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It will be seen from the table that there has been a wave of increasing prevalence of the
disease since 1917, when it reached the lowest point on record. The case mortality
fortunately remains low.
Of the notified cases of scarlet fever, 831 (or 96.3 per cent.) were removed to hospital,
as follows:—
To Metropolitan Asylums Board hospitals 823
To other hospitals 8
831
(Other statistical facts will be found on pages 28 to 30).
Return Cases.—(Definition :—A case of scarlet fever occurring within 28 days of the
return from hospital to the same house of a previous case of scarlet fever). There were 19
such cases in 1920, occurring in 19 houses. In each of two instances two previous cases had
returned within the 28 days, and it was not possible to determine which were the infecting
agents. The (?) infecting cases are therefore taken as numbering 21. In every instance
the return case was in the same family as the (?) infecting case or cases. In 8 instances
the (?) infecting case had rhinitis and nasal discharge since return (accompanied by
sore-throat in one case, ear discharge in one, glandular enlargements in two, and desquamation
on the feet in one), in one other instance ear discharge, and in three other instances
desquamation on the feet. There were no obvious signs of infectiousness in the other 10
cases, though chronic enlargements of the tonsils, often with some glandular swelling, was
found in a considerable proportion of the cases. The intervals between the return of the (?)
infecting case and the onset of the illness of the return case were respectively 2, 3, 3, 3, 3,
3, 4, 5, 5, 5, 6, 8, 8, 8, 15, 16, 17, 21, 21, 24 and 26 days.
There was in addition one return case occurring 41 days after the return in the same
family of a previous case, which suffered from rhinitis and nasal discharge, and another
occurring 45 days after the return in another family in the same house of a previous patient,
who was found to have a catarrhal "cold" giving a negative nasal swab.
There were three instances in which cases of scarlet fever developed within 28 days of
the return from hospital to the same house of a previous case of diphtheria. In each of the
3 cases the scarlet fever and corresponding previous case of diphtheria were in the same
family. In one instance the returned diphtheria case had sores on the face, and in the other
two no signs of infectiousness. In one of the three instances the case of scarlet fever was
followed by a second case taking its onset a day later than the first. In addition to these
three there was one other instance in which a case of scarlet fever occurred 31 days after the
return in the same family of a previous case of diphtheria, which showed no signs of
infectiousness.
DIPHTHERIA.
747 (civil) patients were notified in 1920 as suffering from diphtheria or membranous
croup. Of these, 66 were afterwards found not to be suffering from the disease
by Medical Superintendents of the Metropolitan Asylums Board, and one by other medical
practitioners.
The corrected number of diphtheria cases (civil) notified was therefore 680, equal to
an incidence rate of 2.92 per 1,000 civil population.