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42
III.—INFECTIOUS AND OTHER DISEASES
During the year 1937 the number of notifications of all infectious diseases (excluding
tuberculosis) was 754, as compared with 1,681 for the year 1936. The deaths
from notifiable diseases (excluding tuberculosis) during 1937 numbered 104, which
figure represents 10.1 per cent. of the total deaths for the Borough. The corresponding
number for 1936 was 146 (13.3 per cent. of the total deaths). The decrease in the total
number of notifications was almost entirely due to the low incidence of measles.
Full particulars of the notified cases, classified according to the time of occurrence,
age, and the wards in which they occurred, are given in Table No. 27.
Those diseases of importance, in which a moderate incidence was shown, were
scarlet fever, diphtheria, and dysentery. During the year under review the cases of
both scarlet fever, and diphtheria again showed a considerable decrease on the
corresponding figures for 1936, and the diminution was again more marked in the case
of diphtheria. Examination of Table 27 will indicate that diphtheria showed no
definite seasonal prevalence, but that the number of cases of scarlet fever, as is generally
the case, was higher in the two winter quarters. As was the case during both the
previous years, the disease continued to be a mild one; no deaths occurred from this
cause during the year.
Of the 169 notified cases of diphtheria the diagnosis was subsequently revised
in respect of 44, so that the total accepted cases for the year was 125—which gives a
true attack rate of 1.52 per 1,000 of the population. The number of deaths in these
diphtheria cases was 3, which gives a death rate of 0.04 per 1,000 and a case mortality
rate of 2.40 per cent., compared with a case mortality of 2.84 per cent. for 1936.
Of the 169 patients, 8 (4.7 per cent.) were over the age of 25 years. The reduction of
the incidence and mortality of diphtheria is welcome, as the disease is one of the most
serious of childhood. In previous reports the necessity for action during interepidemic
periods, and the fact that the disease can be very effectively prevented by artificial
immunisation, has been explained.
A noteworthy feature of the history of infectious diseases in various areas during
recent years is the prominence achieved by dysentery bacilli of the Sonne type.
Although the organism has long been known it was only in 1926 that the first outbreak
of an illness due to this cause was described. Nowadays the disease appears
to be almost endemic in certain areas. During the year 1937, 58 cases occurred in
Shoreditch. A further discussion of these cases appears on page 50.
Attention should be directed to the fact that in 21.9 per cent. of the notified cases
of scarlet fever and in 26.0 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. It
should be noted that during the year 87 per cent. of all notified cases of infectious
disease were removed to hospital. When measles cases are left out of consideration
this figure becomes 90 per cent.