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28
DISEASES OF CHILDHOOD.
2.1 and 0.9. The only age-group for which material for comparison can be drawn from the above
statement is that of 0-3 years. For males at those ages the rates were: 1923, 3.4 per cent.; 1917,
10.1; and 1921, 7.8, while the rates for females were: 2.1, 7.3 and zero.
The distribution of cases and deaths (figures in parentheses) by Wards in the three years is
given below.

Of the 396 cases of measles, 86 (21.7 per cent.) were removed to hospital, as compared with 2.8
per cent. in 1917 and 4.3 in 1921. The mortality rates last year were 0.02 per 1,000 persons, 0.02 per
1,000 males, and 0.01 per 1,000 females of all ages.
Whooping Cough.—This disease is not on the schedule for notification, but the Department has
kept records of known cases, after diligent search for the same, for over 20 years. The material available
is not free from suspicion that while the search, having been more successful during recent years,
has resulted in, what may be called, a spurious increase in the number of cases, the records of fatal
cases have been approximately accurate throughout the period. Fatality rates, based on such data,
will give an impression that the fatality of the disease has declined in recent years. The records do
show a lower fatality, but, as will appear presently, the differences are so remarkable that they can
scarcely be put down to the source of error indicated. It is permissible to assume that some part,
at least, of the diminution has been due to the activities of the Department.
Last year the Department noted 1,018 attacks, an average of 19.4 per week for the whole year,
the highest figure since 1914, to go no further back. Prior to last year the highest weekly average
noted was 13.5 in 1918 (705 cases), and the lowest 3.2 in 1919 (170 cases). Those years have, therefore,
been selected for comparison with last year.
The final scrutiny of the year's records reduced the cases to 1,013, 484 in males and 529 in females.
Similarly the corrected figures for 1918 were: Total cases 691, males 313, females 378; and those for
1919 : Total 160, males 81, females 79. The appended statement shows the differences in the numbers
in each sex-age group, the numbers of fatal cases being shown in parentheses.

The fatality rates last year were (at all ages): Total 2.36, males 1.85, females 2.83, which contrast
very favourably with the rates for 1918, viz.: Total 7.81, males 7.02, females 8.46. The rates
for 1919, on the other hand, were notably below those quoted, viz.: Total 0.62, males 1.23, females
zero. At ages under 3 the rates were: 1923, Males, 3.9, females 6.2; 1918, Males 18.6, females
23.6; 1919, Males 5, females zero. The greatest fatility is among infants under one year old, which
rates show striking variations in the three years. In 1923 the rates were: Males 10.1, females 19.6;
in 1918, Males 38.8, females 28.5; and in 1919, males 16.6 and females zero. The disparity between
the fatalities in the two sexes is remarkable. While no explanation can be put forward to account
for the very great differences in the fatalities of 1923 and 1918, it may be observed that in the former
year rather more than 40 per cent. of the attacks were reported in the second and third quarters of the
year, as compared with over 50 per cent. in 1918. On a priori grounds it might be expected that the
quarters mentioned would, as regards weather, be more favourable than the first quarter during
which over 55 per cent. of the attacks were reported in 1923 as compared with 44 in 1918. In 1919
over 78 per cent. of the attacks were reported during the second half of the year—30 during the third
quarter and 48-2 during the fourth.
The following table shows how the cases and deaths were distributed among the Wards, and indicates
the variations in the fatalities observed in the different Wards in each of the three years. The
differences in the fatalities recorded in 1923 and 1918 can only be described as remarkable.