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13
(iv.) E. W. (female, aged 15 years), whose home is in Nuneaton, stayed for
a short time in December with some friends at an address in Fulham. About a
week after her return to Nuneaton information was received that she was suffering
from smallpox and that she had infected her brother and four girls in the factory
in which she worked. Enquiries made by the medical officer of health of Fulham
elicited the fact that the girl, during her stay in Fulham, was noticed to have some
spots on the face which are said to have disappeared under ointment treatment,
but it was not known whether there was a rash on any other part of the body. The
girl had been travelling about during her visit to London, but fortunately no further
case came to light in London as a result of her movements.
Apart from these occurrences there was a distinct menace to London at one
time or another during the year from infection by vagrants, as a number of cases
of smallpox occurred among persons of this class in the Home Counties. Common
lodging houses, etc., were kept under close supervision.
Information was distributed, to the medical officers of health concerned, regarding
the movements of passengers and crews of vessels arriving in London from smallpox
infected countries, or with, a history of smallpox on board.
Measles.
Measles caused 1,330 deaths in London during 1924, the death-rate being -29
per thousand as compared with .08 in 1923 and .34 in 1922. Measles is usually
prevalent in London every other year and was prevalent in 1922, so that an epidemic
became due in 1924: a circumstance which tended to increase the mortality was
the large excess of births over the normal in 1920, resulting in a high proportion of
children in 1924 of an age at which measles takes normally its greatest toll.
Whooping
Cough.
There were 517 deaths from whooping-cough in London during 1924, the deathrate
being .11 per thousand as compared with .09 in 1923.
Diarrhœa
and
Enteritis.
There were 743 deaths among children under two years of age from diarrhœa
and enteritis in London during 1924, this being 8'73 per thousand births; the
corresponding rate in 1923 was 10.3.
Scarlet fever
and
Diphtheria.
The behaviour of scarlet fever and diphtheria in London during 1924 was
watched with the closest attention, particularly having regard to the special measures
of prophylaxis now being adopted in the case of these diseases in New York and
Chicago. There were 11,610 cases of scarlet fever, an increase of 1,563 on 1923,
and 10,684 cases of diphtheria, an increase of 383 on 1923. Following upon the waves
of prevalence which attained their height in London in 1921 and 1922, there had
been a decided fall in both scarlet fever and diphtheria in 1923, but in 1924 this
decline was not continued. In the annual report for 1923 (p. 92) a diagram was
exhibited comparing the death-rates from diphtheria and croup (combined) in
England and Wales, London and New York. The two main lessons to be learnt
from that diaeram are:—
(i.) That in spite of the very differing degrees of aggregation of population,
in the two areas first named, closely corresponding rates were recorded for
England and Wales and London respectively throughout the greater part of
the period of years under review; exception must be made, however, as regards
the epidemics of the late eighties and early nineties, on the one hand, and those
of the years 1916-1923, on the other, when the London rates were higher than
those for England and Wales.
(ii.) That a far heavier rate, from 1859 up to nearly the end of the 19th
century, was recorded in New York than in either England and Wales or London.
It must of course be realised that the great extension of New York's boundary
in 1897 materially affected the statistics of the City from 1898 onwards. It
seemed clear, however, as was pointed out last year (loc. cit. p. 93) that, in old
New York City, "diphtheria" deaths included deaths from "angina, quinsy
and inflammation or ulceration of the throat and tonsils," and also, in all probability,
many deaths from what, in this country at any rate, would at the
time in question have been regarded as scarlet fever rather than as diphtheria
11908 B