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18
notifiable attack of measles before attaining age 15, the risk of attack before age 15
has now fallen to 60 per cent.
An important feature is the reduction in the case-mortality in measles. The
figures are:—
Years Estimated cases* Deaths Crude case-mortality per cent.
1921-25 271,500 3,868 1.43
1926-30 321,000 3,885 1.21
1931-35 208,000 1,912 0.92
1936-40 170,750 876 0.51
1941-45 84,925 170 0.20
1946 22,846 21 0.09
1947 17,486 23 0.13
1948 30,608 26 0.08
*Actual notifications from 1939.
Most measles deaths are due partly to respiratory complications, and the more
recent 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. A steady decrease in mortality
was however in progress long before the more recent accelerated fall, but there is
insufficient evidence as to whether this was due to increased resistance, or to reduced
virulence of the disease.
Ophthalmia
neonatorum
The incidence of ophthalmia neonatorum which, since 1921, remained fairly
constant at between 8 and 10 new cases per 1,000 live births, began to fall slightly
towards the end of the 1931-1940 decade and in recent years has fallen to below 5
new cases per 1,000 live births. There were 224 cases in 1948 (3.7 per 1,000 live
births). The introduction of penicillin has had dramatic results in the treatment of
this disease. Duration of treatment has been reduced from weeks to days and
resulting blindness is almost unknown. There was no case of blindness resulting
from ophthalmia neonatorum in 1948.
Pneumonia
Notified cases of pneumonia in 1948 numbered 1,891, or 0.566 per 1,000,
compared with 0.638 per 1,000 in 1947. It will be seen from Table 11 that these
rates are lower than either wartime or pre-war rates. There is no doubt that the
development of many infections is now inhibited by the early administration of sulpha
drugs or antibiotics.
Poliomyelitis
and polioencephalitis
In 1948 the incidence ot poliomyelitis tell almost to the level experienced in the
endemic conditions which preceded the epidemic of 1947. During the year, 141 cases
occurred (corrected notifications). Research into the causation and behaviour of this
iisease has been intensified and respites such as that of 1948 are to be welcomed as
placing time on the side of the investigators.
Puerperal
pyrexia
During 1948, 460 cases of puerperal pyrexia were reported, or 7.40 per 1,000
total births, compared with 6.05 in 1947.
Rheumatic
fever
Deaths in London from rheumatic fever in 1948 numbered 30, of which 15 were
among children under fifteen years of age. Corresponding figures in 1947 were 34
and 17 respectively.
But to complete the picture it is necessary to consider also the deaths under
45 years assigned to heart disease, since apart from deaths due to congenital heart
disease the vast majority of these deaths are rheumatic in origin. The following
table shows the distribution of heart disease deaths under 45 according to age:—