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11
ENTERIC FEVER.
When writing of secondary cases consideration should be given to the frequency with
which two or more cases are notified simultaneously. In 1912 two cases were reported
together from 12 families and one institution and three cases from one family. In 1920 two
cases were reported together from 12 families, three from three families and four from one.
A special class of secondary cases is constituted by "return" cases, being attacks in
susceptible individuals following the return from hospital of an earlier patient. In 1919 there
were 10 such "return" cases and in 1920, 22. Harrow Road Ward suffered more particularly
from this mischance, but one or more cases occurred in all the other Wards during 1920 save
Lancaster Gate (West) Ward.
Institutional Treatment.—During 1919 237 of the notified cases—including 12 "errors"—
were removed to hospital and in 1920 473 including 20 "errors." The percentages of notified
cases were slightly lower during those years—91.1 per cent. in 1919 and 94.4 in 1920—than
the averages for the two preceding quinquennia—95-6 per cent. 1909-13 and 95 8 1914-18.
Fatality.—Four deaths (one an "error") were recorded among the reported cases during
1919 and only 2 during 1920. The fatality after excluding "errors" was 1.6 per cent. in 1919
and 0.4 in 1920, as compared with mean rates of 1.9 per cent. during 1909-13 and 1.3 during
1914-18. (See Table VII., Appendix).
Mortality.—The total deaths ascribed to this disease were—in 1919, 5 and in 1920, 3, the
annual averages for the two preceding quinquennia being—1909-13, 7 and 1914-18, 5. The
Index Numbers for 1919 and 1920—average 1909-13 100—71 and 43 respectively, pointing to
a low virulence in 1920.
The frequency with which scarlet fever has followed diphtheria and vice versa, during the
past two years, calls for some comment.
Scarlet Fever following Diphtheria. During .1919, in 3 houses, cases of scarlet fever
followed those of diphtheria, the cases of the former disease being suspected to be "return
cases" in two instances. In the third no association could be ascertained. In 1920 there
were 27 houses where the same phenomenon was observed, with 34 cases of scarlet fever. In
10 instances the second disease was reported after the patients had been in hospital for
varying periods, in 2 others (with 5 cases of the secondary disease) the discharged diphtheria
patient was suspected of bringing home the infection, while in the remaining instances no
connection could be traced.
Diphtheria following Scarlet Fever. In 1919 there were 11 houses in which this occurred
with 14 cases of the secondary disease. In 5 instances the patients had been sent to hospital
for the primary disease, in 3 instances (6 cases of diphtheria) the secondary disease followed
the discharge of the diphtheria patients, and in the remainder no connection could be traced.
At an orphanage in the Borough 8 cases of scarlet fever were reported between July 9
and August 27, and 10 cases of diphtheria between August 29 and December 31.
In 1920 there were 10 similar instances with 12 cases of diphtheria. In two of those
instances (4 cases of diphtheria) the secondary disease followed the return home of the scarlet
fever patient. In the other instances no connection could be traced.
Fourteen patients suffered from the two diseases during 1920, 2 having the disease
concurrently, 9 scarlet fever after diphtheria and 3 diphtheria after scarlet fever. One patient
was reported to have scarlet fever twice during the year.
Enteric Fever.*
General Prevalence.—During 1909-13 there were on an average 29 reported cases in each
year, the average falling to 15 during 1914-18. In 1919 10 cases were notified and in 1920 19.
The percentage of "errors" is always so high with respect to this disease that it appears to be
desirable to proceed to that subject at once and to compare corrected rather than uncorrected
numbers
Errors of Diagnosis.—Of the 10 cases notified during 1919 two were found to be errors,
and of the 19 reported in 1920, four. The percentages of "errors" were 20 in 1919 and 21.0 in
1920. During the quinquennium of 1909-13 the annual average of 29 cases included six
*in previous reports cases of continued fever have been included under this designation. Four cases have been
notified as ''continued fever" since 1910, viz.—one in 1913, two in 1914, and one in 1915. In this report "enteric
fever" means and includes the fevers known as "enteric," "paratyphoid A" and "paratyphoid B."