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11
Out of the total of 623 cases, 57 occurred in the Duke of York's
Royal Military School, and 41 in the Chelsea Workhouse and Infirmary.
The Hospitals of the Metropolitan Asylums Board became very full in
the last quarter of the year, and not only was there delay in the removal
of cases to the Hospitals, but many cases were kept at home which would
have been tranferred to Hospital had there been accommodation for
them. Second, third, and even fourth cases of scarlet fever have occurred
within short periods of each other in a house invaded by the disease, and
the majority of these secondary cases have arisen in houses where there
was either a delay in removing the initial case, or where the initial case
was kept at home during the whole period of the disease.
The inability of the Metropolitan Asylums Board Fever Hospitals
to receive scarlet fever cases does not explain the exceptional incidence
of the disease upon Chelsea, as the surrounding parishes laboured under
a similar disadvantage. Removal to hospital was effected in 55.2 per
cent, of the Chelsea cases, or excluding the 57 cases at the Duke of
York's School, which were isolated in the school infirmary forming part
of the school buildings, 60.8 per cent, of the cases were removed to
hospital, as compared with 71 per cent, in 1894. Out of the total 623
cases, 129, or 20.7 per cent., belonged to Kensal Town, which shows
that the disease was not quite so prevalent in Kensal Town as in the
home district, the population of Kensal Town, according to the 1891
census, forming 22.63 per cent, of the population of the whole parish of
Chelsea, or, if we take the estimate for 1895, forming 24.8 per cent, of
the population of the whole parish.
Out of the total 494 cases of scarlet fever occurring in the home
district in 1895, 250, or 50.6 per cent, were notified in the last four
months of the year. This aggravated prevalence in the autumn months
is a usual feature, not only in scarlet fever, but also in diphtheria and in
enteric fever, and has caused in the past autumn a large increase of
work to the officers of the Public Health Department.
Diphtheria was considerably more prevalent in Chelsea in 1895 than
in 1894, and Chelsea's figures for 1895 will be seen from Table VIII. to
be in excess of the figure characterising the metropolis as a whole.
There is only one western parish, namely Fulham, which has a higher
incidence rate for diphtheria in 1895 than Chelsea. If we exclude
Kensal Town, and take the home district alone, the incidence rate of
diphtheria in 1895 per 10,000 of the home district population is 39.9, or
but very little below the figure of Fulham (42.4). Like scarlet fever,
the prevalence of diphtheria was at its maximum in October, November,
and December, when the Metropolitan Asylums Board Fever Hospitals
were crowded with patients, but there was very much less difficulty and
delay in effecting the removal of diphtheria cases than of scarlet fever.
Removal to hospital was effected in 61.7 per cent, of the diphtheria
cases as compared with 58 per cent, in 1894. The excessive prevalence
of diphtheria was practically confined to the home district, the number
of cases occurring in Kensal Town in the year under review being only
32, or 9.6 per cent, of the total cases, whereas in proportion to its census