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Review
. 2015 Oct;143(14):2923-38.
doi: 10.1017/S0950268815000175. Epub 2015 Feb 23.

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939-1945

M R Smallman-Raynor  1 , A D Cliff  2
Affiliations
Review

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939-1945

M R Smallman-Raynor et al. Epidemiol Infect. 2015 Oct.

Abstract

This paper examines the geographical impact of the British Government's wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939-1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline ('raised') disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939-1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales.

Keywords: Childhood evacuation; England and Wales; World War II; diphtheria; scarlet fever.

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Figures

Fig. 1.
Fig. 1.
Evacuation in England and Wales, 1939–1945. (a) Young evacuees from Bristol being ushered onto a bus destined for Kingsbridge, Devon, in 1940. (b) Epidemiologists, such as Greenwood [2], found justification for the evacuation in the disease risks posed by overcrowded air raid shelters. The image shows Aldwych tube station, London, serving as an air raid shelter in 1940. [Source: Imperial War Museum, Photograph Collection. (a) Creator: Ministry of Information Photo Division (IWM cat. no. D 2590). (b) Creator: unknown (IWM cat. no. HU 44 272).]
Fig. 2.
Fig. 2.
Geographical structure of the wartime evacuation scheme. Local government districts are mapped by official designation as (a) evacuation and neutral districts and (b) reception districts at the outset of the war. Dots demarcate the geographical centroids of the districts. The Registrar-General's six standard statistical regions (East, Midland, North, South East, South West, and Wales) are shown for reference. (Source: drawn from data in National Register [13, Table I, pp. 1–28].)
Fig. 3.
Fig. 3.
Annual disease notification rates per 100 000 population in the evacuation, neutral and reception districts of England and Wales, 1931–1947. Extension of the wartime designations to the pre- and post-war years permits an examination of the impact of the evacuation on long-term disease trends in the sets of district categories. (a) Scarlet fever. (b) Diphtheria. Major phases of wartime evacuation [Evacuation Phase I (EP-I) and EP-II] are indicated, as is the period of evacuee drift back associated with the first phase. [Source: data from annual volumes of the Registrar General's Statistical Review of England and Wales (London: HMSO).]
Fig. 4.
Fig. 4.
Annual odds ratios (OR) for above-baseline disease rates in the evacuation, neutral and reception districts of England and Wales, 1939–1947. The graphs are based on the results of logistic regression analysis using the 10-level predictor (X) variable and plot the odds ratio (OR) (circles) and associated 95% confidence intervals (lines); the pre-war years (1931–1938) form the referent (OR = 1·00). ORs that are significantly different to 1·00 at the P = 0·05 level are represented by the solid circles and denote periods of significantly higher (OR > 1·00) and significantly lower (OR < 1·00) odds of above-baseline disease rates. Major phases of wartime evacuation [Evacuation Phase I (EP-I) and EP-II] are indicated for reference, as is the period of evacuee drift back associated with the first phase.
Fig. 5.
Fig. 5.
Maps of odds ratios (OR) for above-baseline disease rates in the standard regions of England and Wales by major phase of the evacuation scheme. The maps identify, for scarlet fever (a–c) and diphtheria (d–f), regions with significantly higher and significantly lower odds of above-baseline disease rates for Evacuation Phase I (EP-I) and EP-II. Maps for the inter-phase period (1942–1943) are also shown. The pre-war years (1931–1938) are formed as the referent (OR = 1·00) in all instances. The maps are based on the OR and associated P values for the entire set of districts (all evacuation scheme classes) in each region. Evacuation and neutral districts are re-plotted from Figure 2, while the vectors on panels (a) and (d) provide a general indication of the direction of movement of evacuees at the outset of the evacuation scheme.
Fig. 6.
Fig. 6.
Annual odds ratios (OR) for above-baseline scarlet fever rates in the standard regions of England and Wales, 1939–1947. The graphs are based on the results of logistic regression analysis using the 10-level predictor (X) variable and plot the odds ratio (OR) (circles) and associated 95% confidence intervals (lines) for each region; the pre-war years (1931–1938) form the referent (OR = 1·00) in all instances. The bar charts plot the number of districts with above-baseline disease rates (Δxit > 0) in excess of the mean annual number for the referent period (1931–1938); zero values mark years with counts at, or below, the referent mean. Standard regions are mapped in Figure 2. See the caption to Figure 4 for other plotting conventions.
Fig. 7.
Fig. 7.
Annual odds ratios for above-baseline diphtheria rates in the standard regions of England and Wales, 1939–1947. See the caption to Figure 6 for plotting conventions.
Fig. 8.
Fig. 8.
Odds ratios (OR) for above-baseline disease rates in relation to estimates of evacuation-related population change in the regions of England and Wales, Evacuation Phase I (EP-I). The OR for each of the six regions (all districts) are plotted for scarlet fever (a, b) and diphtheria (c, d) against the two measures of evacuation-related population change defined in the text. ORs that are significantly different to 1·00 (P = 0·05 level) are represented by the solid circles and denote periods of significantly higher (OR > 1·00) and significantly lower (OR < 1·00) odds of above-baseline disease rates.
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References

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