View report page

41
SEPTIC DISEASES.
proved to have been erroneously diagnosed, the percentage of errors being 24.0, cr 3.3 above the
average for 1908-12 (20.7). Of the 19 definite cases 6 were believed to have been imported,
and one each due to the consumption of winkles and watercress. Only one patient was treated at
home, the patients removed to hospital forming 96 per cent. of the total cases reported, as
compared with 53.3 per cent. in 1912 and an average (1908-12) of 77.2.
Of the 25 persons reported to have the disease 8 died, but in 2 of the fatal cases the disease
(enteric fever) had been erroneously diagnosed. The fatality (Table 29) among the definite
cases was 31.5 last year, as compare with 6.6 in 1912, and an average for the preceding
five years of 13.5. It is somewhat remarkable that all 6 deaths occurred in the
Paddington Infirmary, to which Institution 13 cases (including 1 error) were admitted, while
among the 11 cases (including 5 errors) admitted to other institutions—hospitals of all kinds
and nursing homes—there was not a death. Among the patients treated at the Infirmary there
were two men received from the same common lodging house (one in August and the other in
December), that being the only house with more than a single case during the year. In one
house, however, where resided a married man who was reported to have the disease, it was
ascertained that all his 6 children had been previously ill with diarrhoea at intervals before
the father.s attack. Enteric fever not being suspected until the father.s illness, no Widal
tests were made while the children were ill. Subsequently such tests were applied at the
request of the Medical Officer of Health and in 4 of the 6 children the reactions were found
to be positive.
The Widal test was known to have been used in 17 instances before notification. Positive
reactions were obtained in 16 instances, but in two instances the diagnosis of enteric fever based
on the results of the test was subsequently set aside. In the remaining instance a diagnosis of
enteric fever was given although the reaction was negative. The further progress of the case
failed to confirm the diagnosis.
The mortality from enteric fever last year was at the rate of 0.04 per 1,000 persons, as
compared with 0.01 in 1912 and an average (1908-12) of 0.02. The mortality in St. Marylebone
was at the same rate as in Paddington (Table 24), but lower in all the other districts. The
Ward mortalities are shown in Table 30.
SEPTIC DISEASES.
Puerperal Fever.—The reported cases of this disease after increasing from 7 in 1911 to
11 in 1912 fell to 8 last year, the annual average for the five years 1908-12 being 7 2. The
numbers of cases reported from each of the Wards during the past six years are given in
Table 20.
In the last report (page 24) arguments were adduced in favour of the use of the births
registered, rather than of the number of women of child-bearing ages, for the purposes of calculating
the various rates required. It is unnecessary to recapitulate those arguments here.
The morbidity rate was 2.80 per 1,000 births last year (Table 17), as compared with a rate
of 3.96 in 1912, and an average (1908-12) of 2.50. According to the data used in the preparation
of Table 18, the local rate was 2.61 last year, that rate being exceeded by the rates recorded
in Kensington (3.87), Westminster (2.69), and Willesden (2.72). In Westminster, St. Marylebone
and Hampstead last year.s rates were below the averages, in the other districts, above. In
Extra-Metropolitan England and Wales (Table 19) last year.s rate was 2.13 per 1,000 births, as
compared with 2.36 in 1912 and 2.24 in 1911.
The morbidity rates recorded (see next page) during the year in Queen.s Park and
Lancaster Gate, West, Wards were higher than the corresponding rates in 1912, while, in comparison
with the quinquennial averages, Harrow Road Ward has to be added to the two Wards
just mentioned as having excessive rates.