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 1949
[Report of the Medical Officer of Health for London County Council]
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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 | 0.085 |
| 1949 | 28,816 | 16 | 0.056 |
*Actual notifications from 1939.
Most measles deaths are due to respiratory complications and the more recent
reduction in mortality can largely be attributed to the use of the sulphonamides and
anti-biotics in the prophylaxis and treatment of the respiratory complications.
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.
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 186 cases in 1949 (3.3 per 1,000 live
births), full details of which are shown below. 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.
Ophthalmia
neonatorum
Ophthalmia Neonatorum
| Number of cases | Domiciliary Confinements | Institutional Confinements | Total |
|---|---|---|---|
| Notified during the Year | 79 | 107 | 186 |
| Visited by officers of the Authority | 78 | 101 | 179 |
| For whom home nursing was provided by the Authority | 5 | _ | 5 |
| Removed to hospital for special treatment | 28 | 25 | 53 |
The condition at the end of the year of the 186 cases notified was:—
| 173 | |
| (b) Vision impaired | — |
| (c) Vision lost | — |
| — | |
| 3 | |
| 10 | |
| Total | 186 |
Pneumonia
Notified cases of pneumonia in 1949 numbered 1,858, or 0.550 per 1,000, compared
with 0.566 per 1,000, in 1948. Dr. Stocks is of opinion that pneumonia is considerably
under-notified particularly at ages over 65, and that over the whole age
range only about one-quarter to one-third of the total cases are notified. There is, however,
no reason to suppose that this fraction varies from year to year so that notifications
may still be used as a relative index of incidence. It will be seen from Table
11 that the 1949 notification rate is lower than either war-time 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. See p. 10 for comment on
the death-rate.