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 1910
[Report of the Medical Officer of Health for London County Council]
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51
Report of the Medical Officer of Health.
prevalence of scarlet fever and diphtheria, the amount of decrease would not differ very widely from
year to year, and further that in the same year the decreases in scarlet fever and diphtheria would in
some degree resemble each other.
There are, however, wide differences in these respects, as will be
seen from the following table, which shows the number of cases of scarlet fever and diphtheria notified during the month of holiday influence and the succeeding month among children aged 3—13, per cent, of cases in the preceding four weeks:—
| Year. | Scarlet fever. | Diphtheria. 1 | ||
|---|---|---|---|---|
| Month of holiday influence. | Post-holiday month. | Month of holiday influence. | Post-holidaymonth. | |
| 1892 | -9 | +52 | — 3 | + 29 |
| 1893 | —26 | + 65 | —27 | + 81 |
| 1894 | —21.2 | + 33.5 | —23.9 | + 44.5 |
| 1895 | —22.0 | + 40.0 | 36.0 | + 49.0 |
| 1896 | — 2.9 | +21.3 | —14.9 | + 34.0 |
| 1897 | —12.4 | + 45.4 | —28. 7 | + 30.4 |
| 1898 | —31.8 | + 33.4 | —35.4 | + 47.4 |
| 1899 | —24.5 | +53.8 | 34.7 | + 44.6 |
| 1900 | —15.7 | + 68.9 | 32.3 | + 45.3 |
| 1901 | —22.0 | +56.3 | —19.3 | +55.8 |
| 1902 | —22.7 | + 22.9 | —25.1 | + 37 |
| 1903 | —24.4 | + 28.9 | — 31.7 | + 22.0 |
| 1904 | —24.0 | +51.6 | —16.7 | + 16.6 |
| 1905 | + 6.1 | + 42.0 | 35.6 | +57.5 |
| 1906 | —28.8 | +55.3 | —24.2 | + 17.7 |
| 1907 | — 7.2 | + 44.5 | —26.1 | + 58.7 |
| 1908 | —10.9 | + 43.0 | — 1.0 | + 21.0 |
| 1909 | —26.2 | +52.5 | —36.6 | + 60.7 |
| 1910 | —18.1 | + 25.1 | —28.4 | + 63.5 |
Thus it is difficult to believe if exodus were the main factor in the causation of the holiday
depression that in one year, 1896, exodus should in the main account for a decrease in August of 2.9
per cent, of the cases of scarlet fever, and in 1906 a decrease of 28.8 per cent., or a decrease in 1900
of 32-3 per cent, of the cases of diphtheria, and in 1892 a decrease of 3 per cent. ; or in 1900 a decrease
of 15-7 per cent, of the cases of scarlet fever and of 32-3 per cent, of the cases of diphtheria, (a)
Similar differences are observable in the increase which occurs after the close of the holidays, which,
as already stated, is found about a week after the reopening of the elementary schools.
More recently the suggestion has been made that the diminished notifications of August are
due to the non-discovery of cases through loss during that month of the opportunity of the
school teachers to call attention to children who are absent from school, or whose state of health
indicates the need for inquiry. To whatever extent this loss may have had effect upon the figures
of notified cases it is obvious it would not have affected those relating to registered deaths, and the
August depression in the mortality curves for scarlet fever and diphtheria published in the Annual
Summary of the Registrar General definitely negatives the suggestion that the August depression in
the case curves is materially affected by this cause.
The total figures showing the number of cases of scarlet fever and diphtheria notified in the
London population in the 19 years 1892-1910 (6) were as follows:—
| Period. | Scarlet Fever. | Diphtheria. | ||||
|---|---|---|---|---|---|---|
| Notified cases. | Increase (+) or decrease (—) —___. ._ ___________ _ _ | Notified cases. | Increase ( + ) or decrease (—) | |||
| Cases. | Per cent. | Cases. | Per cent. | |||
| 32,862 | - | - | 15,506 | - | - | |
| 28,312 | -4,550 | —13-9 | 12,815 | —2,691 | —17.4 | |
| 38,144 | + 9,832 | + 34 7 | 16,184 | +3,369 | + 26.2 | |
(cr) The differences between the numbers of cases of diphtheria notified in the years selected for comparison
are not likely to ba vitiated by differences in amount of use of bacteriological methods.
(6) The figures relating to the later years in the case of diphtheria may not improbably be somewhat affected by
increased use of bacteriological methods of diagnosis.