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39
of 0·035 per 1,000, as compared with 7 deaths and a mortalityrate
of 0·04 in 1920.
Of the cases notified 1,338 (or 97·4 per cent.) were removed
to hospital. The 1,374 cases occurred in 1,078 infected
houses. Forty-six cases notified as scarlet fever were found on
removal to hospital not to be suffering from the disease.
The type of the disease was very mild, giving rise at times
to difficulty of diagnosis. No doubt a large number of cases
escaped detection, and in this way the infection, which for a
time assumed epidemic prevalence, was largely spread.
In the autumn, when the epidemic was at its height, the
pressure on the accommodation at the Metropolitan Asylums
Board's hospitals became so strained as to render it necessary
for a time to restrict admissions to the more severe cases, and
to those in which, for other reasons (e.g., unsatisfactory home
conditions) removal to hospital was urgently required.
The mild nature of attack which clinically characterises
scarlet fever in recent years, and which has been maintained in
the epidemic of 1921, has given rise to a considerable divergence
of opinion as to the necessity for notification and especially
isolation in hospital of cases of the disease. Opponents of
isolation in hospital point to the fact that this precautionary
measure has entirely failed to limit the incidence of the disease
in large centres of population. This is undoubtedly true; but,
on the other hand, it should not be forgotten that the fatalityrate
from the disease has fallen. There can be no doubt that
hospital treatment has been a not inconsiderable factor in producing
this gratifying feature of the statistics of scarlet fever
in recent years. In working-class districts when home isolation,
medical treatment and nursing are lacking, the removal to
hospital of scarlet fever cases will, in my opinion, still be a
necessity.
Scarlet fever was most prevalent in Winstanley and
Church Wards, 544 (i.e., 40 per cent.) of the cases notified
occurring in the area of these two Wards.
Diphtheria.
Diphtheria, which had increased in prevalence during
1920, assumed more serious proportions in 1921. The number
of cases notified was 713, as compared with 530 in 1920 and
229 in 1919. Of the cases notified 704 (i.e., 98·7 per cent.)
were removed to hospital.
The number of deaths registered from the disease was
63, giving a death-rate of 0·37 per 1,000, as compared with
37 deaths and a death-rate of 0·22 per 1,000 in 1920, and 20
deaths and a death-rate of 0·13 per 1,000 in 1919,