View report page

London County Council.
ANNUAL REPORT OF THE COUNCIL, 1923.
CHAPTER XXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH
(Sir WILLIAM HAMER) FOR THE YEAR 1923.
Part I.—General.
Introductory Note.
The year 1923 was remarkable for having the lowest death-rate (11.4) ever
recorded in London. The infant mortality rate was even more exceptional, as it
was only 61 per 1,000 births, a considerable fall from the rate of the
preceding year, viz., 75, which was itself a record rate. The comparatively low
mortality from influenza, bronchitis and pneumonia, the low rate from measles and
the improvement as regards the rates from scarlet fever and diphtheria upon those
of 1922, account in large measure for the very low general death-rate of 1923. It
may be noted, however, that diarrhoea and enteritis, and cancer, were registered as
causes of death in rather larger numbers than in 1922.
There was, throughout 1923, great risk of spread of smallpox to London. The
number of cases notified in England and Wales had not reached 150 annually during
the war years ; in 1919 and again in 1920 it exceeded 200; in 1921 the number was
over 300 ; in 1922 it was 967, and in 1923 it was 2,461. Fortunately the mischief
caused by the disease in London was kept within very narrow limits (see p. 14).
Curiously enough the smallpox introduced into London came not from the Midlands
or from other counties, where prevalence of smallpox was more or less established,
but from Spain. Another risk which fortunately did not materialise during 1923
was that of spread of epidemic diseases from eastern Europe. Between 1918 and
1922 twelve million cases of typhus and recurrent fever are reported to have occurred
in Russia. During the first eleven months of 1923, 221,966 cases of typhus and
230,611 cases of relapsing fever were reported. Cholera was at its highest point in
recent years in Russia during 1922. Smallpox in Russia had reached a total of
152,000 cases in 1920, but underwent considerable decline in 1921 and 1922 ; in
northern Russia in 1923 there was a rise, but in the Ukraine a fall. Malaria is said
to be causing great mortality in Russia at the present time. In the Ukraine alone
nearly half a million cases were reported during the first ten months of 1923.
The notifications of scarlet fever and diphtheria in London showed noteworthy
decline during the year. Typhoid fever fortunately remains at a remarkably low
level, moreover, rather more than half the cases notified and subsequently removed
to hospitals of the Metropolitan Asylums Board were ultimately found not to be
examples of that disease ; some further observations on the very remarkable decline
of this disease appear on p. 31. Influenza was beginning to prevail rather extensively
throughout western Europe at the close of 1923 and in January and February
of 1924. Cases of encephalitis lethargica increased in frequency early in 1924.
Poliomyelitis also showed some increase but cerebrospinal fever remained at a low
ebb in this country and elsewhere.
Further progress was made under the county scheme and under the London
and Home Counties' scheme as regards the treatment of tuberculosis and venereal
diseases respectively. The annual enumeration of homeless persons made in the
early hours of the morning of February, 1923, showed a total of 141 as compared
with 112 in 1922. In 1924 the number showed a reduction, despite the amount of
unemployment which continued to exist throughout 1923, to a total of 82.