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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17
Examination of these diagrams leads me to the conclusion that they are very much what might
be expected. The figures supplied by Beilin lend support to the view that the age distribution of
diphtheria mortality is affected by the age at which compulsory attendance at school begins, thus the
following figures show a greater relative incidence of diphtheria mortality upon the ages 3-5 years
in London than in Berlin. The death-rates are shown for diphtheria and for diphtheria and croup. In
the case of Berlin additional columns are given showing deaths and death-rates from diphtheria and
croup plus "scharlach-diphtherie," a disease for which there is 110 equivalent term in the system of
nomenclature adopted in the reports of the Registrar General.
| Age period. | Population, 1890. | Deaths, 1887-96. | Death rates per million. | Death rates per million—Death rates at 0-3 being taken as 1,000. | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Diphtheria. | Diphtheria and croup. | Diphtheria and croup plus "Scharlach diphtherie.'' | Diphtheria. | Diphtheria and croup. | Diphtheria and croup plus "Scharlach diphtherie." | Diphtheria. | Diphtheria and croup. | Diphtheria and croup plus "Scharlach diphtherie." | ||
| 0-3 | 103,409 | 4,552 | 5,072 | 5,327 | 4,402 | 4,905 | 5,151 | 1,000 | 1,000 | 1,000 |
| 3-5 | 60,961 | 3,244 | 3,395 | 3,613 | 5,321 | 5,569 | 5,927 | 1,209 | 1,135 | 1,151 |
| 5-10 | 136,446 | 3,164 | 3,235 | 3,378 | 2,319 | 2,371 | 2,476 | 527 | 483 | 481 |
| 10 and upwards | 1,277,978 | 777 | 797 | 831 | 61 | 62 | 65 | 14 | 13 | 13 |
| All ages | 1,578,794 | 11,737 | 12,499 | 13,149 | 743 | 792 | 833 | - | - | - |
London, 1887-96.
| Age period. | Population, 1891. | Deaths, 1887-96. | Death rates per million. | Death rates per million —Death rates at 0-3 being taken as 1,000. | |||
|---|---|---|---|---|---|---|---|
| Diphtheria. | Diphtheria and croup. | Diphtheria. | Diphtheria and croup. | Diphtheria. | Diphtheria and croup. | ||
| 0-3 | 307,182 | 7,391 | 9,258 | 2,406 | 3,014 | 1,000 | 1,000 |
| 3-5 | 194,440 | 5,916 | 6,882 | 3,043 | 3,539 | 1,265 | 1,174 |
| 5-10 | 454,160 | 4,920 | 5,345 | 1,083 | 1,177 | 450 | 391 |
| 10 and upwards | 3,255,961 | 1,423 | 1,445 | 44 | 44 | 18 | 15 |
| All ages | 4,211,743 | 19,650 | 22,930 | 467 | 544 | — | — |
Hitherto Dr. Smith's report has related only to the examination of figures relating to notification
and death, but on pages 27-30 he gives the result of a special enquiry he made into 2,168
consecutive cases of diphtheria at "all ages" removed to the hospitals of the Metropolitan Asylums
Board.
He divides his cases into three groups—cases aged 0-3, 3-13, and 13 and upwards; cases
aged 3-13 he sub-divides into three groups—
(a) Cases which attended school within seven days of the occurrence of the
first symptoms of disease 839
(b) Cases which did not attend school within seven days of the occurrence
of the first symptoms of disease 545
(c) Cases about which full information as to school attendance could not be
obtained 47
Total 1,431
He then proceeds to point out that the 839 children, constituting "58.6 per cent. of the cases
"of diphtheria at school ages, occurred amongst children attending elementary schools"; that of the
London population "60 percent. of the children living at school ages attend elementary schools;
"and from this it would therefore appear that the disease is equally incident on children attending
"schools and upon those not attending." In other words, Dr. Smith draws the inference that diphtheria
is equally incident on children of school age attending elementary schools and upon those not attending,
from the following data—
(а) Of 1,431 cases of diphtheria at ages 3-13 admitted to the hospitals of the Metropolitan
Asylums Board, 58.6 per cent. had attended school within seven days of attack.
(b) Of the London population 60 per cent. of the children living at school ages are in
average attendance at elementary schools.
It is obvious that no reliable inference can be drawn from these figures.
The figures relating to average attendance at elementary schools are not comparable with the
figures relating to the proportion of children of school age in the hospitals who had attended school
within seven days of attack.
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