View report page

SCARLET FEVER. 7
Carrier Clinic.—Seven (7) "carriers" were referred by the Department to the Special Clinic at
St. Mary's Hospital. One did not go to the Clinic at all, and one went once only, although the bacteriological
specimen taken at the Clinic was found to be " positive." The duration of attendance for
the remaining 5 varied from 3 to 7 weeks.
Since the Clinic was opened in 1920, 48 "carriers " have been dealt with.
SCARLET FEVER.
In 1917, 124 cases of this disease were reported, the number increasing each year to a maximum
of 827 in 1921, since which year the annual totals have decreased to 529 in 1922 and 323. last year.
Last year's total was made up of 150 cases among males and 173 among females, with an equal sexincidence
the figures should have been 150 and 204.* In comparison with the annual average (411)
for 1913-17, last year's total shows a fall of 29 per cent., and as compared with that (454) for 1918-22 a
fall of 21 per cent. Except in Church and Hyde Park Wards the numbers recorded in each of the
Wards during the past year were satisfactorily below the averages for the two preceding quinquennia.
In Church Ward 79 cases were recorded in 1923, as compared with averages of 80 during 1913-17 and 88
during 1918-22, the corresponding figures for Hyde Park Ward being 19, 16 and 23.
As regards age-distribution, at ages under 15 years decreases were observed in each age-group of
both sexes, but there was an equal, if not greater prevalence between the ages 22-45 in both sexes.
Among males aged 25-45, 10 cases occurred last year, the quinquennial averages being 6 (1913-17) and 6
(1918-22), the corresponding figures for females being 16, 16 and 15. The 150 cases among males represent
a reduction of 17 per cent. below the annual average (181) for 1913-17, and 1 of 23 per cent, below
that (196) for 1922. The 173 cases among females were equivalent to falls of 25 per cent, below the
average (230) for 1913-17, and of 33 below that (258) for 1918-22.
Of the 323 notified cases, 39 (12 per cent.) were later on marked as "errors," an increase of 114
percent, above the average percentage (5-6) for 1918-22. The percentages of errors noted in the
Wards ranged from nil (Lancaster Gate, West, and Hyde Park) to 20.2 in Church.
In 4 instances the cases notified last year were secondary to attacks notified in 1922; in 11 the
disease was contracted in institutions; in 12 the disease followed the return of previous cases from
hospital; and in 3 the disease was contracted outside the Borough. Two patients were reported twice
during the year, the second "attacks" being probably relapses.
After eliminating the cases marked "errors," it has been found that in 26 houses there were 2
cases during the year; in 6, 3; and in 1, 5. If the family be considered instead of the house, 19 had
2 cases each during the year, 5, 3, and 1,5. In 7 instances the secondary cases in the families were
due to the return home from hospital of the primary cases. On 2 occasions 2 cases were reported
simultaneously, and on another 2, 3. In 4 instances there was some delay in arriving at a diagnosis,
and to that cause 6 secondary cases were apparently due.
Of the 323 notified cases 315 (97.5 per cent.) were removed to hospital, the percentage of removal
during the years 1918-22 having been 91.5. All the notified cases in the two Lancaster Gate and Hyde
Park Wards were removed to hospital. Three of the notified cases terminated fatally, including one
"error." The corrected fatality was 0.7 per cent., nearly double the mean fatality (0.4) during 191822.
All the deaths occurred in institutions.
The 2 deaths were equivalent to a mortality of 0.01 per 1,000 persons of all ages, half the rate for
1922, when there were 3 deaths. The annual average number of deaths during 1918-22 was 3. The
deaths last year were equally divided among the sexes, the mortality per 1,000 of all ages being 0.01.
For the years 1910-12 the mortality among males was 0.05 and that for the years 1920-22, 0.01. The
corresponding figures for females were : 1910-12, 0.02 and 1920-22, 0.02.
Multiple Infections.—This designation has been adopted to describe the occurrence of diphtheria
and scarlet fever in the same house (or family) during the year under observation. Did time
permit the survey should cover all the notified diseases.
Last year cases of diphtheria and scarlet fever were notified as having occurred in each of 14
houses, but after allowing for errors of diagnosis that number is reduced to 9. In 4 instances the
first case was one of scarlet fever, in 3 of diphtheria, and in 2 the diseases were concurrent, that is
to say, that the same patient was notified as having diphtheria and scarlet fever in combination.
Maida Vale and Lancaster Gate, West, Wards were the only two in which there was no instance of
multiple infection.
Of the 4 instances in which diphtheria was reported after scarlet fever the case of diphtheria
occurred in a different family in 3 instances, and in the fourth diphtheria supervened, while the patient
* Correcting for "errors "—males 15, females 24—the confirmed cases were males 135, females 149, whereas
on an assumption of an equal sex-incidence the latter figure should have been 184.