for the diagnosis and treatment of venereal diseases, inaugurated on 1st January, 1917, was considerably
extended during 1919, and as its usefulness became more appreciated, and with disuse of army
activities, the volume of work undertaken at the civilian treatment centres underwent considerable
augmentation. In all, some 20,908 new London patients made use of the facilities, as compared with
rather more than 12,200 in 1917, and rather more than 12,530 in 1918. The arrangements entered into
with the National Council for Combating Venereal Disease with a view to making more generally known
the nature of the facilities provided were continued.
A large amount of work was entailed in connection with representations relating to unhealthy
areas in London. An account of the measures taken during the year by the Housing of the Working
Classes Committee is given on pp. 29-32. Reference is made to the work under Part I. of the Children
Act, 1908 (p. 44), under the Midwives Act (p. 39), and the Mental Deficiency Act (p. 35). An
analysis of the results of the examination of children referred under the last named Act, was made by
Dr. F. C. Shrubsall and appears on p. 37. Close watch was kept, as heretofore, upon common and
seamen's lodging houses, and upon soldier's rest houses. Account of the work in the chemical branch
of the department is given on p. 47. During the year much attention was directed to the subject
of the biological treatment of sewage, and reports were made to the Main Drainage Committee, who
themselves visited and inspected works in the north and midlands in which experimental enquiry
was being carried on.
The need for a truer and
With reconstruction in the air, it was only to be expected that attention would be, at length,
centred on the very foundations upon which the practice of preventive medicine is built, and an attempt,
epidemilolgy
prehensile however imperfect, must be made to indicate the general trend of the conclusions recently reached in
this connexion.
Dr. Greenwood in the first of a course of lectures, at Cambridge, in July, 1919, on "The Epidemiological
Point of View " (Brit. Med. Journ., 27.9.19), gave his hearers some insight into the purpose and
meaning of the new Epidemiology. He has, in a more recent statement thrown further light upon the
methods to be employed (Proc. Roy. Soc. Med. XIII., No. 4, p. 181). He has pointed out that "the epidemiologist
is concerned with disease as a mass phenomenon; his business is not with individuals but with
aggregates." Sydenham's full recognition of the truth of this constitutes him the founder of epidemiology;
" He laid it down that personal knowledge of the facts was the prerequisite of epidemiological theory,
and he became the first great modern annalist of epidemics The second great contribution of
Sydenham was to the study of short period movements in the prevalence of diseases—the seasonal
variations of epidemics . . . The third contribution " was his " theory of epidemic constitutions."
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