1896 The Lancet  
the county medical officer of health, reports that the incidence rate per 1000 of certain infectious diseases upon the non-burghal portion of the county during 1895 was as follows : diphtheria, 8 ; scarlet fever, 25 ; enteric fever, 12 ; and measles, 154. In reference to the compulsory notification of this latter disease Dr. Munro states that there is a curious lack of courage amongst local authorities and their officers in dealing with this question, and he traverses the contention that
more » ... ation is of use only side by side with adequate hospital isolation. He points out that hospital isolation is of use only in a small proportion of cases, inasmuch as the infectivity of measles in the early stages of the disease renders it extremely probable that in the average case occurring in a family of children the mischief has been done, qua, that family, before the local authority can intervene to isolate. The prevention of the spread of the disease from the invaded house is therefore the main object to be attained. Dr. Munro furnishes some interesting figures in respect to the value of isolation in relation to its fatality rate of infectious disease. In the county of Renfrew the fatality rate of scarlet fever in hospital-treated cases was 1-2 per cent. and in home-treated cases 7.1 per cent. In enteric fever the respective rates were 7'1 and 93 per cent. With reference to the question of school attend--ance as a factor in the propagation of measles Dr. Munro records an outbreak of the disease which extended over two months and ran to 12 cases only. Only two of the children were of school age, and they had been withdrawn from the school before any harm had been done. In a former outbreak, which began and spread in the line of school attendance, the disease extended in a couple of months to 267 cases. Dr. Munro furnishes another instance where a child was at school on the day the rash appeared I and the disease ran to 20 cases in the course of a few uaay s. Leith Sanitary -District.-Dr. W. Leslie Mackenzie records in the first annual report which he has presented to the town council an outbreak of typhus fever which occurred in 1895. The disease seems to have been imported into the town, but it is not clear as to what locality was the source of infection, though there remains a suspicion against Perth as having been the town from which it was introduced. The outbreak was almost entirely confined to the 11 Scoto-Irish population, for the most part dock labourers and their wives and children. Filth and over-crowding were pronounced. Dr. Mackenzie must have spent a large amount of time in tracing out the several cases, but he was rewarded with satisfactory evidence in almost every instance. The disease in most of the cases appears to have presented the usual characteristics, although in some instances the symptoms aborted. There were in all 32 persons (10 males and 22 females) attacked, and the cases were distributed amongst eleven houses. The fatality-rate among the males was 20 per cent. ; amongst the females 4'5 per cent. No deaths occurred among the nurses or attendants, but two of the nurses suffered from severe headache and one of these had an abortive attack of typhus fever. Of all the persons attacked three had previously suffered from typhus fever ; one of these three had a typical attack and two had abortive attacks. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 6775 births and 3655 deaths were registered during the week ending Oct. 24th. The annual rate of mortality in these towns, which had been 16'7 and 16 3 per 1000 in the two preceding weeks, rose again last week to 17'6. In London the rate was 17'1 per 1000, while it averaged 17'9 in the thirty-two provincial towns. The lowest rates in these towns were 11'5 in Croydon, 12'2 in West Ham, 14'0 in Huddersfield and in Newcastle-upon-Tyne, and 14'1 in Cardiff ; the highest rates were 20.8 in Bolton and in Burnley, 21-2 in Hull, and 23'4 in Preston. The-3655 deaths included 349 which were referred to the principal zymotic diseases, against 361 and 351 in the two preceding weeks ; of these, 89 resulted from diphtheria, 67 from diarrhoea, 56 from scarlet fever, 50 from measles, 47 from "fever" (principally enteric), and 40 from whooping-cough. No fatal case of any of these diseases occurred last week in Brighton or din Derby ; in the other towns they caused the lowest rates in Portsmouth, Halifax, and Newcastle-upon-Tyne, and the highest rates in Nottingham, Manchester, Birkenhead, and Liverpool. The greatest mortality from measles occurred in Nottingham, Bradford, Hull, and Plymouth ; from scarlet fever in Birkenhead ; from whoopingcough in Cardiff, Huddersfield, and Swansea ; and from diarrhoea in Birkenhead, Burnley, Gateshead, and Bolton. The mortality from "fever" showed no marked excess in any of the large towns. The 89 deaths from diphtheria included 57 in London, 6 in West Ham, 5 in Leicester, 5 in Liverpool, 3 in Bristol, and 3 in Birmingham. No fatal case of small-pox was registered in any of the thirty-three large towns. There was only one case of small-pox under treatment in the Metropolitan Asylum Hospitals on Saturday last, the 24th inst., against 3, 4, and a at the end of the three preceding weeks; no new cases were admitted during the week. The number of scarlet fever patients in the Metropolitan Asylum I4-ospitals and in the London Fever Hospital at the end of the week was 4164, against 4020, 4105, and 4073 at the end of the three preceding weeks; 448 new cases were admitted during the week, against 454, 424, and 372 in the three preceding weeks. The deaths referred to diseases of the respiratory organs in London, which had been 21S and 238 in the two preceding weeks, further rose to 334 last week, but were 25 below the corrected average. The causes of 60, or 1-6 per cent., of the deaths in the thirty-three towns were not certified either by a registered medical practitioner or by a coroner. All the causes of death were duly certified in Portsmouth, Nottingham, Oldham, Sunderland, and in ten other smaller towns ; the largest proportions of uncertified deaths were registered in West
doi:10.1016/s0140-6736(01)76276-9 fatcat:nmmo7fooifconnhgtk7gtbtw6e