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London County Council.
ANNUAL REPORT OF THE COUNCIL, 1921.
CHAPTER XXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR
THE YEAR 1921.
In the Annual Report for 1916, it was noted that the year" was one in which in a literal and
perhaps in a metaphorical sense also, more water than ever before known flowed under London Bridge."
Last year stands in marked contrast to this; it was a year of excessive drought. In the lower
Thames valley, where during a normal year a fall of 20 to 25 inches of rain is registered, the amounts
recorded were below 12 inches; February and October were almost unprecedently dry months and
June was actually the driest month hitherto known in the London area. The year was warm as well
as dry, every month except November having a mean temperature in excess of the average. The Camdensquare
results indicate that "The record of evaporation from a free water surface is unique, showing
a loss of 5.09 in. in excess of the rainfall. Never before since records of evaporation began in 1885,"
says Mr. Salter, "has the total for the year exceeded the rainfall, the nearest approach being in 1893,
when the rainfall margin was only 1.62 in. The normal excess of rainfall over evaporation is about 11.50
in." The influence of these phenomenal records will be found later to be reflected in the behaviour
of certain epidemic diseases.
The year was also an exceptional one in other respects; at its beginning the trade union returns
showed 6.1 per cent. of members unemployed and the figure had risen to 10 per cent. by the end of
March. From April to early in July the coal strike supervened and by the end of June unemployment
reached 23 per cent., an unprecedented figure. It is further specially to be noted that during 1921 considerable
numbers of transmigrants on their way from eastern Europe to America passed through
London.
The marriage rate was 19.5 per 1,000 as compared with 22 in the two preceding years.
Marriages.
The Registrar General estimates the birth rate to have been 22.1 as compared with 26.4 in 1920,
and 18.2 in 1919.
Births.
The death rate was 12.5, a record rate. The lowest previously reported was 12.6 in 1920. The
rate in 1919, was 13.6. The mortality among infants under one year of age was 81 per 1,000 births, a
slight increase upon that of the preceding year—76 per 1,000 births—a rate considerably below any
previously recorded in London.
Deaths.
Despite the phenomenal prevalence of epidemic diseases in Eastern Europe and the resumption
on a considerable scale of westward emigration, there was no development in London of cholera or
typhus; and although smallpox obtained a footing and smouldered in the north and midlands of this
country, only two cases were encountered in London and there was no spread. Typhoid fever continued
at a very low ebb and it is noteworthy that in 42.5 per cent. of the cases received in the Metropolitan
Asylums Board Hospitals the diagnosis was not finally confirmed; scarlet fever and diphtheria
attained exceptionally high prevalence in the Autumn, but the mortality happily was not proportionately
great; 1,150 deaths from diphtheria were, however, registered. Pulmonary tuberculosis accounted for
4,813 deaths. Diarrhoea, as might have been expected in such a year, was very prevalent, and 2,152
deaths of children 0—2 were registered; this is less than half the mortality, however, of the last hot
year 1911. The deaths from cancer numbered 6,008, the highest number hitherto recorded. On the
other hand, bronchitis with 4,479 deaths yields the lowest rate previously known in London.
Infectious
disease.
The behaviour of influenza was watched with special concern, having regard to the record of this
disease in 1918, and 1919. The total number of deaths ascribed to influenza in 1921, was 1,024 as compared
with 1,364 in 1920. The number of notifications of cerebrospinal fever, poliomyelitis and
polioencephalitis, as was anticipated, remained low during the recent years of special influenza
prevalence. The notifications of encephalitis lethargica, however, which in 1920 numbered 140
underwent some increase in 1921 to 233. Many and varied forms of manifestation of influenza were
again met with in 1921. In the report for 1920, it was noted that "there is reason for thinking that some
of the cases, at any rate, of glandular fever and of anomalous scarlatinal sore throat, as well as much
of the so-called epidemic hiccough, epidemic lethargy, poliomyelitis and cerebrospinal fever of 1920
were in fact of influenzal origin." Occurrence during that year and in 1921, of glandular fever and anomalous
throat illness, with an eruption resembling that of scarlet fever, is commented upon in the second
part of this report (p. 45). Epidemic hiccough has not again been commonly observed; but confusion
has undoubtedly existed with regard to diagnosis between whooping-cough and influenza, just as raised
mortality from "whooping-cough" was associated with the influenzas of the early months of 1918 and
1920. "False mumps "has, moreover, been an occasional source of difficulty in diagnosis. The
strange disguises of influenza have further, as in previous years, included gastro-intestinal disturbance,
stiff neck, lumbago and other myalgias, as well as the now commonly recognised nervous manifestations
of the disease. While these forms of the protean malady have been encountered in large urban centres,
the characteristic pandemic type of influenza has continued to manifest itself in outlying places, e.g., in
St. Kilda late in 1920, among army recruits in various parts of France in 1921, in the Faroe Islands
epidemic at the close of 1921, and in the outbreak in the Azores a few months later.
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