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20
DISEASES OF CHILDHOOD.
worst part of the Borough, there has been a notable improvement. In the years 1909.13 the mortality
averaged 172 per 1,000 births. During 1922 it was 116, and the average for 1918.22 was 144.
During 1909.13 the mortality in the Borough averaged 106, that in the combined six Areas, 131,
and in the Rest of the Borough, 93. Last year the figures were: Borough, 69; Combined Areas, 96;
and Rest of the Borough, 59. For the five years, 1918.22, the figures were: Borough, 89 ; Combined
Areas, 103; and Rest of the Borough, 84.
In comparison with the mean rates (1909.13) the age.group rates for last year show the following
reductions : 0.3 months C.A.,* 15 per cent.; R.B., 29 ; 3.6 months, C.A. and R.B., 50 ; 6.9 months,
C.A., 36; R.B., 42; 9.12, C.A., 21 ; R.B., 54. As regards causes of death, increases have to
be recorded in the Combined Areas from Premature Birth (mean, 16.67, 1922,22.16), Meningitis
(from 1.78 to 2.61) and Respiratory Diseases (from 25.81 to 31.30). In the Rest of the Borough increases
took place in the mortalities from Atelectasis (mean 1.79, 1922 2.04), Syphilis (1 .39 to 2.03)
and Other Causes (from 7.09 to 8.65). Although there has been a satisfactory reduction in the infantile
mortality in these areas the disparities between the rates recorded therein and those recorded
in the Rest of the Borough indicate that there is still much room for improvement.
Mortality at Ages 1.5 Years.—By a method of survivorship it was estimated that the children
aged 1.5 years numbered 8,630 individuals of both sexes in 1921. According to the Census the number
was 7,453—a difference of nearly 16 per cent. Such difference is not material as regards local comparisons,
but would vitiate comparisons with other districts.
Last year the number living at these ages was estimated to be 9,459, the increase being due
partly to the large number of children born in 1920 and 1921, and partly to the reduced infantile
mortality. The deaths during the year among these children numbered 115, giving a mortality of
12.15 per 1,000, the mean rate for 1917.21 being 15.36, and that for 1909.13, 13.97. The mortality
rates at these ages are liable to considerable fluctuations from year to year, in response to the prevalence
in epidemic form of such infantile diseases as measles, whooping cough and diarrhoea. The
rates (sexes combined) recorded last year were : At ages 1.2 years, 24.26 ; 2.3, 8.73 ; 3.4, 5.35 ;
and 4.5, 8.14. And the means for 1917.21, 30.95, 14.69, 9.00 and 6.33. The only age showing
an increase above the mean was that of 4.5 years where the increase was 29 per cent.
DISEASES OF CHILDHOOD.
Measles.—Notification of this disease has been in force in the Borough since March, 1914, at
first by an Order made by the Council, pursuant to Section 56 of the Public Health (London) Act, 1891,
requiring notification of all cases of measles. In January, 1916, the Order of the Council was replaced
by Regulations—applying to England and Wales generally—issued by the (then) Local Government
Board under which notification of first cases only of measles and german measles was required. Those
regulations were repealed in December, 1919, and the " Paddington Measles Regulations " were
issued by the Ministry of Health under which notification of all cases of both diseases was required.
The year 1922 was marked by a major epidemic of the disease, 3,049 cases of measles being notified
or otherwise reported to the Department. Since 1914 that total has been exceeded twice only,
viz., in 1915 (3,628 cases) and in 1917 (3,437 cases). In addition to the cases of measles, 171 of german
measles were notified or reported last year.
Of the cases notified or reported during the past year, 72 per cent. were notified under the Regulations,
18 . (mostly secondary cases) were reported by the Women Inspectors, and 10 . by School Teachers on " Form 84."
The epidemic began in the course of the 7th week of the year (that ending February 18th), and
continued until the 27th (ending July 8th). While the weekly average number of cases during the
whole year was 62, less than half that number were reported in 29 weeks. In the autumn the weekly
totals ranged from 0 to 9. The peak of the epidemic fell somewhere in the four weeks, April 8th to
May 6th, during which period 660 cases occurred.
Of the 3,049 cases of measles 1,706 (56 per cent.) were in children aged 0.5 years, 1.223 (40 per
cent.) in children aged 5.15, and 120 (4 per cent.) in adults. At ages 0.5 there were 874 cases among
males and 832 among females, the incidence on the sexes being (approximately) 174.4 and 170.0
per 1,000 (of each sex) respectively. At ages 5.15 years the distribution was 578 cases in males and
645 in females, the corresponding incidences being 57.9 and 62.4 respectively. At higher ages the
attacks among males numbered 25, and those among females 95, the incidences being 0.5 and 1.3
respectively. Except in the last group the disease was fairly equally prevalent in the two sexes.
Taking the estimates of the number living at each age as calculated in the Department, the
following incidences (rates per 1,000 persons) have been obtained: At ages 0.1 year, 63.5; 1.2,
156.7; 2.3, 144.6; 3.4, 170.4; and 4.5, 224.5.
* "C.A."—Combined six Areas. " R.B."—Rest of the Borough.