London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
Chelsea 1921
Annual report for 1921 of the Medical Officer of Health
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10
Scarlet Fever.
During the year, 233 cases of Scarlet Fever were notified in Chelsea,
as against 191 in 1920, 148 in 1919, and 67 in 1918. There was only
one death from this disease. Of the total cases, 208, or 90 per cent.,
were removed to hospital, as against 97 per cent. in 1920. The months
of greatest prevalence were May (34 cases), October (26 cases), and
November (33 cases). January and February were the months of least
prevalence, 13 cases and 10 cases respectively; but in the latter month
8 cases occurred in the Cheyne Hospital for Children, followed by two
additional cases in March. All these children resided when at home
in outside Boroughs, and are not counted as Chelsea notifications. The
percentage of cases of school-age (3 to 13 years), was 75, as against 69
in 1920.
The followmg table shows the average annual case rate, case fatality rate, and percentage of cases removed to hospital in each of six quinquennial periods since 1891 in Chelsea Home District (1891-1900) and Chelsea Borough (1901-20).:—
| Quinquennial Periods. | Average Annual Case-rate per 1,000 pop. | Average Annual case fatality rate. | Average Annual percentage of cases removed to Hospital. |
|---|---|---|---|
| 1891-5 | 4.54 | 4.7 | 55 |
| 1896-1900 | 3.91 | 3.8 | 70 |
| 1901-5 | 2.60 | 3.2 | 88 |
| 1906-10 | 3.20 | 2.3 | 93 |
| 1911-15 | 2.69 | 1.8 | 91 |
| 1916-20 | 1.95 | 1.0 | 92 |
The decline in the case-rate has, no doubt, been largely influenced
by the fall in the birth-rate, which has taken place during the past 25
years, the number of children between the ages of 2 and 10—the susceptible
age for Scarlet Fever—being now considerably less in proportion
to population than 30 years ago. In 1891-5 the average birth-rate in
Chelsea was 27.7 per 1,000, and in 1916-20 only 16.1 per 1,000.
The decline in the case fatality rate is due chiefly to change of type
of Scarlet Fever. There has been no such change in medical treatment
of the disease, similar to that occurring in Diphtheria after the introduction
of Diphtheria Antitoxin in the early nineties, as would account
for the progressive decline from 4.7 in 1891-5 to 1.0 in 1916-20.
Scarlet Fever is now such a mild disease that only one per cent. of
the cases prove fatal; and it has become a question whether the great
expenditure incurred in London in isolating over 90 per cent. of the
notified cases—the great majority of which are mild cases—could not
be expended in other ways with better advantage to the public health.
Diphtheria.
During the year, 112 cases of Diphtheria were notified in Chelsea,
as against 148 in 1920, 71 in 1919, and 47 in 1918. The disease caused
6 deaths in 1921, the case fatality rate being 5.4 per cent., as compared
with 4.7 per cent. in 1920, 9.9 per cent. in 1919, and 10.6 per cent. in
1918; of the total 112 cases, 103, or 92 per cent., were removed to