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15
scarlet fever.
All the circumstances of the outbreak favoured an unduly large proportion of multiple
cases. There were 181 secondary cases last year, equal to rather more than 25 per cent.
of all the notified cases as compared with 15 per cent, in 1905 and 23 per cent, in 1904.
The numbers of houses with multiple cases during the last three years are given below:—
1906. 1905. 1904.
Houses with 2 cases each 77 31 35
„ 3 „ „ 23 6 10
„ 4 ,, „ 7 3 7
„ 5* „ „ 4 — 2
„ 6 ,, „ 2 - -
„ 19 „ „ 1 - -
99 99 99 ••• A
It is impossible within the compass of this report to deal fully with the circumstances
attending the occurrence of multiple cases, but the following few facts will serve as illustrations
of the factors operative in such cases. In 17 houses where multiple cases occurred two
families were infected, and in 2 houses, 3 families. Infection from patients recently discharged
from hospital was suspected in 20 instances in all, 9 of such cases leading to the
occurrence of multiple cases. On 32 occasions two cases were reported from the same
house at the same time ; on 5 occasions, 3 cases ; and on 2 occasions, 4 cases.
As regards the two houses from which 6 cases were reported, in one two families were
infected, 4 of the reported cases being, however, errors of diagnosis, and in the other
3 families, with 5 errors. At the house from which 12 cases were reported, 3 families
were infected, 5 of the cases ultimately being certified to be errors of diagnosis. In the
whole Borough 30 out of the 715 reported cases were known to have been wrongly
diagnosed, and it is probable that other cases fell within the same category.
In 37 instances importation of infection from outside districts was known, or strongly
suspected, and one patient contracted the disease while in hospital.
Of the cases reported during the year, 692 were removed to hospital for isolation
( I able 13), equal to 96*7 per cent., nearly 9 per cent, more than the average for the preceding
five years. (Table 14). After making corrections for the known errors of diagnosis, &c.,
the fatality among the cases treated at home (23) was at the rate of 4.5 per cent, as
compared with a mean of 1*3, while the fatality in hospitals was only 2.4, or very little above
the quinquennial mean (2T).
According to the Department's figures the mortality from scarlet fever last year was
equal to 0*12 per 1,000 persons (Table 14), compared with the mean rate of 0.05, which figures
agree with those obtained from data contained in the Registrar-General's Reports (Table 10)*
I he local rate was higher than that of the Metropolis or anv of the adjacent districts.
After correction for sex-age constitution of population (Table 15) the local rate becomes
0*15, more than double the mean rate (0*06). The nearest rate to that of the Borough was
recorded in Marylebone (0*13, equal to the mean).
*In one house whence 5 cases were reported there were really G, all in one family, with 4 deaths. The first
case was not reported during life, the cause of death being arrived at by Inquest. The other cases occurred
between the date of the first death and the holding of the Inquest. The first patient was ill less than 24 hours and
all the cases sickened within 4 days. The variety of the disease was the most malignant form which has come to
the knowledge of the Department.