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12
pneumonia.
THE PNEUMONIAS.
The diseases to be notified under the "Pneumonia, etc., Regulations" of 1919 are the "Acute
Influenzal" and "Acute Primary" Pneumonias. The latter term covers "Lobar" and "Lobular
(Broncho.) "Pneumonia, but only such attacks as are not secondary to other diseases, e.g., measles,
are to be notified. Influenzal pneumonia may be primary or secondary to an attack of epidemic
influenza. From the figures about to be submitted, it will be evident that, although there has been
a great increase in the number of cases notified, notification is still incomplete.
Acute Influenzal Pneumonia.—Last year 72 cases were notified, the totals for the three
preceding years being : 1919 (1st year of notification), 87; 1920, 45; and 1921, 27. It is doubtful
whether the increase observed last year implies anything more than improvement of notification.
Last year's total comprised 35 males and 37 females. The close approximation to a numerical equality
of distribution between the sexes is borne out by the total numbers of cases reported since the beginning
of 1919, viz., males 117, females 114. Had, however, the incidence of the disease been the same in
* the two sexes, the number of cases among females corresponding to the 117 among males would have
been 161.
Of last year's cases, 2 were subsequent to notification marked "errors." The cases receiving
institutional treatment numbered 45 (62.5 per cent.), 38 being admitted to the Paddington Hospital.
The deaths among the patients whose cases were notified numbered 26, 15 among hospital patients,
of whom 12 were in Paddington Hospital. The fatality among the whole group (72 cases) was at the
rate of 36.1 per cent., and among the patients admitted to hospital 57.7. Of the 26 deaths, 22 were
certified due to epidemic influenza, 3 to " pneumonia," and 1 to other disease (diphtheria).
Acute Primary Pneumonia..—The cases notified during 1922 numbered 254, the totals for the
preceding three years being : 1919, 83; 1920, 96; 1921, 105. It is thought that, here again, the
increase is largely a matter of more complete notification.
The sex.distribution of primary pneumonia is very different to that of the influenzal form. Last
year's cases comprised 159 of males and 95 of females. The cases reported during the four years
covered by notification comprised 327 of males and 211 of females. If the disease had been equally
prevalent among the two sexes, the number of cases last year among females (given 159 cases in males)
would have been 451.
Of the 254 notified cases, 163 (64.1 percent.) received institutional treatment—131 at the Paddington
Hospital. The District Nurses were in charge of 14 of the patients treated at home, and 3 patients
entered nursing homes. Among the notified cases 74 ended fatally (29.1 per cent.), 50 of the deaths
taking place in hospital and 24 at home. The fatality among the patients treated in institutions was
at the rate of 30.6 per cent., and that among patients treated at home 26.3. Five persons were
reported twice during the year as suffering from the disease, the second attack in each instance terminating
fatally. The cause of death was not always certified as a pneumonia, 62 of the 74 deaths
being attributed to various forms of pneumonia, 2 to epidemic influenza and 10 to other causes.
Defect in Notification.—Last year 68 deaths of residents of the Borough were due to epidemic
influenza, of which 49 represented attacks of which no information was obtained until the deaths were
registered. Of the 49 deaths 2 occurred in St. Marylebone and 4 were registered after inquest. The
deaths from the various forms of pneumonia numbered 162—excluding those of an influenzal origin—
100 of which were not represented by notified cases. Among those 100 cases were 11 which took
place outside the Borough and 7 inquest cases, leaving 82 deaths which, apparently, ought to have
been notified.
Epidemic Influenza.—The 68 deaths from this cause comprised 33 of males and 35 of females.
The disease was most prevalent in January (46 deaths) and February (8 deaths). The mortality
rate for the Borough was 0.46 per 1,000 persons, which rate was exceeded in Maida Vale (0.58), Westbourne
(0.66) and Lancaster Gate, East (0.98) Wards. During 1910.12 the mean mortality was 0.18
per 1,000, and that during 1920.22, 0.31—an increase of 28 per cent.
The mortality among males in 1922 was 0.54, the mean rate for 1910.12 being 0.19, and that
during 1920.22, 0.34. The rates among females were : 1922, 0.41; 1910-12, 0.18; and 1920-22, 0.30.
Respiratory Diseases.—The total of the deaths during 1922 from these causes was 375—202
of males and 173 of females. The numbers entered under each of the diseases included under this
general heading are given inTable VI. The mortality rates in 1922 were: Persons, 2.58, males, 3.31
and females, 2.04. The mean rates for persons was 2.11, both for the years 1910-12 and 1920-22.
The rates for males were : 1910-12, 2.58; 1920-22, 2.64 ; those for females : 1910-12, 1.75; 1920-22,
1.72.