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INFANT MORTALITY
The rates of infant mortality in Lewisham remain above those for England and
Wales generally. Although statistical tests show that there is no mathematical
significance in the figures, there can be no cause for complacency here.
The perinatal mortality rate for Lewisham (i.e. deaths of infants in the first week
of life plus stillbirths per 1,000 births—including live and stillbirths), although
still higher than that for England and Wales, has shown a reduction since 1970.
The fall is entirely due to a reduction in the stillbirth rate which is now lower than
the stillbirth rate for England and Wales.
A reduction is also to be seen in the infant mortality rate for illegitimate babies
in Lewisham but this is compensated by a slight rise in the legitimate infant death
rate, so that the overall infant mortality rate is almost the same in 1971 as in 1970.
Factors which influence infant mortality include the illegitimacy rate (which in
Lewisham is twice that for England and Wales), and social conditions; it is probable
that these factors contribute to the fact that Lewisham's figures are above the national
average.
POLIOMYELITIS
A case of paralytic poliomyelitis in an adult female was notified in February 1971.
The case history prior to notification and the subsequent investigations involved
reveal the complexities of dealing with a major infectious disease in present day
urban society. E. L. M. Millar (Public Health, London (1971) 85. 103-106) revises
the present means of control of poliomyelitis, namely: "oral vaccination of all
children in the neighbourhood of, or attending the same school as, a paralytic case.
This and isolation of the case and school exclusion of household contacts forms
the basis of control measures". He points out that the only uncertainty is in deciding
how far the neighbourhood extends.
In this particular case the onset of symptoms was some six days prior to the
date of notification. No medical advice was sought for the first three days in spite
of the severity of the symptoms which included weakness of the legs. The patient
was due to attend hospital out-patients for a routine follow up and intended to use
that opportunity to seek advice. She was subsequently transferred to Hither Green
Hospital and notification was made by the consultant in infectious diseases to
whose ward the patient had been admitted. The Department of Health and Social
Security was notified.
The patient's seventeen-month-old daughter had received her first dose of oral
trivalent poliomyelitis vaccine exactly twenty-eight days prior to the onset of
symptoms.
The patient, her husband and two children (seventeen months and four years old)
lived in a single room on the first floor of a two-storeyed house in which three other
families also lived. One of these families (a woman and her school-aged son) lived
on the same floor as the patient and shared the kitchen, toilet and bathroom with
her. The other two families, one with six children (the landlord) and one with
two children, occupied the ground floor; five of the children were of school age
and attended different schools. The staircase, hall and front door were common to
all families. Some rooms on the first floor were unoccupied and had been so for
several weeks.
There was no history of contact between either the patient or her family and
any other occupant of the house. In spite of the lack of contact the school child
living on the same floor was excluded from school. Since he travelled to an adjoining
borough to school the Medical Officer of Health of the area was informed.
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