London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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Annual Report of the London County Council, 1912.
It will be seen that the scarlet fever death-rate was, in the period 1907-11, highest in Bethnal
Green (0.19), and lowest in Kensington and the City of London (0.03); in the year 1912, St. Marylebone
and Greenwich (0.09) had the highest death-rate, and Hampstead (0.01) the lowest, exclusive of Stoke
Newington, Holborn and the City of London, where no deaths occurred. The scarlet fever death-rates
obtaining in London in the four quarters of the year 1912 were as follows: first quarter, 0.02, second
quarter, 0.04, third quarter, 0.04, and fourth quarter, 0.04 per 1,000 persons living.
During the year 1912 the diminished prevalence of scarlet fever observed in the years 1910 and
1911 was maintained. The mortality rate, moreover, is quite remarkably low, and in most of the
reports comment is made upon the prevailing mild type of the disease. One or two medical officers
state that there are indications of increased prevalence, and this view has been borne out by the
behaviour of the disease, during the last quarter of the current year. In commenting upon the disease
in Bermondsey Dr. Brown writes: "The form of the disease is very mild and it is possible that this is
one of the causes of the increase. Many cases seem to have no rash, or if one occurs it is so slight that
it is liable to be missed." This evidence is supported by other observers.
In some of the reports record is made of the attempts to trace the cause of infection. For instance,
in Paddington of 260 definite cases, 18 were believed to have been infected outside the borough; in 6 cases
the disease was contracted in hospitals where the patients were being treated for other complaints,
and 14 were "return" cases.
The medical officer of health of Kensington states that in 84 cases inquiry elicited a definite
history of contact with previous cases ; 19 cases were due to infection in school; 12 were due to contact
with persons recently discharged from hospital; 5 were contacts of missed cases; and 6 were infected
outside the borough. In Chelsea there was only 1 "return" case, after an interval of 7 days. In
Marylebone, of 259 cases, 17 were traced to a previous case in the same family; 6 to cases in the same
house, 17 to cases in the neighbourhood. Holborn had 105 cases, of which 23 were secondary cases in
the same house and of these, again, 11 were "return" cases. In Finsbury there were 23 cases arising
from previous infection, 2 of them from mild unrecognised cases; 4 were infected by playfellows; 4 by
friends and 9 cases developed in hospital attended for other causes. 43 cases in Bermondsey were analysed
and 29 were traced to previous cases in the same house or family, or among neighbours, 11 were,
attributed to school infection, and there were 3 "return" cases. In Wandsworth there were 39 "return"
cases and in Greenwich 5. In the case of the latter borough it is mentioned that 10 patients were discharged
from hospital still suffering, 8 from chronic rhinorrhcea, and 2 from intermittent rhinorrhoea. In
Woolwich 37 were due to "return" cases, 36 to other inmates of the house, 7 to friends and neighbours,
32 to school attendance, 5 to fever hospitals, and 6 to other hospitals.

The number of dwellings in which multiple cases occurred is shown as follows:—

Metropolitan borough.Number of houses.
One case.Two cases.Three cases.Four cases.Five cases.More than five cases.

Thus of 1,580 houses invaded, multiple cases occurred in 236 or 14.3 per cent. In 1911, the
number of houses in which multiple cases occurred was 14.6 per cent. of the houses invaded in the
districts concerning which the facts were stated in the annual reports.
It will be seen from diagram (K) that the proportion of cases of scarlet fever admitted to the
hospitals of the Metropolitan Asylums Board was about the same as in the preceding year.

Cases certified to be those of scarlet fever and admitted into the hospitals of the Metropolitan Asylums Board in which the diagnosis was not subsequently confirmed, constituted in successive years the following percentage of the total cases admitted:—


Scarlet fever
not confirmed.
The cases of diphtheria (including membranous croup) notified in the Administrative County of
London in 1912 (52 weeks) numbered 7,101, compared with 7,385 in 1911 (52 weeks). The number
of deaths was 452 in 1912 (52 weeks), compared with 612 in 1911 (52 weeks).