View report page

SCARLET FEVER.
9
During 1920, the frequency of these cases called for special enquiry. Unfortunately the
"Discharge Notes" from the Board's Hospitals do not distinguish between "clinical" and
"bacteriological" diphtheria, many of the latter being reported as "errors" without comment.
The duration of treatment of every case admitted during 1920 has been taken out with the
result that an average duration of 49.6 days has been obtained. Assuming that cases
discharged within 28 days of admission are not cases of "clinical diphtheria," it may be
concluded that 73 out of 343 cases admitted and recovering were cases of "bacteriological
diphtheria," that is no less than 21'2 per cent.
Another estimate based on a scrutiny of all cases reported during the year, gave
55 "carriers" among "family" cases and 39 among "institutional," or 94 in all, that is 20.2 per
cent, of all notified cases.
f
Institutional Treatment. —During 1919 223 of the reported cases, including 11 errors, were
removed to hospital and during 192Q, 408 including 30 errors. The percentages of removals
to notifications for the two years were 86.1 and 87.9 respectively, showing fairly considerable
reduction below the mean rates for 1909-13 (93-5 per cent.) and 1914-18 (95.4). The lower
proportion observed in 1919 may, have been due to difficulty in securing accommodation.
That difficulty did not recur in 1920 and the smaller proportion of cases sent to hospital was
due to many of the cases of "bacteriological diphtheria" being kept at home.
With the co-operation of the Inoculation Department of St. Mary's Hospital, a special
"Carrier" Out-patient Clinic was opened in the early months of 1920. To that clinic
"carriers" were referred during the remainder of the year.
Fatality.—There were during 1919 14 deaths among the notified cases, and 25 during
1920. In the former year there was one "error" which ended fatally and in 1920, 2. The
fatality—per cent. of the total cases (corrected for "errors" only, and not for "carriers") was
6.0 per cent. in 1919 and 6.2 per cent. in 1920, as compared with mean rates of 5.6 and 6.9 per
cent, for the two preceding quinquennia. (See Table VII. Appendix).
Mortality.—The total deaths certified due to diphtheria were 17 in 1919 and 25 in 1920,
as compared with annual averages of 10 (1909-13) and 16 (1914-18). The Index Numbers
average 1909-13=100) 170 and 250 for 1919 and 1920 respectively.
Scarlet Fever.
General Prevalence. The total of 501 cases reported in 1920 was nearly double of that of
1919 (260). As will be seen from Table III., Appendix, the disease .after attaining a maximum
of 738 cases in 1914, declined in prevalence to a minimum of 124 (in 1917) and has increased
each year thereafter. The Index Numbers for 1919 and 1920—basis, average 1909-13—are
69 and 134 respectively, and a basis of the average for 1914-18, 75 and 146. In comparison
with the returns for the quarterly averages for 1914-18, the cases reported during the eight
quarters of 1919 and 1920, show higher Index Numbers in three quarters only. (See below).
The high prevalence of the disease in the third quarter of 1920 is an unusual phenomenon.

The distribution of the disease—both as to locality and time—throughout the Borough
was irregular, certain of the Wards (viz., Westbourne, Church and Lancaster Gate, West)
presenting decreases in their yearly totals—See Table IV., Appendix. The differences are
well shown in the following statement of the Index Numbers for the two years.