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as compared with 2.7 in 1926. The deaths numbered 63, giving a death-rate of .01
per thousand, while the case mortality was .5 per cent., compared with .7 per cent.
in 1926.
An exhaustive report upon administrative practice in the control and treatment
of scarlet fever prepared by Dr. Allan C. Parsons, with the assistance of a committee
of medical officers of the Ministry of Health, has been issued by the Ministry, being
No. 35 of their series of Reports on Public Health and Medical subjects. Sir George
Newman, in a prefatory note, refers to the need for a reconsideration of the use to
which isolation hospitals are put, in view of the changes both in incidence and fatality
which have occurred in recent times. The Ministry's committee conclude that
"under present conditions and on general public health grounds, too many beds in
fever hospitals are being reserved for scarlet fever patients, and that some of these
beds could be more profitably used for the isolation and treatment of patients suffering
from infectious diseases of more importance than scarlet fever at the present
time."
The notified cases of diphtheria numbered 12,183 in 1927 (52 weeks) as compared Diphtheria,
with 13,526 in 1926. This gives an attack-rate of 2.7 per thousand, as compared
with 2.9 in the preceding year. During the first three quarters of the year the
notifications were below those for the same quarters of 1926, but in the last quarter
the notifications increased considerably and exceeded those of the last quarter of
1926 by 202. The increase is still being maintained. There were 397 deaths in
1927, as compared with 547 in 1926.
The remarkable decrease in diphtheria case-mortality referred to in last year's
report and associated with earlier and more general use of diphtheria anti-toxin
prior to admission to hospital, was similarly maintained in 1927, the case-mortality
being 3.3 per cent., as compared with 3.9 in 1926, and with an average of 7.4 in
1919-1922, the four years preceding the issue of the Ministry of Health's memorandum
on the subject.
Diarrhœa and enteritis caused 556 deaths among children under two years Diarrhœa
of age in London during 1927, this being 7.59 per thousand births. The corresponding and enteritis,
rate in 1926 was 12.03.
There were 261 notifications of puerperal fever and 892 of puerperal pyrexia Puerperal
in 1927 (52 weeks). The puerperal fever case-rates per 1,000 births in each metro- fever and pyrexia
politan borough are shown in the table on page 23.
The mortality from puerperal fever is much lower in boroughs with poorer-class
populations than in those occupied largely by the well-to-do. In the five years,
1921-25, the average number of deaths in the aggregate population of Bermondsey,
Bethnal Green, Finsbury, Stepney and Shoreditch was .88 per 1,000 births, as compared
with l.80 in the boroughs of Hampstead, Kensington, Lewisham, Stoke
Newington and Wandsworth. There is some correlation between the incidence of
maternal mortality and the percentage of illegitimate births, a closer correlation
with the percentage of domestic servants and closer correlation still with the
percentage of single women between 20 and 25 years of age. In 1927 the London
mortality from puerperal fever among single women was 3.22 per 1,000 births, as
compared with 115 per 1,000 births among married women. For other accidents
of child-birth the figures were 2 93 and 146 respectively.
It would add materially to the value of the statistics of maternal mortality if the
deaths of married women were stated as a rate per 1,000 legitimate births, and of single
women as a rate per 1,000 illegitimate births.
In the medical press references have recently been made to the increase of
abortion among married women. It is probable that one of the factors in the present
unsatisfactory position with regard to maternal mortality, in spite of improvement
in administration measures, is the increased burden of motherhood resulting from
present economic conditions.