View report page

152
In comparison with previous years both the numbers of persons removed by
ambulance to hospital as in-patients in the County, and the number of applications to
the Emergency Bed Service in the whole of Greater London were running at an
appreciably higher rate throughout November. But it is necessary to use these figures
with considerable caution in making comparisons over a period of years. Admissions
to hospital depend as much on the availability of beds as on the need for them and the
figures from year to year may reflect the former as much as the latter. (Judging by the
yardstick of the E.B.S. warning system there was no undue pressure on hospital beds
during this month, the first white warning being issued on 8th December). Again, the
numbers of applications to the Emergency Bed Service may reflect the amount of use
general practitioners choose to make of the service as much as the amount of acute
sickness.
District nursing cases completed were appreciably higher than in the previous two
years and this was even more marked for those of their cases classified as respiratory,
1,126 in November, 1952, as against a November average of 750 for 1950 and 1951.
These respiratory cases form the major part of the acute sickness dealt with by the district
nursing associations during the winter. Some part of this increase can be accounted for
by the fact that the district nursing service in London has been expanding steadily
since 1948 but there remains a definite indication of a higher incidence of acute sickness
so far as it affected district nursing.
Of the two measures, the deaths registered and the First Certificates for Sickness
Benefit, neither would appear, a priori, to be by itself a particularly accurate index of
morbidity, the deaths relating only to those whose illnesses have terminated in one
particular way and the sickness benefit claims being restricted to the employed (and
presumably healthier) section of the community. Both measures, however, are free
from the distortion introduced by variations in the availability of services and for
comparative purposes depend only on the numbers exposed to risk—in the case of
deaths the total population, in the case of sickness benefit claims the employed population.
Over the years concerned the total population has remained substantially constant
and the employed population in November, 1952, was less than 1 per cent, different
from the average in November, 1950 and 1951. Both measures have shown themselves
in the last few years particularly sensitive to widespread winter changes in morbidity
and during the growth of a considerable epidemic, as for instance an influenza epidemic,
they move very closely together. The correlation between the numbers of sickness
benefit claims in the week ending on a Tuesday and the number of deaths, registered in
the week ending the following Saturday is strikingly high especially during an epidemic
period. For this November both measures were running at much the same rate as
in the immediately preceding years, but showing a steady increase.
Altogether it is reasonable to say that in November, 1952, there was a slightly higher
incidence of sickness generally in London than might have been expected at this time of
year from experience of the immediate past, while at the same time the weather was
also somewhat worse than normal. There was nothing, however, in any of the morbidity
indices on the scale of what is experienced during the growth of an influenza epidemic
when the sickness benefit claims rise above 20,000 a week for several weeks in succession.
As December began, this slow steady increase in new sickness continued. The
sickness benefit claims were 11,678 in the week up to and including 2nd December,
and 12,553 in the week up to and including 9th December. The deaths registered were
945, in the week up to and including 6th December. On the basis of the relationship
between the sickness benefit claims to a Tuesday and the deaths to the following
Saturday, as experienced in the period 14th October-6th December, 1952, and during
the first 8 weeks of the influenza epidemic of early 1951, the 12,553 sickness benefit
claims in the week ending 9th December, would be accompanied by an expected number
of about 1,100 registered deaths in the week ending 13th December; or to allow for