London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1898
[Report of the Medical Officer of Health for London County Council]
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The report of the Statistical Committee of the Metropolitan Asylums Board for the year 1898 contains a table enabling comparison to be made of the fatality of cases of diphtheria treated in the Board's hospitals in the years 1888.94 before antitoxic serum was generally used, and of the fatality of cases treated in these hospitals in the years 1895-8, antitoxic serum being first generally used in the year 1895. The fatality in these two periods was as follows—
| Ages. | 1888-94. | 1895-8. | Decrease per cent, in the period 1895-8. | ||||
|---|---|---|---|---|---|---|---|
| Admitted. | Died. | Mortality per cent. | Admitted. | Died. | Mortality per cent. | ||
| 0— | 199 | 123 | 61.8 | 363 | 138 | 38.0 | —38.5 |
| 1— | 688 | 434 | 63.1 | 1,250 | 471 | 37. 7 | —40.3 |
| 2— | 966 | 532 | 55.1 | 1,817 | 521 | 28.7 | —47.9 |
| 3— | 1,259 | 608 | 48.3 | 2,461 | 594 | 24.1 | —50.1 |
| 4— | 1,323 | 516 | 39.0 | 2,586 | 591 | 22.9 | —41.3 |
| 5— | 3,723 | 1,046 | 28.1 | 7,405 | 1,208 | 16.3 | —42.0 |
| 10— | 1,330 | 141 | 10.6 | 2,432 | 154 | 6.3 | —40.6 |
| 15— | 782 | 34 | 4.3 | 807 | 31 | 3.8 | —11.6 |
| 20— | 543 | 25 | 4.6 | 474 | 11 | 2.3 | —50.0 |
| 25— | 354 | 19 | 5.4 | 336 | 6 | 1.8 | —66.7 |
| 30— | 183 | 9 | 4.9 | 229 | 11 | 4.8 | —2.0 |
| 35— | 110 | 5 | 4.5 | 114 | 4 | 3.5 | —22.2 |
| 40 and upwards | 138 | 24 | 17.4 | 108 | 7 | 6.5 | —62.6 |
| All ages | 11,598 | 3,516 | 303 | 20,382 | 3,747 | 18.4 | —39.3 |
In view of what has been said in my previous annual reports as to variation in fatality, it
must be admitted that there is possibility that some part of this reduction in fatality may be due
to natural causes. It is interesting, therefore, to compare the fatality of scarlet fever in these
hospitals in the two periods 1888-94 and 1895-8, and it will be seen from the following table that,
as in the case of diphtheria, there has been a considerable reduction in the case-mortality in the
later period compared with that of the former; diagrams XII. and XIII. showing the case
mortality of scarlet fever and diphtheria in each year since 1890 are also worthy of study in this
connexion.
| Age-period. | Case-mortality per cent. | Increase or decrease per cent, in the period 1895-8. | |
|---|---|---|---|
| 1888-94. | 1895-8. | ||
| All ages. | 7.0 | 4.4 | —37.1 |
| 0 | 29.6 | 22.7 | —23.3 |
| 1 | 26.7 | 17.2 | —35.6 |
| 2 | 20.7 | 12.3 | —40.6 |
| 3 | 14.6 | 9.4 | —35.6 |
| 4 | 10.3 | 5.6 | —45.6 |
| 5 | 4.2 | 2.3 | —45.2 |
| 10 | 1.7 | 1.0 | —41.2 |
| 15 | 1.8 | 1.1 | —38.9 |
| 20 | 1.8 | 1.3 | —27.8 |
| 25 | 1.9 | 0.6 | —68.4 |
| 30 | 3.0 | 1.1 | —63.3 |
| 35 | 3.0 | 0.7 | —76.7 |
| 40 and up. | 4.5 | 5.7 | + 26.7 |
While, however, the above tables suggest that the behaviour of scarlet fever has not greatly
differed from that of diphtheria as regards general reduction of case mortality, the following tables
are of interest in showing a difference between the behaviour of diphtheria and scarlet fever in the
period 1895.98, which was not manifested in the period 1892.94.
These tables enable comparison to be made of the fatality among cases treated in hospital,
and the fatality among the cases notified in London but not admitted to the hospitals of the
Metropolitan Asylums Board, for both diseases. It will be seen that in the period 1895.98 the
fatality of diphtheria cases treated in hospital is practically the same at " all ages," and much
lower at the younger ages than the fatality obtaining among notified cases not so treated, whereas
in the case of scarlet fever the fatality among cases treated in hospital is greater. In the antecedent
period, however, 1892.94, the hospital fatality was greater than that obtaining among cases
not treated in the hospitals of the Metropolitan Asylums Board in the case of both diseases—