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14
Annual Report of the London County Council, 1914.
given in table I., page 40. Inasmuch as the birth-rate has not been constant during these periods
and the proportion of population in the early years of life has probably diminished in recent years, the
death-rate of children under five years of age is also shown in the same table.
The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1914,
calculated on the population at all ages, is shown in diagram (G). The monthly deaths from measles
in relation to the mean of the period 1891—1914 is shown in diagram (H).

Deaths and
death-rates
from measles
in London
boroughs.
In the distribution of measles mortality throughout the year 1914, the highest death-rate
obtained in Shoreditch (l-02) and the lowest in St. Marylebone, Hampstead and Stoke Newington (0.02)
For the period 1909-13, Bermondsey (0.94) had the highest measles death-rate, and the City of London
and Lewisham (0.09) the lowest. The death-rates from this disease in London in each of the four
quarters of the year 1914 were as follows: first quarter, 0.13; second quarter, 0.31; third quarter,
0.37 and fourth quarter, 0 43 per 1,000 persons living.
Measles was made compulsorily notifiable during the year in the borough of Paddington. A
system of notification to the sanitary authorities through the school organisation has been in existence
for many years, and thus during some nine months a double system of notification was in operation
in the borough. On the one hand practitioners and parents and on the other teachers and school
attendance officers reported the cases, but in addition through the school organisation many cases came
to light of children not attending school owing to the fact that older brothers and sisters or children
living in the same house were school attendants. A large number of cases thus came to the knowledge
of the authorities which were not being attended by a medical practitioner, and it is in these cases that
the authority can give advice and adopt precautions of the greatest assistance in saving life.
In order to test the relative numerical values of the two systems of notification, an analysis has
been made of all the cases in which houses were known to have been invaded by measles during September,
October and November of the year 1914. The total number of houses was £5, and 87 per cent,
of them contained school children. Seventy-eight per cent, of the houses were reported through the
school organisation, and the comparatively small leakage of 9 per cent. could no debutt be further reduced.
Of the remaining 13 per cent, of cases in which knowledge could not have been obtained through the
school organisation 6 per cent, came from houses in which there were no children of school age, 4 per cent,
were above the elementary school class, and in 3 per cent, information could not be obtained. There
were two instances in which the primary case in the house was made known through the school organisation,
but subsequent cases were known only by compulsory notification. Of the whole 95 houses
invaded, 66 per cent, were made known through compulsory notification. These figures show that
under a school system, almost all the cases concerning which knowledge is of practical value come under
the notice of the sanitary authorities and school authority. This is still more apparent when it is considered
that Paddington stands fairly high in the scale of London boroughs as regards social position;
in poorer boroughs the proportion of cases in which a doctor is net called in is still higher. In Paddington
the measles death-rate in 1914 was 0.03 per 1,000 persons living, while in Finsbury 0.90;
in Bermondsey 0-65, and in Shoreditch l.02 per 1,000 persons living.
Scarlet Fever.
The cases of scarlet fever notified in the Administrative County of London during 1914 (52 weeks)
numbered 25,018, compared with 17,552 in 1913 (53 weeks). The number of deaths registered from
this cause was 316 in the year 1914 (52 weeks), compared with 188 in 1913 (53 weeks). The scarlet
fever death-rates, case-rates and case-mortality for 1914 and preceding periods are given in tables I.
and II., pages 40 and 41.
The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591914
will be seen on reference to diagram (I). The monthly case-rate and case-mortality in each of the
years 1891-1914 in relation to the mean of the whole period is shown in diagram (K).