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of diphtheria has always been considerably less than that of scarlet
fever, and now, for the first time, the conditions are reversed. It is
very difficult to explain the increase in the prevalence of this disease,
but I frequently remarked during the years of the war and up to the
Autumn of 1921 that both diphtheria and scarlet fever in Bermondsey
were remarkably low. This was probably an accidental occurrence,
and no doubt a new and susceptible population was growing up at
this period, and they have now become the soil for the great increase
in these two children's diseases. The case mortality in diphtheria
has remained about the same in spite of the increased prevalence,
but owing to the great increase in the number of cases it now causes
many more deaths than scarlet fever.
Scarlet Fever.
The notifications of scarlet fever in 1921 were 1,164 against
976 in 1920.
This is an increase of 188. The distribution of the disease in
the various Wards, as shown in Table V. of Appendix, was fairly
uniform.
27 cases were returned from hospital as not suffering from
scarlet fever.
There were 18 deaths, which gives the very low case mortality
of 1.5 per cent., against 0.72 per cent. in 1920. The disease, as in
recent years, was of a very mild type. The attack rate per thousand
inhabitants was 9.66 against 7.56 in 1920.
Many of the remarks made about diphtheria will apply to scarlet
fever. The case mortality has been extremely low, and the relative
increase has been about in the same proportion. During recent
years scarlet fever has become a comparatively mild and innocuous
disease, and the question arises as to whether one should not make
provision in the hospitals for some more deadly disease, such as
measles, by not removing so many cases of scarlet fever into hospital.
The question, however, is a difficult one, for although measles causes