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A moving weekly total, however, is not a very sensitive measure when the incidence
of acute sickness is changing with the rapidity which characterised the period 6th—10th
December ; and Dr. Abercrombie shows that on the day when applications for admission
were at their maximum, Tuesday, the 9th, the daily admission-rate fell steeply to only
just over 71 per cent. On this particular day some 30 new respiratory cases were taken
on in the Administrative County by the district nursing associations, either on direct
application from hospitals for attention pending admission or where the cases were
admitted to hospital within a day or two; few other cases of this type occurred during
November or December. It seems therefore that by this Tuesday, the incidence of new
acute sickness had been rising and was still rising so rapidly that for a very short period
there was a substantial gap between the demands on the hospitals and the ability to
meet these demands immediately. In view of the present efficiency of the system for
emergency admission, this gives an indication of how sudden and how great was the
rise in acute sickness.
The diagram opposite shows graphically the variation day-by-day from 27th
November to 18th December of the atmospheric conditions and of mortality in the
County of London ; also the number of new respiratory cases undertaken by District
Nurses and the average time per call taken by the accident service ambulances, the
former as an index of the variation in morbidity and the latter as an index of the difficulty
of traffic movement.
All these measures show a close correspondence in their movements over this period.
Dr. Logan, Chief Medical Statistician at the General Register Office, *says of the mortality
'One of the most striking features was the rapidity at which deaths started to
increase Even on 5th December, the first day of the fog, there was an obvious
increase in the number of deaths, and the daily totals mounted rapidly to their highest
levels on 7th and 8th December There was some decline on 9th December, and
a still greater decline on 10th December; but even on 15th December, the daily total
was almost twice as high as before the fog began.' The increase on 5th December in
new respiratory cases begun by district nurses was almost exactly the same as the
increase in the deaths—the deaths increased 52 per cent, over the average of the preceding
four days, the new nursing cases 45 per cent. On Saturday, 6th and Sunday, 7th, however,
the new respiratory nursing cases declined again before rising sharply on Monday,
8th, and again on Tuesday, 9th, to a peak 240 per cent, above the average of the first
four days of December. Normally the number of new nursing treatments falls off
on a Saturday and Sunday, due in part no doubt to patients' unwillingness to bother
their doctor at the week-end; a similar drop every Sunday is noticeable in the applications
to the Emergency Bed Service and this drop duly took place in the applications
on 7th December as compared with 6th December. The true pattern of daily incidence
of sickness is thus obscured in the only figures available by the fact that the critical
days fell at a week-end; but it is clear enough that the daily number both of persons
needing admission to hospital and of those needing home nursing began to increase
with startling fapidity on the first day of the fog simultaneously with the rise in the
number of deaths; and it is a reasonable assumption that the number of persons falling
sick, as distinct from the numbers contacting the medical services, continued to increase
over the week-end so that their accumulated numbers gave rise in part to the great
increase of apparent new sickness on Monday and Tuesday. It is also reasonable to assume
that this does not wholly account for the peaks of sickness falling later than the peak
of deaths. The maximum deaths were on Sunday and the maxima of applications to
E.B.S. and of new respiratory cases begun by district nursing associations were both
on Tuesday. If the two latter maxima represented merely the back-log from the weekend
they should have fallen on the Monday rather than Tuesday. The figures strongly
suggest that there was some difference between the time incidence of deaths and that
of acute sickness in relation to the fog ; that whereas the daily number of deaths started
*Logan, W. P. D. 'Lancet,' 1953, 1. 336.