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began. What is perhaps not immediately obvious is the magnitude of this change ; by
the time the fog had lain over London for two days and three nights with the temperature
below freezing for almost the whole of that time, the death rate had risen to a height
last experienced in this city in the influenza epidemic of 1918 and the deaths continued
at this rate for two whole days and fell only slightly on the third. During these three
days, December 7th, 8th and 9th, in London Administrative County approximately
440 persons out of every million living died; in 1918 during the worst three days of
the week ending 9th November, approximately 470 persons out of every million
living in London died; and during Monday, Tuesday and Wednesday, September 3rd,
4th and 5th, 1849, approximately 570 persons out of every million living in London
died—these were the worst three days in London of the worst cholera epidemic on
record. With regard to the extent of sickness, it is not possible to make such clear and
chilling comparisons for want of information. But the rise in incidence was as sudden
from the level of the previous weeks as was the rise in the deaths; district nurses took on
an average of 67 new respiratory cases a day in the first four days of December; on
December 8th, 9th and 10th they took on 173, 227 and 181 such cases. Dr. Abercrombie
in a detailed analysis* of the work of the Emergency Bed Service covering Greater
London during this period says:
'In 1952, owing to the prevalence of cold weather since early November, the
work of the service rose steadily throughout that month with the result that on
1st December, 243 general acute applications were received instead of the normal
130 or so. This rise continued until 6th December, when the fog settled on London,
and the number of applications rose very rapidly, reaching an unprecedented peak
on 9th December, when 492 were received. Applications continued in abnormally
high but diminishing numbers until the 13th, after which a fairly stable state was
reached.'
It has already been noted that the Emergency Bed Service applications tend to
over-emphasise a rise in acute sickness since general practitioners will make more use
of the service under such conditions; but a rise such as that described by Dr. Abercrombie
must very largely represent a real and sudden increase.
In the Administrative County the total number of patients removed to hospital by
the ambulance service (excluding maternity and accident patients) was 2,493 in the
week, Sunday, 30th November-Saturday, 6th December ; in the following week it
was 3,287. The proportion of these removals, for whom arrangements were made
through the Emergency Bed Service, had been rising steadily over the preceding weeks;
it was 17 per cent, in the week ending 8th November, 18 per cent, in the two following
weeks, 19 per cent, in the next week, 22 per cent, in the week ending 6th December
and 24 per cent, in the week ending 13th December. The variation in this proportion
can be taken as an indication of the extent to which general practitioners shifted their
demands for hospital accommodation from the more usual channels to the E.B.S.
Dr. Abercrombie describes also how the demands on the hospitals through the E.B.S.
were met and the workings of the E.B.S. warning system :
'When the percentage of admissions to applications, calculated on the moving
weekly totals, falls below 85 per cent., a "white" warning is sent to the appropriate
hospital authorities' 'If the percentage falls below 80 per cent, a "yellow"
warning is issued, and if below 75 per cent, a "red" warning' 'On 1st December
the admission-rate was 88.5 per cent., and in spite of increasing pressure it was kept
above 85 per cent, until Sunday, the 7th, when it fell to 84.9 per cent.; a "white"
warning was issued at 11 a.m. next day. On Tuesday, the 9th, the rate was 79.9 per cent.,
and the "yellow" warning was issued. The response was such that, despite the high
total of applications, the admission-rate fell only a further 1.5 per cent. The "yellow"
warning was cancelled on 15th and the "white" on the 17th.
*Abercrombie, G. F. * Lancet,'1953, 1.234.