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Prevention and Control of Infectious Disease.
Last year it was incumbent on me to report a great and widespread
prevalence of scarlet fever. One would have expected and
hoped that in 1921 there would have been no necessity to repeat
this, but rather to have been able to say there was much less of this
disease. Instead of this, however, scarlet fever prevailed among us
to a considerably greater extent than in 1920, there being
notifications instead of 1,308. A large proportion of these (1,752)
were removed to hospital.
The epidemic started in the early part of July, reached its
maximum at the end of September, but it was not until January,
1922, that the number of cases fell to the level of July, 1921.
There were 23 return cases of this illness, compared with 12 in
1920, and these were referred to their own doctors.
The continued prevalence, although with a diminished mortality,
of this disease, in spite of the measures of notification,
removal, and disinfection, has naturally given rise to doubts,
perhaps vague and ill-defined, but certainly existent, as to whether
the existing practice is a costly mistake.
It has gone on with little question for some thirty years, but
when one meet's with a continued high prevalence a justifiable and
well-grounded suspicion may arise as to the necessity for some
radical change. Allowing for differences in the amount of susceptible
material and alterations in the population, it certainly seems
strange that in the year 1893 there were 1,886 notifications, and in
1921,59 the differences in the population being 1893, population
247,950, and 1921,600 and this followed 1920, also a year of
exceptionally high notification.
Some observations were made as to the results of the ordinary
methods of disinfection carried out after this disease. Without an
extended enquiry in many different localities it would be unwise to
make any alteration, but so far as one went it was enough to show
the advisability of further and critical enquiry in order to confirm
or do away with any doubt as to its value.
There were 870 notifications of diphtheria, and of these 829 were
removed to hospital. No series of cases occurred which might have
aroused the suspicion of any local outbreak.
The continued prevalence and fatality of this disease is difficult
to understand. For there is a well-recognised means for its control
and prevention, and this has been in universal use since its
discovery in 1894. That by this time the disease has increased in
its virulence and consequent high mortality, just as scarlet has
diminished, is possible, but it i 3 not likely that the antitoxin which
formerly was so potent has now lost its power. It is far more
probable that antitoxin is not used to the extent that it should be,
not only among the sufferers, but on those who are exposed to
massive infection. The injection of antitoxin should be made
directly strong suspicion is aroused and before the diagnosis is