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11
scarlet fever
Errors of Diagnosis.—Of the 827 notified cases 43 were subsequently found to have been
erroneously diagnosed. These "errors" formed 5.2 per cent. of the reported cases, a higher
proportion than that reported in 1919 (4.6) or 1920 (4.1). The proportion recorded last year
shows an improvement on the proportions observed during 1909-13 (7.4) and 1914-18 (7.1).
House, Family Distribution.—After correcting for errors, it is found that the secondary
cases in houses during the past year numbered 111, equal to 14T per cent. of the corrected
total. In 1920 these cases numbered 71 (14.3 per cent.) and in 1919, 39 (15.5). The
proportions set out below show that on the whole there was less tendency to multiple cases in
houses last year than in the earlier periods mentioned.

In thinking of multiple attacks in houses, it is necessary to bear in mind the fact that most of
the houses where such cases occur are occupied by two or more families. Whereas the 784
"confirmed" cases came from 673 houses, the actual number of families invaded was 695.
The secondary cases in those families numbered 89, or 11.3 per cent. of the total. Two cases
occurred in each of 56 families, 3 in 15 and 4 in one. On 15 occasions two cases were reported
simultaneously and on 3, three.
In this connexion mention should be made of the frequency of "return cases," being new
attacks in the family (or house) at various (short) intervals after the return of an earlier case
from hospital. Last year 43 such cases were noted, there being two other instances of a
somewhat doubtful character. Cases occurred in all Wards of the Borough, Harrow Road
and Church Wards being most affected with 15 cases each. The patient suspected of giving
rise to the "return case(s)" was seen by the Medical Officer of Health, as soon as possible after
the occurrence of the return case(s).
Institutional Treatment.—Of the total 827 cases reported 804 were removed to hospital,
equivalent to 97.2 per cent. of the the total. In 1920 the percentage so removed was 94.4, and
in 1919, 91T, the averages for the two quinquennia 1909-13 and 1914-18 being 95.5 and 95.8
respectively. (See Table VIII.).
Fatality.—Last year there were three deaths among the 827 persons reported to have
scarlet fever, but only one of those deaths was certified as primarily due to the fever. That
death occurred in a boy aged 8 years who was under treatment in an outlying institution and
contracted scarlet fever there, there being, apparently no connection (qua source of infection)
with the Borough. Of the other two deaths, one a girl aged 10 was first reported with diphtheria
and removed to hospital where scarlet fever was subsequently diagnosed. The death was
attributed to diphtheria. The remaining death, that of a girl aged 5, who was removed to hospital
as a case of scarlet fever and succumbed in hospital to an attack of appendicitis, to which disease
the death was allocated. The statement given below shows how the fatality of this disease has
diminished during the last few years.
Scarlet Fevee : Borough.
Fatalities—Per cent. Reported Cases.
1909-13 1.9 1919 1.6
1914-18 1.8 1920 0.4
1921 0.1
Mortality.—The deaths from scarlet fever numbered 5 in 1919, 3 in 1920 and 1 last year.
Table IXa shows how the Index Numbers for the three years have fallen.