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40 PUBLIC HEALTH SERVICES. Public Health Services. THE HEALTH OF LONDON IN 1924. Sir William Hamer, medical officer of health and school medical officer to the London County Council, estimates the mid-year civilian population of the County of London in 1934 as 4,576,505, and there were in addition 9495 non-civilian residents. The marriage-rate was 17-2, about the same as in the previous year. The birth-rate was 18-6, as compared with 20-1 in 1923 and 20-9 in 1922. A diagram shows that while the birth-rate has been halved since 1870, the ma,rriage-rate has remained practically stationary. ’Thus the birth-rate for 1871-75 was 35-3 a,nd the rate for 1921-25 was 20-0. During the same quinquennia the marriage-rates were 19-6 and 18-0 respectively. The regularity of the diagram is broken by the increase in the marriage-rate caused by the war marriages aand a temporary subsequent increase in the birth-rate. The death-rate was 12-2, as compared with 11-4 in the previous year. The increase is chiefly due to the increased fatality of measles among children under 5 years of age, and the greater number of deaths at ages over 45 due to the greater prevalence of influenza. Encephalitis lethargica caused a considerable number of deaths. The cancer and phthisis deaths increased somewhat, while a decrease occurred in the mortality from diarrhoea and enteritis. A table is given showing the death-rates for the county and the 29 metropolitan boroughs. The infant mortality for London was 69-0 the typhoid fever-rate 0-01 ; the phthisis-rate 0-98 ; and the cancer-rate 1 -42. Turning to the metropolitan boroughs and excluding the small resident population of the City (13,621), the highest birth-rates were found in Shoreditch (25-0) and Bermondsey (21-3) ; the lowest in Westminster (11-2), Holborn (13-4), and Hampstead (13-5). The lowest death-rates from all causes occurred in Lewisham (10-4), Woolwich (11-0), Wandsworth (11-1) and Fulham (11-1) ; while the highest were 14-3 in Finsbury and 11-1 in South- wark. The best infant mortality-rates were in Lewisham (48), Hampstead. (56), Stoke Newington 56), Wandsworth (57), and Hackney (59). Bethnal Green had a typhoid-rate of 0-10, the only other boroughs which reached 0-03 being Hampstead and Deptford. The highest rates from phthisis were 1-4 in Southwark, 1-24 in Chelsea, 1-23 in Finsbury, and 1-22 in Woolwich ; the lowest being 0-66 in Hamp- stead, 0-68 in Kensington, 0-7 in Stoke Newington, 0-73 in Lewisham, and 0-73 in Wandsworth. The highest cancer-rates were 1-83 in St. Marylebone and 1-73 in Hampstead ; the lowest being 1-0 in Paddington and 1-02 in Bethnal Green. Deaths caused by vehicles and horses show an increase. In London there were 593, 166 being children under 15. Taking for comparison Great Britain as a whole, motor vehicles caused more than eight deaths per day in 1924, being an increase of 21 per cent. on 1923. In the United States during 1924 motor vehicles caused 52 deaths per day, being an increase of 4 per cent. on the 1923 figure. The condition of Europe as regards small-pox was more favourable than recently, but the presence in the North and Midlands of a mild form of small-pox was a continual menace to London. Prompt and correct diagnosis and efficient administration, in the absence of full protection by vaccination and re vaccination, are the chief measures by which London is protected. The County Council places at the disposal of medical officers of health and medical practitioners in London and certain neighbouring areas the services of its expert medical staff to] assistance in diagnosis, and cooperates with all th( . sanitary and port authorities in the country. - history is given of the five ca.ses of small-pox whiel occurred in London during 192-1 and of the fou: persons, who sojourned in London, en route for othe: destinations, and were attacked by small-pox afte leaving. In London the death-rate from diphtheria and scarlet fever. was practically stationary, while in New York diphtheria showed a small increase on the comparatively low rate for 1923. Sir William Hamer has previously shown that from 1859 to the end of the nineteenth century New York had a far heavier death-rate from diphtheria than England and Wales or London, and suggested that in New York City, before it was extended, diphtheria deaths frequently included scarlet fever and other forms of throat inflammation. This view is confirmed by a diagram showing the similar beha,viour of diphtheria and scarlet fever mortality, when taken together, in New York and London from 1866 to 1924. Except for the period from 1870 to 1890 the mortality curve of the two cities from these two diseases is very much alike. Another interesting diagram dealing with the diphtheria record of 24 towns in this country shows the remarkable way in which diphtheria gradually spreads from one part of this country to another. " ’1‘he impression left on the mind," says Sir William I-lamer, " is one of an eminently infectious disease, but of one which spreads quite slowly from one area, town, or country to another, so that whereas in a period of four. five, or more years a continent or large area may suffer severely, the extent to which portions of such continent or other large area are involved varies greatly within the series of years under review." The outstanding fact is that wide- spread epidemics of throat disease have shown a tendency to occur in Europe and America at recurring intervals of some 20 to 30 years. It has also been noted that epidemics of influenza influence throat epidemics. There were six cases of human anthrax reported during the year, one of which proved fatal. In four cases the employment of the patients involved handling imported hides ; the fifth case was a girl of 10, whose father and brothers handled hides, and the sixth case was thought to have contracted it from. a shaving-brush. Notified cases of encephalitis lethargica numbered 605. In 64 cases the diagnosis was revised, reducing the number to 541, with 122 deaths and a case fatality of 45-9 per cent. The prevalence of the disease was most marked in April and May. Sir William Hamer considers in detail the relationship between influenza and cerebro-spinal fever, poliomyelitis and polio-encephalitis, and encephalitis lethargica. The pandemic of influenza in 1918 was preceded by unusual prevalence of cerebro- spinal fever in 1915, and of poliomyelitis in 1916, and was succeeded by the encephalitis prevalences of 1921 and 1924. After discussing the matter at length, Sir William Hamer inclines " to accept the conclusion that the whole group of epidemic diseases primarily affecting the nervous system exhibits a close family likeness (epidemiologically speaking) and a very close relationship, too, with influenza." After full consideration of the circumstances of the Bethnal Green prevalence of typhoid fever during 1924, Sir William Hamer thinks that the various facts elucidated point very suggestively to small plaice or dabs as the source of infection. " Prior to 1906 these fish, he says, were widely implicated on several occa- sions in London. This cause, however, ceased to operate in 1909 and (with an exception in 1911) remained conspicuous by absence until after the war. It is suggested that this source of danger, judging from London experiences in the autumns of 1923 and 1924, has recurred and that a close watch should be kept. The need for removing conditions likely to cause patients to discontinue attendance at the venereal disease cliriics is receiving careful attention, and the , fact that during 1924 the ratio of attendances to venereal cases was in the proportion of 32 to each new case is valuable evidence of improvement in methods. Such a ratio has never been greater in . countries where compulsory notification has been adopted. The Public Health Committee is investigating the possibility of arranging for a large scale test of
