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(10) It is shown to be improbable that infection brought home on demobilisation
after the European War was responsible for an increased puerperal fever
mortality (p.23).
(11) The possible psychological effect of adverse economic conditions upon the
maternal risk is referred to (p.25).
(12) The need for more detailed records relating to the maternal state is stressed
throughout, and the tentative character of many of the rates shown, owing to the lack
of necessary data, must be borne in mind.
Conclusion.—This statistical analysis shows that the sustained rate of maternal
mortality, in spite of improvements in the maternity service, is in general terms the
result of the repression of natural fertility brought about by economic conditions.
Enteric
fevers.
There were 580 notifications of enteric fevers in London in 1928 (52 weeks),
as compared with 322 in 1927. The deaths in the calendar year numbered 51, as
against 30 in 1927, when the mortality was the lowest recorded.
Outbreak of
paratyphoid
B fever in
JulyAugust.
A widespread outbreak of paratyphoid B fever occurred in London and certain
neighbouring areas in July and August. The outbreak, which was remarkable for
the mildness of the majority of the cases, was attributed to infected cream. A
detailed report on the prevalence by the Council's Medical Officer of Health may be
obtained from the Council's publishers.*
There were 36 instances in 1928 where two or more cases of enteric fever occurred
in the same house or institution during the year. Of these 14 were associated with
the paratyphoid outbreak previously referred to, and, including these, the number
of which is shown in parenthesis, there were 27 (10) instances of two cases in the
same house, 4 (2) of 3 cases, 2 of 4 cases, 1 of 5 cases and 2 (2) of 6 cases.
Anthrax.
Three cases of anthrax, one of which proved fatal, were notified in London
during 1928 the diagnosis was in each case confirmed by bacteriological examination.
The patients were all infected by handling foreign hides or skins, which are
known to be a fruitful source of infection. They were all admitted to Guy's Hospital.
One was treated with anti-anthrax (Sclavo's) serum and the other two with novoarseno-benzol.
Plague,
cholera and
typhus fever
No cases of plague or cholera occurred in London in 1928. Ihere were two
notifications of typhus fever, in both of which the final diagnosis was not without
doubt.
Cerebrospinal
fever.
Seventy cases of cerebrospinal fever were notified during the year, but in 14
of these the diagnosis was not confirmed. Of the remaining 63 genuine cases, 41
(65 per cent.) proved fatal. In addition, 25 fatal cases which were not notified were
discovered through the medium of the Registrar-General's death returns, making a
total of 66 fatal cases during the year.
Poliomyelitis
and polioencephalitis.
Fifty-four cases of poliomyelitis or polioencephalitis were notified during the
year, but in 12 of these the diagnosis was revised. Of the 41 confirmed cases,
9 (19 per cent.) proved fatal. In addition, 5 fatal cases which had not been notified
were recorded in the Registrar-General's death returns, making a total of 14 fatal
cases for the year. The arrangement whereby children suffering from infantile
paralysis are admitted for treatment to the Metropolitan Asylums Board's institution,
Queen Mary's Hospital, Carshalton, for residential treatment was continued throughout
the year. At the end of 1927 there were 47 cases under treatment. During
1928, 27 children were admitted (including 4 re-admissions), 48 were discharged,
and one child died, thus leaving 25 Datients under treatment at the end of 1928.
Encephalitis
lethargica.
One hundred cases of encephalitis lethargica were notified, and of these 24
were not confirmed. Of 83 actual cases, 27 (32 per cent.) proved fatal. In addition,
22 fatal cases had never been notified, and in many of them the onset of the postencephalitis
symptoms were not observed until some years had elapsed since the
primary illness, often of a mild nature, had occurred.
* Outbreak of Paratyphoid Fever. No. 2643. Price Is.