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

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London County Council 1934

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

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In the annual reports for the years 1931-3, there have appeared reports by the
medical superintendent of the North-Western hospital (Dr. Joe) on the length of
stay in that hospital of scarlet fever cases. The following is a further contribution
from him on the subject:—
The following table sets forth the duration of stay of 852 scarlet fever patients, who were
discharged direct from, or who died in, the North-Western hospital, and whose period of isolation
was not interfered with by concurrent or intercurrent disease. As the number of deaths was
on])' 7, the figures may be accepted as giving accurate representation of the duration of stay
8-2 per cent, discharged by the end of 4 weeks.
36-3 between 4 and 5 weeks, i.e. 44-5 per cent, within 5 weeks.
26-6 5 and 6 71.1 6
13-2 6 and 7 84-3 7
6-1 7 and 8 90-4 8
2-9 8 and 9 93-3 9
1-5 9 and 10 94-8 10
Of the 852 cases mentioned above 212, i.e., 25 per cent., were treated by anti-streptococcal
serum, in practically all cases by the intramuscular route ; of those 32.1 per cent, showed one or
more of the complications of arthritis, otitis, rhinitis, and adenitis. In these cases, one of late
albuminuria was present, but none was complicated by nephritis. Serum sickness, in the form
of rash in practically every instance, appeared in 33-5 per cent, of cases. In the 640 non-serum
treated cases, the complication of arthritis, late albuminuria and nephritis, otitis, rhinitis and
adenitis appeared either singly or in combination in 25-3 per cent, of cases.
It should be pointed out that anti-streptococcal serum was only given to the more severe
cases and that the complication rates given for serum and non-serum treated cases are not intended
to be comparative.
The medical superintendent (Dr. Pereira) has reported that, at the Eastern
hospital, during the year, there were four deaths among the patients admitted with
scarlet fever. The causes of death were as follows :—
(1) Toxic scarlet fever.
(2) Advanced pulmonary tuberculosis, plus scarlet fever.
(3) Cardiac failure following severe faucial diphtheria.
(4) Acute rheumatic fever and scarlet fever.
Patients (2), (3) and (4) were all admitted suffering from both diseases.
The use of anti-streptococcal serum was limited to the more severe type. These
numbered 37. Serum treatment did not appear to have any effect on the toxic case
which ended fatally.
The medical superintendent of the Park hospital (Dr. Banks) has reported as
In last year's report a short account was given of the results of the treatment of scarlet fever
with intravenous serum as compared with non-serum treatment. As the results were considered
to be outstandingly in favour of intravenous serum treatment, the latter was adopted
as the routine method during 1934. During the last three months of the .year, however, a further
departure took place in the use of serum by the intraperitoneal route, and for this purpose the
wards were divided into two groups, having an approximately equal age and sex distribution
of cases. In one group the intravenous and in the other group the intraperitoneal route was
employed as the standard method, due regard, however, being always paid to the special needs
of individual cases. While the results of intraperitoneal serum treatment as shown below
appear to be highly satisfactory, experience with it is too limited to admit of generalisation at
present, and this work is being continued.
In both the intravenous and the intraperitoneal series the policy of short stay in hospital
was continued as in 1933. As by this treatment the acute stage was shortened, nutrition relatively
unimpaired and complications few, it is considered that no advantage was to be gained
by keeping these fit and healthy patients in hospital longer than an average period of two to
three weeks. No evidence has been obtained that complications occur at a later date when
they are so discharged and " return " cases appear to occur almost indifferently, whether after
a long or short stay. It is the " long stay " patients who are at a disadvantage in scarlet fever
wards. The majority of young children are not yet immune to infectious diseases, and are
consequently liable sooner or later to be re-infected with scarlet fever, tonsillitis or other strep
toeoccal infection, or to contract another infectious disease from patients admitted to the ward
in the incubation stage of the other disease. Such a combination of infectious diseases, sustained