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London County Council.
ANNUAL REPORT OF THE COUNCIL, 1924.
CHAPTER XXL
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH
(Sir WILLIAM HAMER) FOR THE YEAR 1924.
Part I.—General.
Introductory Note.
The death-rate in 1924 was 12-2 per 1,000 and thus slightly higher than in 1923,
when the lowest death-rate ever recorded (11.4) was registered The infant mortality
was 69 per 1,000 births as compared with 61 in 1923, the latter being also a record
year in this respect. The small rise in the general death-rate may be attributed to
prevalence of measles, early in 1924, and to a slight increase in the deaths from
influenza, bronchitis and pneumonia; the mortality from diarrhoea and enteritis
was lower than in 1923 ; an increase in the death-rate from whooping cough was
apparent in the closing months of 1924 and was continued in the early months of
1925.
As was the case in 1923, contacts of cases of smallpox came to reside in or passed
through London on several occasions. Only four cases, however, resulted from
the disease in London. The condition of Europe as regards smallpox was more
favourable than before, but the presence in the North and Midlands of this country
of a mild form of smallpox was a continued and an increasing menace to London,
especially in view of the exceptionally large number of persons from affected parts
of the country visiting London.
Typhus and relapsing fever showed decline in Eastern Europe as compared
with 1923. Typhoid fever remained at a comparatively low ebb ; there was some
increase of the disease in certain countries bordering upon the Baltic ; in England
and Wales there was a slight rise in the number of notifications ; both in this country
and in the United States there were outbreaks associated with eating oysters ;
in a circumscribed area in East London a prevalence of upwards of 70 cases
occurred—much the most considerable London outbreak since 1911—which was in
all probability due to the consumption of small plaice. (See pp. 38-42.)
Scarlet fever and diphtheria showed some increase in prevalence in this country
and in Germany and the Netherlands. In London the death rates from diphtheria
and scarlet fever were practically stationary; in New York diphtheria showed a
small increase on the comparatively low rate for 1923. On p. 16 a diagram is presented
showing the remarkable way in which diphtheria gradually spreads from one
part of this country to another, as evidenced by death-rates over a series of years
in the large towns. The phenomena have not inaptly been compared with those
exhibited by living protoplasm when seen under the microscope, allowing of course
for enormous magnification in the scale of such " amoeboid " movements, and for
great extension of the time occupied in their development.
The behaviour of influenza and epidemic diseases affecting the central nervous
system during 1924 was particularly deserving of note. There was no marked
increase in deaths from influenza in England and Wales, but encephalitis lethargica
rose to an unprecedented height, in May, when some 1,000 notifications were received.
In London also the prevalence was at its height in this month. Poliomyelitis was
rather more common than usual during 1924 in London, Denmark, England and
Wales and the United States, and quite late in the year, in Iceland. A remarkable
epidemic of an " unidentified disease involving the central nervous system," variously