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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20
Although there has frequently been laboratory evidence of the presence of the
virus the last major outbreak was in 1937. At the end of 1950, however, too late to
affect the statistics, influenza became prevalent first in the North West of England
and later in the South. (In London 704 deaths were registered in the first 13 weeks
of 1951, compared with 146 in the corresponding period of 1950. The outbreak will
be recorded fully in the 1951 report.)
Measles
Measles became notifiable in London in 1938. Before that year records of
incidence were built up from reports of absences from school, from hospital
admissions and from mortality records. Up to the outbreak of the war of 1939-45
there had been biennial epidemics of such magnitude that more than 70 per cent,
of children suffered an attack before age 15. The evacuation movements of 1939
and subsequent years disturbed this biennial rhythm and since 1940 the outbreaks
have been annual and of the same order of magnitude each year.
In 1950 the annual rise in notifications did not occur until April, three or four
months later than expected, and the outbreak did not develop to normal post-war
magnitude before the September refractory period when the incidence of measles is
usually minimal and outbreaks rarely persist. Notifications fell in late August and
early September but rose rapidly again in the remaining months to begin a sharper
epidemic than any which had occurred since 1938. (The peak did not occur until
after the end of the year and details of the epidemic will be given in next year's
report.) In total the notified cases in 1950 amounted to 22,282 giving an attack
rate of 6.57 per 1,000.

An important feature is the reduction in the case mortality in measles. The figures are :—

YearsEstimated cases*DeathsCrude case mortality per cent.
1921-25271,5003,8681.43
1926-30321,0003,8851.21
1931-35208,0001,9120.92
1936-40170,7508760.51
1941-4584,9251700.20
194622,846210.09
194717,486230.13
194830,608260.085
194928,816160. 056
195022,28240.018

* 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.
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 145 cases in 1950 (2.7 per 1,000 live
births), 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

Number of casesDomiciliary confinementsInstitutional confinementsTotal
Notified during the year41104145
Removed to hospital for special treatment43236