London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1928
[Report of the Medical Officer of Health for London County Council]
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139
of control and generally as to the action taken during the epidemic, it was
ascertained that 16 of the medical officers of health thought that the special
procedure was valuable and should be continued, inasmuch as the existence of cases
was brought to their notice at an earlier date. In one borough (Deptford) the
information had been so valuable as to enable compulsory notification to be discontinued.
In certain other boroughs no definite expression of opinion was offered,
and one medical officer of health, in whose borough (Finsbury) measles is notifiable
as regards the first cases in a household, did not think the scheme was of any material
assistance to him.
Generally speaking, the local resources of the borough for dealing with the
outbreak were said to be adequate, but in some boroughs the amount of work was
so heavy that many cases were left unvisited. In a few instances additional visiting
staff was temporarily appointed.
The following table shows the number of homes in which nursing assistance was provided by 28 borough authorities, the number of cases removed to M.A.B. and other hospitals, and the number of deaths occuring (a) at home, and (b) in hospitals:—
| Nursing assistance. | Removed to hospitals. | Deaths. | |||
|---|---|---|---|---|---|
| M.A.B. | Others. | At home. | In hospital. | ||
| No. of cases— (28 boroughs only) | 1,403 homes. | 6,702 | 988 | 341 | 898 |
The mortality among those treated in hospital was, therefore, 11.9 per cent.
On the question of hospital treatment it may be mentioned that difficulties were
experienced in securing immediate removal of patients at the height of the epidemic
and the delays which occurred were no doubt largely responsible for the heavy
proportion of deaths among those so treated, as no doubt in many instances complications
such as broncho-pneumonia may already have supervened before admission
to hospital.
Although the Metropolitan Asylums Board had agreed to allocate more beds
to the treatment of measles it was impossible to provide accommodation for all
cases of measles requiring hospital treatment at the height of the epidemic and early
in January, 1928, the Board communicated with borough medical officers making
them responsible for the selection of the most urgent cases.
Dr. Sowden, medical officer of health of St. Pancras, provided some very useful, though disturbing, information in regard to hospital treatment as regards the cases in his borough, and in this connection the following table is illuminating:—
| Ages. | Total number of cases. | Kemoved to M.A.B. hospitals. | Removed to Highgate Hospital. | Nursed at home. | Cases outside boro'. | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | Died. | % | No. | Died. | % | No. | Died. | % | No. | Died. | % | ||
| Under 1 | 199 | 30 | 15.08 | 46 | 6 | 13.04 | 24 | 17 | 70.83 | 129 | 5 | 3.88 | |
| 1 and under 2 | 454 | 51 | 11.23 | 84 | 11 | 13.10 | 68 | 29 | 42.65 | 302 | 10 | 3.31 | |
| 2 and under 3 | 485 | 17 | 3.50 | 82 | 7 | 8.54 | 37 | 8 | 21.62 | 366 | 2 | 0.55 | |
| 3 and under 4 | 495 | 9 | 1.82 | 71 | 4 | 5.63 | 37 | 3 | 8.11 | 387 | 2 | 0.52 | |
| 4 and under 5 | 553 | 2 | 0.36 | 45 | 1 | 2.22 | 26 | — | — | 482 | — | — | |
| 5 and over | 1,412 | 10 | 0.07 | 98 | 4 | 4.08 | 50 | 1 | 2.00 | 1,264 | 5 | 0.40 | |
| 3,598 | 189 | 3.30 | 426 | 33 | 7.70 | 242 | 58 | 23.90 | 2,930 | 24 | 0.80 | 4 | |
Dr. Sowden points out that when children of the same age group are compared,
there is a striking contrast between the mortality rates in hospital and those at
home, in favour of the latter. He states that whilst possibly the more severe cases
were selected for hospital treatment, it is doubtful whether this is the whole explanation
as medical officers of health were required to base their selection upon home