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remains very low when it is remembered that fifty years ago before modern methods
of treatment were available and when the disease was more severe than now, the annual
death roll in London from scarlet fever or streptococcal sore throats was over 500.
Smallpox
and typhus
Tuberculosis
There were no notifications of either smallpox or typhus during 1953.
Detailed figures of new cases of tuberculosis notified in 1953 are shown in Tables 9
to 12 (pages 150 to 154). Non-civilians are included in the statistics and total (home)
populations are used.
The general trend of morbidity and mortality since 1921 is indicated in Table 9
(page 150) and is also illustrated by the diagram (page 22). The consistent decline in deaths
and notifications during the inter-war years was substantial. New cases of pulmonary
disease were reported at the rate of 2.1 per 1,000 population in 1920, and only 1.3 per
1,000 in 1938, a fall of about 40 per cent. in just under 20 years. During 1938 the deathrate
from pulmonary tuberculosis was 0.64 per 1,000, i.e., about 40 per cent. lower than
in 1920 ; a reduction of some 1,600 deaths annually at the 1938 population level. In the
years of the war the general deterioration in living conditions, the strain placed upon the
population by bombardment and the increased opportunities for the spread of infection,
all combined to reverse the trend of both morbidity and mortality and by 1941 the
ground gained in inter-war years had been lost. Mortality rates rose to a peak of 1.02
per 1,000 for pulmonary disease and 0.14 per 1,000 for non-pulmonary disease in 1941.
In so far as this rise was mainly due to the impact of the hard conditions of war upon
existing advanced cases, it was short-lived and mortality began to decline again as the
war proceeded. By 1946 the mortality rates had fallen below the pre-war levels and they
may now be regarded as having fallen well below the level to which they might have
been expected to decline on the basis of pre-war trends.

With regard to morbidity the rate of diagnosis of new cases of pulmonary tuberculosis
rose by nearly 50 per cent. between 1938 and 1941, remaining at the higher level
until the end of the war, when a decline took place, at first quite rapidly. The statistical
improvement, however, was short-lived, for between 1947 and 1949 the notification
rate rose slightly. It must, however, be remembered that diagnostic services are now
more used than ever before and also that new methods, such as mass miniature radiography,
now discover early cases which normally might have recovered without
notification or would not have been notified until the disease was more advanced. It is
likely that part of the rise in notification was due to improved case-finding and that
pre-war and post-war rates are not strictly comparable. The notification rate of
pulmonary disease in 1953, of 1.40 per 1,000, was the same as the rate recorded in 1952.
A war-time increase in non-pulmonary tuberculosis was less severe than for the
pulmonary form and the rates have fallen below the pre-war level and have continued to
decline to a very low level. The non-pulmonary notification rate in 1953 was 0.12 as
compared with 0.15 for 1952.
The age distribution of new notifications of tuberculosis is shown in Table 10(a) ;
the numbers on the registers at 31st December for 1943 to 1953 in Table 10(6) ; the
numbers of new cases diagnosed as tuberculosis at chest clinics during 1953, the percentage
found to be positive and the number of contacts examined, in Table 10(c)
and the occupations of adult cases notified in 1951 and 1953 in Table 10(d).
Specific notification and death-rates are shown in Tables 11(d) and 11(6), and the
distribution of notified cases of non-pulmonary tuberculosis by site in Table 12.
Tables 10(c) and (d) are new. No particular significance should be attached to the
fact that the rates in Table 10 (d) differ unduly in some instances—the numbers involved
are in many cases so small that random fluctuations are to be expected and in any case