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London County Council
ANNUAL REPORT OF THE COUNCIL, 1922.
CHAPTER XXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH
(Sir WILLIAM HAMER) FOR THE YEAR 1922.
Part I.—General.
Introductory Note.
The mortality statistics of 1922 are by no means so unfavourable as, prior to
the autumn of that year, it seemed likely that they might be. Following upon the
influenza, measles, whooping cough, scarlet fever and diphtheria prevalences of
the earlier months of 1922 there came a wet cool summer, and epidemic diarrhoea was
held in check (partly by natural conditions and partly too by the art exercised
by the infant welfare centres and other agencies) to an extent quite unprecedented.
The rate of mortality from diarrhoea among infants under 1 year of age was only
6.26 per 1,000 births, as compared with 18"63 in the preceding hot and dry year,
and with 24'28 on the average of the four years 1911-14. There was, however, a
threat of smallpox prevalence in the late summer and autumn, but this did not very
seriously materialise in 1922; on the whole the death-rate from all causes was 13.5
was compared with 12.5 in 1921; only 1 per 1,000 in excess of the record rate of the
previous year.
The behaviour of typhoid fever continues to be of very special interest. The
notifications, 264, were smaller in number than ever before, and for the eleventh
year in succession there was an almost complete absence of excess of prevalence
in the autumn. The occasion seems an appropriate one for a review of the whole
question of typhoid prevalence.
It has, again and again, been observed that both typhoid fever and cholera,
as manifested in this country, and the phenomenon has been especially conspicuous
in London, tend to occur in groups of cases; this grouping may be displayed in
cincumscribed areas, which (it may be) are attacked year after year, or it may be displayed
in institutions, and in some instances these too have been attacked time and
again. When the groups are well marked the occurrence of multiple cases in houses
is usually noted, and when the group is outside an institution a special age incidence
in the sufferers is wont to be observed. In the case of cholera, the writers on the outbreaks
of the forties, fifties and sixties insisted again and again on this grouping,
and on the fact that very poor people especially suffered. In the Annual Report
for 1911 (vol. III., p. 87) attention was called to similar behaviour in the case of
typhoid fever, and it was pointed out that in London this disease is as a rule met
with mainly in houses occupied by Chas. Booth's classes C and D, living in streets
coloured light blue or purple on the maps originally prepared by him, i.e., the prevalences
affected families living in conditions of poverty. The facts thus elicited
have been explained by differing schools of thought in two very different ways.
On the one hand appeal has been made to direct case to case infection, and during the
last 15 years to "healthy carriers of bacilli." The alternative hypothesis is that
water and food have been at fault. Murchison pointed out 40 years ago or more that
"all supposed contact cases are as readily explicable on the supposition that the
disease has had a common origin, as upon that of infection"; and Bulstrode in his
report on Typhoid at Whitehaven in 1903, urged that, before accepting direct case to
case infection as an explanation, it was necessary to eliminate the possibility of "continued
operation of the cause which may have given rise to the first case in the house