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11
These results are admittedly based upon an inquiry too limited in scope to serve
as a basis for anything but a tentative conclusion, but they open a question of considerable
importance in their bearing upon school measures of control of measles
outbreaks.
There is no evidence that the sudden addition of "susceptibles" owing to the
high birthrate of 1920 resulted in any increase in the severity of the type of measles
in London, the deaths showing no excess over the number in 1928, if the decline in
the birthrate is taken into account.
In a paper read before the Royal Statistical Society in December, 1928 ("The
Interpretation of Periodicity in Disease Prevalence") Mr. H. E. Soper endeavours
to find a mathematical expression for the periodicity of measles epidemics in terms
of "exhaustion" and "replenishment" of susceptibles in the population of Glasgow.
He observes "although the course of epidemic measles in Glasgow during 40 years
is far from yielding obedience to the simple law of infection that is modelled on mass
action in a perfect mixture, yet the over-riding waves possess features similar to those
shown proper to such an action."
Measles was prevalent in London both in 1917 and 1918 and since then has been
epidemic in alternate years; it is therefore due next winter, and observation of the
records suggests that it is likely to be accompanied by a prevalence of whooping-cough
above the average.
Whooping
cough.
There were 405 deaths from whooping cough in London during 1928 as compared
with 548 in 1927. The present prevalence of whooping cough was foreshadowed by
the marked increase towards the end of 1928, and during the first quarter of 1929
the deaths recorded have been in excess of any first quarter since 1918. The distribution
of the mortality in the various metropolitan boroughs in 1928 is shown
in the table on page 30.
Scarlet
Fever.
There were 15,297 cases of scarlet fever notified in 1928 (52 weeks), the corresponding
figure for 1927 being 13,178. The attack rate was 3.5 per thousand as
compared with 2.9 in 1927. The deaths numbered 81 giving a death rate of 0.02
per thousand, and the case mortality was 0.5 per cent.
Diphtheria
The notified cases of diphtheria numbered 12,155 in 1928 (52 weeks) as compared
with 12,183 in 1927. This gives an attack rate of 2.7 per thousand, being the same
as in the preceding year. There were 399 deaths as compared with 397 in 1927.
The case mortality was 3.3, as in 1927.
Diarrhoea
and enteritis.
Diarrhoea and enteritis caused 747 deaths among children under two years of
age in London during 1928, this being 10.32 per thousand births. The corresponding
rate in 1927 was 7.59.
Puerperal
fever and
pyrexia.
There were 294 notifications of puerperal fever and 768 of puerperal pyrexia
in 1928 (52 weeks) as compared with 261 and 892 respectively in 1927. The deathrates
from puerperal fever and other accidents of childbirth per thousand
births in each metropolitan borough, and the percentage of illegitimate births, in
1920-1927, together with the deaths in childbirth in 1928 are shown in the
following table:—
District
Puerperal
Fever.
Other
Causes.
Total.
Illegitimate
births per
cent. of
total births.
Deaths in Childbirth,
1928.
Puerperal
Fever.
Other
Causes.
West—
Paddington 1.48 1.81 3.29 8.3 3 4
Kensington 1.93 1.65 3.58 6.9 3 4
Hammersmith 2.09 1.75 3.84 5.4 5 5
Fulham 1.95 1.55 3.50 4.9 5 1
Chelsea 1.84 2.93 4.77 7.7 — 3
Westminster, City of 1.51 2.87 4.38 10.0 9 9