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28
III.—INFECTIOUS AND OTHER DISEASES.
During the year 1934 the number of notifications of all infectious diseases
(excluding tuberculosis) was 950, as compared with 1,191 for the year 1933. The
deaths from notifiable diseases (excluding tuberculosis) during 1934 numbered 142,
which figure represents 11-9 per cent. of the total deaths for the Borough. The corresponding
number for 1933 was 137 (11.3 per cent. of the total deaths). Full particulars
of the notified cases, classified according to the time of occurrence, age, and the wards
in which they occurred, are given in the table on page 29.
The outstanding feature of this table is the number of cases of scarlet fever
(409) and diphtheria (362) which were notified during the year. The table shows that
seasonal factors had little effect upon the incidence of these two diseases. Scarlet fever
is nowadays of a mild type, but diphtheria is a very dangerous disease of childhood.
In the case of diphtheria the diagnosis was altered later in 74 cases, so that the
actual incidence of the disease for 1934 was 3.2 per 1,000 of the population.
This incidence must be considered fairly high. The number of deaths in these
288 diphtheria cases was 13, which gives a case mortality rate of 4.5 per cent. The
disease was therefore not of such a severe type as is found in some parts of the
country. Nevertheless the incidence is a matter of some concern. In another part
of this report particulars are given regarding the progress of diphtheria immunization.
Although the population as a whole has considerable general knowledge of the purpose
of immunization, individual parents often lack the will to apply this knowledge in the
case of their own children unless they are stimulated to do so by some external
influence. Of all such influences there is no doubt that the most potent is the realisation
by parents during the course of a diphtheria epidemic that the disease may
halt with dire results at their own thresholds. Fear is the greatest of all propagandists.
During the early part of the present year (1935) diphtheria was extremely prevalent in
many parts of the country, and reports in the press diffused knowledge of the dangers
of the disease. The result of this knowledge, which was stimulated by the personal
efforts of members of the health department staff, was a very marked increase in the
number of children who attended for immunization. It is not generally recognised
by individual members of the community that all other measures for the prevention
of diphtheria pale into insignificance when compared with specific immunization.
Until this dictum receives widespread recognition, there is little chance of effecting
a substantia] reduction in the incidence of this disease.
Attention should be directed to the fact that in 11 per cent. of the notified
cases of scarlet fever and in 20 per cent. of the notified cases of diphtheria the diagnosis
was subsequently altered. These percentages may appear to be high, but it should be
remembered that the London County Council requires every case to be certified as
suffering from one of the notifiable diseases before the Council will remove the patient
to one of its infectious hospitals. The result is that the weekly figures of notifications
are unduly swollen by the inclusion of patients who obviously require observation
in hospital, but who are possibly not suffering from one of the notifiable diseases.