London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1950

[Report of the Medical Officer of Health for London County Council]

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17
Infectious Diseases
The attack rates and death-rates of the principal infectious diseases in London
during 1950 and earlier years, and for the constituent metropolitan boroughs in 1950,
are shown in Tables 2, 3 and 9. In order to preserve uniformity with national statistics
the notification figures used in this section of the report have been corrected as far
as possible to take account of changes of diagnosis made after the original notifications
had been received. See footnote to Table 9.
Anthrax
Two cases of anthrax were notified during the year, one was confirmed bacteriologically
but the other could not be confirmed because penicillin had been administered
before admission to hospital. One patient was a lime jobber employed in a tannery
and handling foreign hides ; the other was a tanner handling goat skins. Appropriate
precautionary action was taken by the responsible medical officers of health of the
metropolitan boroughs concerned and no secondary infections occurred. Both cases
made good recoveries.
Meningococcal
infection
Prior to the war the attack rate for cerebro-spinal fever had fluctuated mainly
between 0.02 and 0.05 per 1,000. Not unexpectedly the rate rose during 1940-41
to 0.3 per 1,000, a similar rise being experienced by most of the combatant nations
coincidental with military and industrial mobilisation. Subsequently the rate fell
rapidly. In 1949 the incidence was only 0.023 per 1,000 (76 cases), the rate being
the lowest since before the 1914-18 war.
As from 1st January, 1950, the notification regulations were amended to require
the notification of all " meningococcal infection " as a single entity. There were
90 such notifications in 1950, giving an attack rate of 0.027 per 1,000. There were
21 deaths but owing to imperfect notification the case fatality from the disease is
less than would appear from this figure. Mortality is greatest at the extremes of age,
viz., 62 of the total of 90 cases were in infants under the age of five years and of
these 47 were boys and 15 girls. The attack rates for males are consistently higher
than for females at all ages.
Dysentery
The increase of dysentery notifications from 1940 to 1945 coincided with an
increase in the available facilities for bacteriological examination and it is impossible
to say how far the increase of notification was due to increased incidence and how
far it was due to better recognition of the disease. The subsequent marked fall in
notifications from 1946 to 1949 and the sudden rise in 1950, cannot be explained on
the basis of changes in the degree of recognition, and it seems probable that they do
represent changes in incidence and indicate a renewed epidemicity of the disease
after an interval of 5 years.
It is, however, an undoubted fact that a large number of mild infections pass
unrecognised and unnotified and that the actual figures of notifications are a gross
underestimate of the number of cases in the community.
The wide fluctuation in incidence since notification became operative has not
been accompanied by corresponding fluctuations in the number of deaths as the large
epidemics have been almost entirely of the mild Sonne type.

In London the death-rates from dysentery since the beginning of the century have been as follows :—

Mean annual death-rale per 1,000
1901-19100.0052
1911-19200.0321
1921-19300.0054
1931-19400.0036
1941-19450.0096
19460.0035
19470.0033
19480.0009
19490.0012
19500.0018

In 1947, 1948, 1949 and 1950, the deaths were 11, 3, 4 and 6, respectively.