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SCARLET FEVER.
Further swabs were submitted on November 18th (the day of the discharge) and December 8th, both
containing the Klebs-Loffler bacillus. A final swab on January 1st of this year was reported "negative."
The patient does not appear to have had any clinical symptoms.
V.—A. T., m., aet. 11, was excluded from a Kensington school on October 24th. There had been
cases of diphtheria at the school, and his throat and nose were swabbed in the course of a special inspection,
the Klebs-Loffler bacillus being found in the nose. Swabs were examined on November 12th, 19th, and
26th, and December 4th and 17th. All were "positive" except the last. He was certified as a case of nasal
diphtheria on November 18th, but was not sent to hospital.
The following appears to have been a case of post-scarlatinal diphtheria :—
VI.—E. S., f., aet. 2, sickened October 1st, removed to hospital October 4th, and died.
E. S. was taken ill with scarlet fever in July of last year and removed to the hospital from her home in
Liverpool on the 25th of that month, three weeks after her brother. Both children were discharged on
September 2nd. They were brought to London on the 15th of that month. On the 30th the children went to
Southend, where E. S. was taken ill the same night. She was seen by a doctor at Southend on October 2nd,
who found the child looking ill but no evidence of any infectious disease. " The doctor is confident that there
was then no exudate on the tonsils, although he admits the fauces were congested." (Letter from the Medical
Officer of Health of Southend.) The patient was brought to London on the 3rd.
Two cases of diphtheria occurred in a distant part of the Borough at the end of the year
which were apparently due to the above case. The mother took home some of the clothing
left behind by the S. family on their return to Liverpool. One of the two cases was not
certified owing to a "swab" being reported "negative." It was subsequently ascertained that
the non-reported patient had membrane in his throat, and that the case was complicated by
intercurrence of pneumonia and followed by paralysis.
SCARLET FEVER.
The eases reported during the year* (484) were equivalent to a morbidity rate of 3.34 per
1,000 persons, as compared with a rate of 1.91 in 1912, and an average of 2.89 for the five years
1908-12. The disease was markedly more prevalent throughout the country than in 1912, as is
shown by the figures given in Table 19. The chart (facing page 24) shows clearly that in London
the increased prevalence began as early as end of the second quarter of the year—about the 25th
week—but was checked, about the 30th week, by the commencement of the school holidays,
and did not again cross the curve of the 1903-12 average until the last week in September (38th
week). The curve for Paddington (1913) shows wider excursions than does that for London,
owing to the smaller numbers to which it relates, but the local curve for last year crossed the
average curve finally in the 37th week—a week earlier than did the London curve—and remained
above until the end of the year, save for the Christmas (52nd) week, when the descent was
almost certainly accidental and due to the intervention of the holidays of the Clerical Staff
resulting in delay in booking cases.
The total of 484 cases recorded last year is the highest noted since 1910, but is considerably
lower than the totals for 1901 (503), 1906 (715), 1907 (579), 1908 (681) and 1909 (629). Last
year's prevalence was, however, remarkable for the very great differences observable in the
numbers of cases reported in the two half-years (123 during January to June, 361 July to
December), and also for the limitation of the disease to the Northern Wards of the Borough.
(See Tables 20 and 21.) In Church Ward, Lancaster Gate, West, and Hyde Park Wards, the
numbers recorded last year were less than the quinquennial averages. (Table 21.) The greatest
proportional difference from the average is to be noted in Lancaster Gate, East, Ward, last year's
total being four times the average, but the absolute maximum increase in cases (37 in excess of
the average) occurred in Queen's Park Ward. From the morbidity rates given below it will be
seen that the disease was (in comparison with 1912) much more prevalent in Harrow Road,
Westbourne and Lancaster Gate, East, Wards than in the others. In comparison with the
averages the greatest increases were recorded in Queen's Park and Lancaster Gate, East, Wards.
* Including two cases originally certified as having diphtheria but transferred to scarlet fever by reason of the
subsequent course of the attacks, and three patients certified to have " scarlet fever and diphtheria." One patient
was reported during the year with a second attack of the disease.