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93
A diagram is given on page 92 showing the mortality from diphtheria and Death rates in London and certain
croup in England and Wales, London and New York City, annually, for the years
1859-1923. Croup was more frequently returned as a cause of death in the earlier other
years both in England and in New York. Up to about 1885 deaths certified as due localities,
to croup in England exceeded those from diphtheria, but thereafter diphtheria
is in excess, and in the past 15 years the deaths certified as due to croup are relatively
insignificant. Similar changes in the relative mortality ascribed to diphtheria
and croup are observed in American cities.
In regard to the New York diphtheria and croup mortality shown in the diagram,
it is observed, in the report from which the figures are taken, that in the earlier
years registration of deaths was incomplete and that diphtheria deaths include
angina, quinsy, and inflammation or ulceration of the throat or tonsils; attention
is also drawn to the confusion in the earlier years between scarlet fever and diphtheria.
In England and Wales these latter diseases were not separated by the Registrar
General until 1859.
It is remarkable that the mortality from diphtheria and croup in New York
in the earlier years was much above that from scarlet fever : thus in the decennium
1871-80 the diphtheria death-rate was about twice that from scarlet fever: in
the same period the London figure for scarlet fever was just twice that for diphtheria
and croup. Subsequently the figures for the two cities have converged, and the rates
for the decennium 1911-20 show a mortality in both from diphtheria and croup
about four times that from scarlet fever.
The late Sir Shirley Murphy in his Annual Report for 1898 (p. 31) drew attention
to the fact that the case mortality of scarlet fever had declined very nearly as
much as that of diphtheria in the period during which antitoxic treatment of
diphtheria was generally adopted; from which he concluded that there was a
possibility that some part of the reduction in diphtheria might be due to natural
causes.
The relationship shown by the diagram between the London and New York
incidence of diphtheria in the last three years is interesting in view of the work
done in the latter city, more especially in the Boroughs of Manhattan and
Brooklyn, by Drs. Park and Zingher in the prophylactic treatment of diphtheria.
The number of children dealt with during recent years might be regarded as large
enough to influence the mortality, but the difference in the trend of the curves for
New York and London is not sufficient to warrant any final conclusion. In
considering the marked prevalence of diphtheria in London, in 1921 and 1922,
now happily decidedly on the decline, it is worthy of recall that many years ago
Sir Arthur Newsholme found that years of high diphtheria mortality were associated
with periods of dry weather; and it is perhaps not without significance that the
abnormal drought of 1921 was most severe in the south-eastern area of England.
The cases of measles numbered 13,784 as compared with 34,385 (1922), 8,317 Measles.
(1921) and 28,888 (1920). Towards the end of November measles commenced to
show clear indications of a rise in prevalence. The number of cases reported steadily
mounted week by week and by the time the children had resumed school after
the Christmas holidays it was clear that an epidemic was in progress. The special
scheme of visitation by the school nurses with a view to co-operating with the
teaching staff, the school attendance authorities and the borough medical officers.
described in the Annual Report for 1919 (Vol. III., p. 85), was at once put into
operation.
In the Annual Report for 1920 (Vol. III., p. 90) the result of the scheme was
given. In addition to speeding up of notifications generally, it was shown that a
number of children actually suffering from measles was detected as a result of the
daily visits of the nurses to the affected schools. Measles became prevalent in the
spring of 1922 and the outbreak which commenced in November 1923 is now
(April, 1924) declining.
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