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case was admitted into hospital. Bearing in mind that the natural
stimulants to immunity are declining rapidly, as judged by the
rarity with which any form of diphtheria organism is reported
during the routine bacteriological examination of throat swabs,
it is all the more necessary to maintain the immunity of the
population by artificial means.
SCARLET FEVER.
This disease remains of a very mild type and only 68 cases
were notified as compared with 80, 90 and 149 in the previous
three years.
To what extent the number of these known cases represents
the degree of infection in the District it is impossible to say.
There is a good deal of evidence to show that while the disease
remains so mild a number of missed cases occur, the mildest often
not coming to the notice of the doctors or being regarded as due
to other causes; moreover it is well known that for every case
exhibiting a rash, others suffer from a temporary sore throat or
slight upset without producing a rash, although they have been
infected with the same organism.
The question naturally arises whether all known cases of
streptococcal infections should be notified, or alternatively whether
the notification of scarlet fever and the measures associated therewith
should be dropped. It is thought that wider notification would
cause a great deal of inconvenience without materially affecting
the spread of the infection, but on the other hand, in view of the
tendency for scarlet fever to gradually vary in its severity, it is
considered that it would be unwise to give up the present practice
completely. Modifications in procedure have, however, gradually
been introduced. The mildest cases are, for example, allowed to
return to school earlier if they are normal clinically, though a
mimimum exclusion of fourteen days is probably desirable in case
complications arise. Similarly normal contacts return after a
week irrespective of whether the case is being treated at home or
in hospital.
The disease has for some years been mainly associated with
school children and particularly the 5-8 year old children, 52%
being in this group in 1954 compared with 17% under school age
and 20% older school children. Six cases occurred among adults,
but half of these were connected with schools.
Almost all schools in the District, including a number of
private schools, had one or more cases, the maximum in any one
school being ten. Attention has been focussed on the examination
of contacts at school and in general this policy appears
justified, bearing in mind the factors mentioned above which foster
the spread of this usually mild infection.
The hospitalisation of cases has further decreased, only 15
cases being admitted in 1954, (Wandle Valley 8, Bletchingley 5,
Queen Mary's 1 and Waddon 1).
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