View report page

11
Scarlet Fever.—This disease has been very prevalent in the metropolis
during the year. The type, however, has been mild and the mortality not
great. In Shoreditch, 1,007 cases were notified and 38 deaths were registered.
The case-mortality was therefore 3.7 per cent. and the death-rate per 1,000 was
0'31. It will be observed from Table I. that 26 of the 38 deaths were of
children under five years of age, and that, with the exception of four, the
deaths were all amongst persons under the age of 15 years.
Children are by far the most frequent sufferers from scarlet fever and the
mortality is greatest amongst those attacked who are under 10 years of age.
The immunity of adults from this disease increases with increasing age. The
mild character of the cases in many instances, has, I believe, contributed very
materially to the spread of infection. The symptoms not being sufficiently
alarming to raise the necessity of calling in a medical man, many cases have escaped
observation or have been regarded as ordinary sore throats. The deficiency
of beds for fever patients at the command of the Metropolitan Asylums Board has
already been remarked upon. It lasted for several months, during which time
the removals of numbers of patients had to be put off from day to day, so that
ultimately many remained at home until the termination of their illness. It is
needless to point out that where the accommodation for the sick and healthy
is limited to two or three rooms, the likelihood of the disease affecting the
other susceptible members of the family is very great indeed. There is no
doubt that this was one of the principal reasons why the disease obtained such
widespread prevalence during the latter part of the year.
The greatest number of cases notified in Shoreditch in any one week, was
during that ending September 16th, viz.:—50. In the week ending October
28th, there were nearly as many.
The prevalence of this disease is favoured by bad hygienic conditions, such
as air vitiated by sewer gas, dampness of dwellings, a polluted subsoil and
imperfect ventilation. Thorough ventilation is of the utmost importance where
children are gathered together as in schools.
Scarlet fever is infectious from the very commencement of the attack, but
it becomes more liable to spread during the period of desquamation, that is to
say, when the patient is peeling. The little pieces of skin, which come off the
patient, cling to garments, curtains, bedding, &c., and the poison contained in
them has been known to retain its vitality for many months. The utmost
care is requisite during the stage of peeling, both for the sake of the patient
and for the sake of the community. Inasmuch as peeling may continue for
very variable lengths of time, extending over from two or three weeks to two
or three months, and so long as a patient is peeling, he must be regarded as
infectious. It is obvious how difficult becomes the question of isolation of scarlet
fever cases in the homes of the poor.