Annual report of the Council, 1920. Vol. III. Public Health.

  • London County Council (London, England). County of London.
Date:
1921
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Annual report of the Council, 1920. Vol. III. Public Health. Source: Wellcome Collection.

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    London Coming Council. ANNUAL REPORT OF THE COUNCIL, 1920. CHAPTER XXIII. REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. HAMER) FOR THE YEAR 1920. PART I.—GENERAL. Introductory Note. The Vital Statistics of London for 1920 arrest attention. The marriage rate remains, it is true, the same as last year; but the birth rate has risen from 18.2 to 26.4; the death rate has fallen to 12.6, the lowest London rate ever registered, and the infant mortality has dropped to 76, also a record, lower even than the 80 of England and Wales as a whole, and comparing favourably with the 85 of the other great aggregation of population, that of New York. These phenomenal general and infantile death rates, relating as they do to so large a population as that of the County of London, must give pause to those who advocate, at any rate on grounds of health alone, a return to the land, and cause hope to spring in the breast of even the most gloomy and pessimistic of the 4½ millions of human beings, whose avocations compel them to live or work within a few miles of St. Paul's. A death rate of 12.6 if it were possible to maintain it at that level for a scries of years, would entail an average duration of life of the fourscore years deemed some thousands of years ago to be attainable only by reason of strength, and far exceeding the expectation of life of the first Life Table of William Farr and of all the later Life Tables too. But the critic may object that 1920 was an exceptional year, coming as it did after five years of war, in which appalling losses were sustained ; following, moreover, upon the great influenzas of 1918 and 1919, in which such heavy toll was taken of the weak and infirm as to leave the survivors by com parison resistant to the ill-effects of disease. Again, it may be urged by the critic, the rising birth rate in itself may have tended to influence favourably the rate of infant mortality. In reply, it may be well differentiating and drawing within an inner circle, to limit the argument, as a recent Chadwick lecturer has done, to comparison between the rates of mortality of fevers in, say, the four years 1847-50 (during which the first great Public Health Act was passed) and 1916-19. In the latter the rate of mortality in England and Wales from typhus, typhoid, cholera, small-pox, scarlet fever, diphtheria, and whooping-cough was only in the proportion of about 1 to 8 of that in the earlier period ; while the death rate in a single year, 1849, was 18 times as great as in 1919. Again a comparison of the corresponding London figures for 1920 and for 1849 shows a closely similar proportion between the earlier and the later rates. Of course 1849, as well as being a heavy cholera and fever year, was an influenza year; and while 1920 was comparatively free from influenza, two years before, in 1918, a very high death rate from influenza was registered in London. Still, even in the year 1918, the total London death rate was only rather more than half that of 1849, the earlier year of exceptionally heavy mortality. The high marriage rate of the previous year was maintained in 1920, being 22 per 1,000 of the Marriage estimated population. The Registrar-General estimates the birth rate to have been 26.4 per 1,000, as compared with Births. 18.2 in 1919. In the first quarter of the year the birth rate was 31.4, but thereafter it declined, and in the fourth quarter it had fallen to 22.9, a figure somewhat below the pre-war average for this quarter. The death rate among civilians is estimated by the Registrar-General to have been 12/6, as Deaths. compared with 13.6 in 1919. There were relatively few military deaths in the year, and the number belonging to London cannot be ascertained ; but even allowing for these deaths, and for the uncertainty as to the true population, there seems little doubt that the mortality was well below any previous record in London. The mortality among infants under one year of age per 1,000 births was 76 in 1920, which is considerably below any London rate previously recorded. Comment was made in the report for 1919 upon the fact that certain notifiable infectious diseases infections were showing increase upon the low rates of prevalence of the preceding two or three years. This upward disease. movement continued last year so far as scarlet fever, diphtheria, erysipelas and puerperal fever were concerned, and the high incidence of the two first-named diseases in 1920 is referred to in detail in the second part of this report. The case-mortality happily continued to be far lower than that of earlier experience, as has now been the case for the last forty or fifty, and very notably so during the last twenty or twenty-five, years. Smallpox did not establish itself in 1920, though several imported cases naturally gave rise to apprehension. Typhus, though widespread in some parts of the Continent, particularly Poland and Russia, obtained no footing here. The special efforts made to minimise risk of spread of typhus in London by a more systematic delousing campaign in the elementary schools, are described in the second part of this report. The urgent need for taking these steps was emphasised by the revival of the transmigrant traffic between Europe and the New World, to which reference is made on p. 33. Dysentery, which had declined in 1919 as compared with 1918, showed further decline in 1920. The behaviour of typhoid fever in the years preceding the war, during the war years and sub sequently, is one of the most noteworthy epidemiological phenomena of the time. So much misappre hension exists on this subject that it was thought desirable in last year's report to review the whole position so far as the decline of typhoid fever in the last fifty, and particularly in the last twenty, years is concerned. 61004 B