Highest Mortalities by Scarlatina in three Epidemics.

1863 1864 1868 1869 1870 1874
England and Wales 30475 29700 21912 27641 32543 24922
London 4955 3244 2916 5841 6040 2648
Lancashire 4580 4854 4445 4890 3702 6404
West Riding 2218 3135 1676 2870 3718 3779
Durham 1216 403 2678 1512 983 1941
South Wales 501 1990 285 804 1370 1388
Staffordshire 1147 1134 943 1198 1064 1270
Devonshire 778 1054 60 155 646 72
Cornwall 995 572 254 161 587 50
Somerset 773 1013 55 154 584 173

In Lancashire and South Staffordshire there has been less fluctuation of the mortality from year to year than elsewhere. The stress of an epidemic has not fallen equally on all the principal centres in the same year or years: thus Durham has had the epidemic in advance of other centres, while South Wales has had it in arrear. The decline of the south-western counties from their leading position in 1863-64 has been remarkable. Plymouth, Devonport and Stonehouse, which had contributed most to the high scarlatinal death-rate of Devonshire in 1863-64, were found on the average of the next decennial period to have low rates from scarlatina, but death-rates from measles which were unapproached in any other region of England. In the following table four Devonshire towns are compared with certain Staffordshire registration districts in which the scarlatinal death-rate has remained high.

Annual average Death-rates per 1000 living, 1871-80.

All causes Scarlatina Measles
{
{
{		Plymouth 22·63 ·25 1·13
E. Stonehouse 28·23 ·33 1·79
Stoke Damerel 20·42 ·37 1·19
Exeter 24·99 ·50 ·82
{
{
{		Stoke-on-Trent 25·80 1·22 ·49
Wolverhampton 22·78 1·05 ·35
Walsall 22·82 1·21 ·30
Dudley 24·24 1·18 ·59

This looks like a correlation between measles and scarlatina. The excessive death-rate from measles in Plymouth, Stonehouse and Devonport was due to a disastrous epidemic in the last two years of the decennium, 1879 and 1880 (338 deaths at Plymouth, 121 at Stonehouse, and 235 at Devonport). Measles remained high in Plymouth all through the next decennium, scarlatina still continuing low until the very end of it, when in 1889 there was a mortality of 270, equal to a death-rate of 3·39 per 1000 living. In like manner Stoke-on-Trent had its great epidemic of measles in 1888, causing 342 deaths, or a rate of 2·8. The high Plymouth death-rate, after nearly twenty years with extremely little scarlet fever, was surpassed in 1882 by an epidemic of 346 deaths in the colliery townships of Aberystruth and Tredegar, Monmouthshire, equal to a death-rate of 6·1 per 1000. Other high death-rates for single years were at Wakefield and Swansea in 1889 and at Neath in 1890. The highest death-rates from scarlatina on an average of ten years, 1871-80, were at Durham 1·70, Todmorden 1·64, Auckland 1·63, Gateshead 1·60, Sheffield 1·49, Leigh 1·41, Wigan 1·30, Newcastle 1·28. The purely agricultural counties have the lowest death-rates[1351].

As to age-incidence, the proportion of deaths under five has been almost exactly two-thirds steadily for the last four decennial periods (supra p. 625). The following table by Dr Ogle, the Superintendent of Statistics, shows both age and sex of the scarlatina mortality[1352]:

Mean annual Mortality from Scarlet Fever per million living at successive age-periods 1859-85. England and Wales.

Age Males Females
0-1 1664 1384
1-2 4170 3874
2-3 4676 4491
3-4 4484 4332
4-5 3642 3556
0-5 3681 3482
5-10 1667 1613
10-15 346 381
15-20 111 113
20-25 59 77
25-35 36 58
35 and upwards 13 15
All ages 778 717

From certain hospital statistics on a large scale, and some figures of cases and deaths at Christiania, it was also found that the attacks of scarlatina were much more fatal in the first years of life, the fatality decreasing rapidly after five. This was only to be expected. But it was somewhat surprising to find that more girls were attacked than boys, while the fatalities among boys were more than among an equal number of girls at all ages until womanhood, when the few females attacked by scarlatina had more fatalities among them than the somewhat fewer males of the same ages. A slight excess of fatality in the female sex over the male between the ages of ten and twenty years, is shown also for smallpox by the table at p. 618. Recent notifications of infectious diseases to medical officers of health have enabled a comparison to be made between the number of cases of scarlatina notified, with age and sex, and the number of deaths certified in the corresponding time and place to the Registrar-General; from which the above generalities as to the proportions of fatal cases in the several age-periods of either sex have been confirmed[1353].