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A clinical-statistical study of scarlet fever, diphtheria, and enteric fever
1929.
PUBLIC HEALTH.
stimulation. So fascinating, stimulating and interesting indeed did he prove that sight was lost almost at once of the fact that the lectures were being delivered in a tongue other than his own. W h e n it was remembered that this was so, admiration was added to the other sensations and inevitably it occurred to the mind that in all probability Professor Madsen had equal mastery of other tongues and could, with similar readiness to that with which he had addressed ~n English audience in their language, address audiences in the capitals of other European countries in theirs. And apropos it occurred to wonder who there was here, in the group that might claim to contain the opposite number to Professor Madsen, to accept such an invitation as that extended to him and to stand before a Danish or other foreign audience and, possessing such a mastery of their tongue as he has of ours, address them so easily and fluently. At the closing meeting Dr. Charles Porter, Chairman of the Board of Studies in H y g i e n e in the University, and Professor Topley, Professor of Bacteriology in the new School, voiced the appreciation of all those who had had the privilege of meeting and hearing Professor Madsen. It is unfortunate that the visit of Professor Madsen was not made during a week in which a meeting of the Society was held, when an opportunity of honouring him and of offering a welcome and expressing esteem on behalf of the health service as a whole would have offered. Since this was denied there is extended here to Professor Madsen the assurance that the esteem exists and that the entire Fellowship of the Society endorses every expression of .eiatification and appreciation that his visit and his lectures evoked.
A Clinical-Statistical Study of Scarlet Fever, Diphtheria, and Enteric Fever. E D I C A L statistics of a large number of M cases can, as a rule, only be obtained by combining the records of many observers, and this introduces a possibility of error owing to the differences of individual judgment. In the preface to the report under review* it is SCARLET FEVER, DIPHTHERIA, AND ENTERIC FEVER, 1895-1914 : A Clinical-Statlstical Study. By E. W. Goodall, M.D., M. Greenwood, F.R.C.P., F.E.S., and W. T. Russell. Medical Research Council, SpeciaI Report Series, No. 137. H.M. Stationery Office, 1929. pp, 58. Price ~s. net.
~7
claimed that the special value of the analysis of the data, which is based upon records of over 21,000 cases of s c a r l e t fever, 15,000 diphtheria cases and 2,000 cases of enteric fever, lies in the fact that they are derived from a single source, the cases with few excep= tions being under the care o f D r . Goodall and the records edited by him. It does not, however, seem that the possible fallacy of the former method is a serio.us one. Such tables of this report as can be compared with other published tables, viz., those on annual admissions, age incidence, and seasonal incidence, either correspond closely or, where they differ, the latter are probably the m0re reliable. The report discusses also the form of disease, complications and their relation, and on these matters there exists no previous information, at least to a n y t h i n g like this extent. In this respect it breaks new ground. The particulars noted include year and date of admission, sex, age, district, form of disease, complications, and result. No diminution of scarlet fever was found during the school holidays, though such a diminution occurred in diphtheria, but enough evidence of this diminution exists in other publications. Scarlet fever cases were classified into mild, 88"7 per ceni. ; septic, 8"3 per cent. ; toxic, 0"4 per cent. ; and undefined,. 2"6 per cent. Septic cases are commoner in childhood and form about 12 per cent. of all cases under five but only 5 per cent. of all cases over eight years of age. T h e y also occur approximately with equal frequency throughout the year, the autumnal rise in scarlet fever being due to the milder form. Consequently the proportion of septic cases is highest when the disease is least prevalent. From tables given 'showing the correlation of complications and age it appears that otitis is far commoner in the earliest ages, the other complications showing a less marked ageincidence. On the whole, complications were least common in 1910-1914, next in 1895-1899, and most common in the middle period. In diphtheria a diminution occurred during the summer tiolidays. Laryngeal and nasal forms are commonest in children. Over 25 years 98 per cent. of cases were faucial. Paralysis is most common at 9 years, and albuminuria at 6. As with scarlet fever the complications were less common in the last quinquennium. In enteric fever the complication rate increased with age for all complications except otitis.
PUBLIC HEALTH.
stimulation. So fascinating, stimulating and interesting indeed did he prove that sight was lost almost at once of the fact that the lectures were being delivered in a tongue other than his own. W h e n it was remembered that this was so, admiration was added to the other sensations and inevitably it occurred to the mind that in all probability Professor Madsen had equal mastery of other tongues and could, with similar readiness to that with which he had addressed ~n English audience in their language, address audiences in the capitals of other European countries in theirs. And apropos it occurred to wonder who there was here, in the group that might claim to contain the opposite number to Professor Madsen, to accept such an invitation as that extended to him and to stand before a Danish or other foreign audience and, possessing such a mastery of their tongue as he has of ours, address them so easily and fluently. At the closing meeting Dr. Charles Porter, Chairman of the Board of Studies in H y g i e n e in the University, and Professor Topley, Professor of Bacteriology in the new School, voiced the appreciation of all those who had had the privilege of meeting and hearing Professor Madsen. It is unfortunate that the visit of Professor Madsen was not made during a week in which a meeting of the Society was held, when an opportunity of honouring him and of offering a welcome and expressing esteem on behalf of the health service as a whole would have offered. Since this was denied there is extended here to Professor Madsen the assurance that the esteem exists and that the entire Fellowship of the Society endorses every expression of .eiatification and appreciation that his visit and his lectures evoked.
A Clinical-Statistical Study of Scarlet Fever, Diphtheria, and Enteric Fever. E D I C A L statistics of a large number of M cases can, as a rule, only be obtained by combining the records of many observers, and this introduces a possibility of error owing to the differences of individual judgment. In the preface to the report under review* it is SCARLET FEVER, DIPHTHERIA, AND ENTERIC FEVER, 1895-1914 : A Clinical-Statlstical Study. By E. W. Goodall, M.D., M. Greenwood, F.R.C.P., F.E.S., and W. T. Russell. Medical Research Council, SpeciaI Report Series, No. 137. H.M. Stationery Office, 1929. pp, 58. Price ~s. net.
~7
claimed that the special value of the analysis of the data, which is based upon records of over 21,000 cases of s c a r l e t fever, 15,000 diphtheria cases and 2,000 cases of enteric fever, lies in the fact that they are derived from a single source, the cases with few excep= tions being under the care o f D r . Goodall and the records edited by him. It does not, however, seem that the possible fallacy of the former method is a serio.us one. Such tables of this report as can be compared with other published tables, viz., those on annual admissions, age incidence, and seasonal incidence, either correspond closely or, where they differ, the latter are probably the m0re reliable. The report discusses also the form of disease, complications and their relation, and on these matters there exists no previous information, at least to a n y t h i n g like this extent. In this respect it breaks new ground. The particulars noted include year and date of admission, sex, age, district, form of disease, complications, and result. No diminution of scarlet fever was found during the school holidays, though such a diminution occurred in diphtheria, but enough evidence of this diminution exists in other publications. Scarlet fever cases were classified into mild, 88"7 per ceni. ; septic, 8"3 per cent. ; toxic, 0"4 per cent. ; and undefined,. 2"6 per cent. Septic cases are commoner in childhood and form about 12 per cent. of all cases under five but only 5 per cent. of all cases over eight years of age. T h e y also occur approximately with equal frequency throughout the year, the autumnal rise in scarlet fever being due to the milder form. Consequently the proportion of septic cases is highest when the disease is least prevalent. From tables given 'showing the correlation of complications and age it appears that otitis is far commoner in the earliest ages, the other complications showing a less marked ageincidence. On the whole, complications were least common in 1910-1914, next in 1895-1899, and most common in the middle period. In diphtheria a diminution occurred during the summer tiolidays. Laryngeal and nasal forms are commonest in children. Over 25 years 98 per cent. of cases were faucial. Paralysis is most common at 9 years, and albuminuria at 6. As with scarlet fever the complications were less common in the last quinquennium. In enteric fever the complication rate increased with age for all complications except otitis.