London's Pulse: Medical Officer of Health reports 1848-1972

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Paddington 1900

[Report of the Medical Officer of Health for Paddington, Metropolitan Borough of]

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105
Report of Medical Officer of Health.
(b) Cases in which the secondary illness differed from the primary. In this group he
includes 8 cases of diphtheria following the return of discharged scarlet fever patients, and 10
cases of scarlet fever following the return of discharged diphtheria patients. 18 cases.
(c) Cases due to infection traceable to sources other than the discharged patient. 26 eases.
(d) Cases due to house infection. "By house infection I include infected clothing, toys,
dampness, drainage, and general insanitary condition of the house. They are, as a rule,
difficult to separate, and may, I think, be best dealt with under the general term, house
infection." 20 cases.
(e) "Cases in which there was no evidence either in the condition of the primary case, or
in the circumstances under which the illness of the secondary case took place, to show that the
infection was connected with the return home of the primary." 52 cases.
(f) Cases in which the alleged return case was a patient discharged from hospital who
had been re-infected at the hospital. 4 cases.
By such process of exclusion the original 339 "return cases" are reduced to 212. Of the
127 excluded cases, certain would not be regarded by most officials as "return cases" at all, e.g.,
those in groups (a) and (f), while others, e.g., some of groups (b) and (e), would not in all
probability be excluded as has been done by Prof. Simpson. The report does not, unfortunately,
contain particulars of the cases investigated, so that it is impossible to decide how far Prof.
Simpson's decisions qua exclusion would accord with general experience. For the present purpose
the results of inquiries as to the 212 remaining cases can only be considered. These are divided in
the Report into 3 classes:—
Class 1.—Doubtful cases in which it was impossible to decide whether the infection was
caused by the primary cause or not. 36 cases.
Class 2.—Cases in which it was impossible to dissociate infected clothing, &c., or house
infection from personal infection. 17 cases.
Class 3.—Cases which were probably due to personal infectivity of the primary case.
159 cases.
In the absence of all details of the cases, this classification has to be accepted as it stands. In
his detailed inquiry Prof. Simpson confines himself to the 111 primary cases which are included
in Class 3 and gave rise to 159 "return cases." The primary cases included 90 cases of scarlet
fever and 21 of diphtheria. These figures are equal to 1.3 and 0.5 per cent. respectively of the
discharges.
The percentage of cases in connection with the various hospitals varied from 0.5 at the South
Western to 1.3 at the North Eastern.* The duration of hospital isolation, so far as can be judged
from the small numbers dealt with, bears little or no relation to the frequency of return cases.
"If any opinion may be hazarded on such data, it may be stated that the variation in
frequency of such cases does not appear in any way to be connected with shorter detention
of patients in the hospitals concerned, for the Brook, North Eastern and the Western, which
detain their patients the longest, do not occupy so good a position as the Eastern and the
Park, which detain their patients the shortest period, while Gore Farm and Winchmore
Hill, the convalescent hospitals, contribute as large a percentage of 're-infecting cases.'"
The inquiries made respecting the 111 re-infecting cases brought out two facts: (1) That
desquamation was not apparently a factor of prime importance in the conveyance of infection, only
27 per cent, of the cases being attributable to "desquamation of the skin or eczematous eruptions"
in the discharged patient; and (2) that discharges from mucous surfaces were noted in the larger
proportion of discharged patients.
"The remarkable fact in this analysis of the condition of the primary cases suspected
of having caused secondary cases is that 80 per cent. had discharges from the mucous
membranes, chiefly of the respiratory tract, and that 9 per cent. showed au unhealthy
condition of the throat with corresponding secretion." †
* It has to be noted here that these percentages relate to scarlet fever and diphtheria taken together.
† This has been frequently alluded to in the paragraphs on "return cases" given in each Annual Report.