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14
epidemic outbreaks have occurred, but there is not yet any evidence that conditions
have been stable sufficiently long to restore the biennial wave.

* Actual notifications from 1939.
† These rates differ slightly from those suggested in the Annual Report for 1945. In some
of the earlier years the separation of rubella cases in the school reports was difficult, and evidence
on this point which came to hand later suggested that the above estimates would be more
accurate.
Most measles deaths are due to respiratory complications, and the dramatic
reduction in mortality can largely be attributed to the discovery of the antibiotic
drugs such as penicillin or the sulphonamides, which either by prophylactic administration
usually prevent the onset of respiratory complications or improve the treatment
of these complications when they do occur.
Ophthalmia
neonatorum
The incidence ot ophthalmia neonatorum which, since lyzi, remained iairiy
constant at between 8 and 10 new cases per 1,000 live births, began to fall slightly
toward the end of the 1931-1940 decade and in recent years has fallen to below 5
new cases per 1,000 live births.
Rheumatic
fever
Deaths in London trom rheumatic lever in ly4b numbered 28, ot which 12 were
among children under fifteen years of age. Corresponding figures in 1945 were 28
and 13, respectively.
Scabies
Scabies became notifiable in London in August, 1943. Notifications in 1946
numbered 11,892, compared with 14,753 in 1945, and 16,450 in 1944. The effect of
improved control resulting from notification is evident from the persistent decline in
incidence.
Scarlet fever
The incidence of scarlet fever was lower than in 1945 — 4,595 cases (1.48 per
thousand), compared with 4,252 (1.64 per thousand). There was again only one
fatal case in 1946. Fifty years ago the annual death roll in London amounted to
over 1 000.
Smallpox
Typhus
There were two notifications of smallpox, both were confirmed.
No case of typhus was notified to the metropolitan borough medical officers of
health during 1946.
Whoopingcough
There were b,olo notifications ot whooping-cough during the year, compared
with 3,307 in 1945. The death-rate was 0-017 per thousand (crude case-mortality
0.78 per cent.). Corresponding rates for 1945 were 0-018 per thousand and 1.4 per
cent. It will be seen from table 4 that the fatality for this disease is now less than
a twentieth part of what it was fifty years ago.
Tuberculosis
Detailed figures of new cases of tuberculosis notified in 1946 are shown in
tables 15 and 16, pages 26 and 27, and the trend of mortality and morbidity is
indicated by the rates shown in table 14 (p. 26).
The experience of the war years may be briefly summarised in retrospect.