London's Pulse: Medical Officer of Health reports 1848-1972

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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London

London County Council 1897

[Report of the Medical Officer of Health for London County Council]

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11
The diagrams enable the decrease in the month of August to be appreciated, and the close
correspondence in point of time between this decrease and the closing of the schools when due
allowance is made for period of incubation, and a little delay in notification is noteworthy. The
further fact that the decrease in the age 0—3 curves generally occur somewhat later than in the
age 3—13 curves, suggests a lessening of the infection of the younger by the older children.
With a view to enabling the effect of the increased incidence of diphtheria mortality upon
particular ages to be easily appreciated, the following table (XII.) and the accompanying diagram have
been prepared. The diagram shows the effect on the "all-ages" death rate of the increased incidence of
diphtheria on the age period 3—10 years. The diagram had been prepared before this report was
written, and hence the age period 3—15 years was not adopted. The effect of the addition of the
age period 10—15 years to that of 3—10 years makes, however, no difference deserving of comment.

Table: TABLE XII. London. Diphtheria and croup.

TABLE XII. London. Diphtheria and croup.

Period."Ages 3-10.""All ages."
Estimated deaths assuming same proportion of deaths at ages 3-10 in 1871-5 and successive periods as obtained in 1861-70.Registered deaths.Excess.Estimated deaths assuming same proportion of deaths at ages 3-10 in 1871-5 and successive periods as obtained in 1861-70.Registered deaths.Death rate per million calculated on estimated deaths shown in column 4.Death rate per million calculated on registered deaths shown in column 5.Death rate in 1861-70 taken at 100.
On estimated death rate in column 6.On death rate in column 7.
123456789
1861-704,8054,805-13,03113,031431.7431.7100100
1871-51,7762,2734974,7835,2802843136673
1876-801,6782,4838054,4915,2962462905767
1881-52,4264,0191,5936,5038,0963334157796
1886-902,4684,5052,0376,6968,7333274267699
1891-53,4126,8703,4589,32012,778433594100139

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It is desirable to use the experience of notification with a view to learning as far as possible the
actual amount of increase of the disease which is due to infection at school.
For this purpose tables VI. and VII. may be referred to. The decrease of diphtheria in the
holiday month of August among children at school age is conspicuous. But for the holiday the number
of cases notified in August would probably stand somewhere between the numbers in July and
September. In the following table (XIII.), the estimated mean weekly number of cases in August
has been obtained by interpolation, using for this purpose the figures supplied by June, July, September
and October. It will be seen that at all ages the estimated figures exceed the actual notification by
24-1 per cent., i.e., the holiday in August has reduced the total number of cases by one-fifth, the most
conspicuous reduction being at age 5—, at which age the holiday reduced the number of cases by onethird.

Table: TABLE XIII. London, 1892-96.

TABLE XIII. London, 1892-96.

Age—period.Estimated mean weekly number of notifications in August on the assumption of a continuous curve of prevalence extending over the months of June. July, August, September and October, 1892-6.Mean weekly number of cases notified in August, 1896.Increase or decrease per cent. of estimated notifications over actual number of cases notified.
0—5.65.5+ 1.8
1—13.612.6+ 7.9
2—17.117.5— 2.3
3—24.320.7+ 17.4
4—24.617.6+ 39.8
Under 5.85.373.9+ 15.4
5—76.250.2+ 51.8
10—33.225.5+ 30.2
15—20.917.9+ 16.8
20 and upwards45.643.0+ 6.0
All ages.261.2210.5+ 24.1