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Annual Report of the Medical Officer of Health,—1893. 13
Such a reform would, I believe, materially assist in reducing the excessive deathrate
from diarrhoea. Prompt removal of all decomposing matter in or about houses,
a pure and plentiful supply of water, good food, and, in the absence of mother's milk,
the feeding of infants on boiled cow's milk, are among the chief safeguards against
this disease. Table XI. discloses the fact that the actual number of deaths in St.
George's from diarrhoea is 16 in excess of its proportion of total London deaths
according to population.
Whooping Cough.—This fatal complaint is not included in the list of " dangerous
infectious diseases " that are notifiable. In 1893 it killed 59 infants and children
as against 46 in 1892.
Of the 59 deaths 20 were those of infants under one year of age. The annual
mortality from whooping cough in St. George's is 27 in excess of the average for
London.
The disease is commonly looked upon as a trifling and necessary evil, and the
sufferer often succumbs to secondary lung troubles induced by neglect.
Scarlet Fever or Scarlatina.—The epidemic prevalence of this disease in London
during 1893 has exceeded that of any year on record. The total number of scarlet
fever cases admitted to the Metropolitan Asylum's hospitals was 14,548, of which
total 901 died. In 1892, 13,093 admissions gave 839 deaths.
The annual mortality in the Board's hospitals, per 1,000 of estimated population,
was 0.37 as against 0.27 in 1892.
Out of a total of 581 cases of scarlet fever—notified in St. George's—there were
41 deaths, of which number 32 were under and nine above the age of five years.
This agrees with the known behaviour of the disease, which, as a rule, is most
fatal to children under five years of age, and notably so to infants in the first and
second years of life.
A remarkable feature shown by Table XI. is the large excess of 19 deaths in
St. George's from scarlet fever over and above its proportioo/to the total London
deaths. The curves relating to scarlet fever on chacj^indicate the seasonal
prevalence of the disease. The managers of the Asylurtr Board's hospitals warned
the various local authorities on May 13, 1893, that all their available beds would
shortly be filled up and that sanitary authorities would be called upon to provide
for their own infectious sick.
These anticipations were more than realised, and from the middle of June to
nearly the end of the year the removal of large numbers of infectious patients was
deferred, so that many patients remained at home until the end of their illness.
By means of frequent personal application at the chief office of the Board I
succeeded in gaining the early removal of several cases from one and two-roomed
tenements in crowded flats and from self-contained houses with small shops attached.
I have no hesitation in asserting that a saving of much suffering, broken health and
loss of life would have been effected had the following advice contained in my
Annual Report for 1892 been acted upon:—
" Should the Parish be again visited by a similar outbreak of scarlet fever or
other communicable disease—not at all an unlikely occurrence—the putting into
practice the principles advocated by me in a Special Report ' on a Proposed
Reception House' and approved by the Vestry, might be the means of averting
similar catastrophies."
The Report advises, amongst other matters, " the isolation of the healthy
members of an infected family in a temporary shelter, which might also be
utilised, should the accommodation in the Asylum Board's hospitals fail at any time
(in which case the Vestry would become responsible), as a temporary substitute for
hospital isolation."