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INTRODUCTION
This report records the activities of the department for 1950. It is the half-wayyear
of a century and it is not inappropriate to look back to the beginning of the
present century and indicate the principal changes in the vital statistics of London
since that date. For instance, the expectation of life of a baby born in 1900 was
44 years if a boy or nearly 48 years if a girl; by 1925 it had increased to 56 and
60 years, while today it is 66 and 71 years respectively. The greatest single factor
contributing to this 50 per cent. increase in the expectation of life is in the reduction
in the number of deaths of infants under one year of age (the Infant Mortality Kate)
which fell from 158 per 1,000 live births in 1900 to 68 in 1925 and is now only 26.
Similarly whereas in 1900 3.29 women died in childbirth for every 1,000 births (3.19
in 1925) now the rate is 0.70. This means that in 1900 more than one mother died for
every 300 children born and in 1950 it was one death for 1,400 births. These deaths
include those following abortion. Excluding those the maternal mortality rate in 1950
was 0.53 or one death for 1,880 births.
Progress in the conquest of the acute infectious diseases is striking. Scarlet
fever caused 329 deaths in 1900 and 4 in 1950; the numbers for diphtheria were
1,593 and 4 ; typhoid fever 767 and 3 ; smallpox 2 and nil; measles 1,946 and 4 ;
whooping cough 1,957 and 30 ; enteritis under 2 years of age 3,401 and 64. Pulmonary
tuberculosis killed 7,748 in 1900, 4,361 in 1925 and 1,225 in 1950 ; the non-pulmonary
form of tuberculosis was responsible for 2,339 deaths in 1900, 796 in 1925 and only
122 in 1950.
The crude death-rates in 1900, 1925 and 1950 were 18.6, 11.9 and 11.3. If the
death-rate in 1950 had remained at the rate for 1900 and taking into account the
difference in the age constitution of the population for the two years, there would
have been 88,000 deaths instead of the 38,300 which actually occurred. The number
of deaths of children under one year of age would have been 8,400 instead of 1,372.
The population of the county of London is now three-quarters of what it was in 1900—
3,390,000 against 4,543,000.
Many factors have contributed to these results. They include advances in
medical knowledge both in the curative and preventive fields and what is even more
important the application of that knowledge. But knowledge and its application
profit not, if those whom it will benefit do not avail themselves of it at the proper time.
This involves a continuous process of education of the general public as to the services
available, again both curative and preventive, and the circumstances in which they
should apply for them. Simple illustrations in the preventive field are immunisation
against diphtheria and vaccination against smallpox. These should be started in
infancy and the immunity reinforced at appropriate intervals. It is a depressing
thought that there was a lag of thirty years between the discovery of the method of
immunising against diphtheria and an intensive campaign to have it used. The
results have been remarkable. Again the spectacular reductions in infantile mortality
are largely due to the efforts over many years of health visitors, infant welfare clinics
and of doctors in the public service and in individual practice to educate mothers in
the principles of parentcraft. On the curative side there is no doubt that a doctor
can do his best and most effective work if he is called in during the earlier, rather than
the later, stages of a serious illness and dissemination of knowledge about health and
disease with this objective in view is of paramount importance.
It must, however, be remembered that the deaths from some diseases have
declined for reasons beyond our present knowledge. The mortality from scarlet