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12
enteric fever
Second Attacks.—An attack of scarlet fever is usually regarded as conferring immunity
against the disease. While more complete knowledge derived from notification has given rise
to doubt as to such immunity, second attacks in the same person are sufficiently rarely recorded
to justify the placing on record of cases as they become known. Last year four instances
of second attacks were recorded, of which the particulars are as follow:—
f., æt 12, to hospital with (supposed) diphtheria, 17th February, 1921: scarlet fever
diagnosed at hospital; discharged 5th May; sickened with scarlet fever,
12th December, 1921; removed to hospital 13th December, and diagnosis
confirmed.
m., æt., 7, treated at home in January, 1920, for an attack of scarlet fever:
sickened 12th June, 1921, with the same disease; removed to hospital 15th June,
and diagnosis confirmed.
The practitioner who treated the case in 1920 wrote, in response to an
inquiry, confirming the diagnosis of the earlier attack.
f., æt. 5, sickened 6th September, 1920: removed to hospital 10th September;
home 20th October; sickened 3rd June, 1921; to hospital 5th June.
Enquiries addressed to the medical superintendents of the hospitals
concerned elicited confirmation of the diagnosis in both instances.
m., æt. 4, sickened 11th November, 1920: to hospital 15th October; home
25th November; sickened 22nd April, 1921; to hospital 23rd April.
The first attack was apparently a "return case," and the second occurred
while the boy was in a general hospital for treatment of a tuberculous gland.
The medical superintendents concerned confirmed the diagnosis in both attacks.
Hitherto second attacks have been reported only at long intervals after the first. In
each of the above cases the interval was considerably less than a year. There is ample
evidence of the low virulence of the infecting organism to which scarlet fever has been due
during the last two years. It is permissible to surmise that in consequence of that low
virulence, the immunity acquired by an attack of the disease is not so complete as when
the organism is of high virulence.
Enteric Fever.
General Prevalence.—Last year 13 cases were notified as compared with 10 in 1919 and 19
in 1920. The annual averages for the two quinquennia 1909-13 and 1914-18 were 29 and 15
respectively.
Errors of Diagnosis.—Of the 13 cases notified, 4 were subsequently found to be other
diseases, the "errors" forming no less than 30.7 per cent. of the notifications. The increase in
the proportion of errors is remarkable. The percentages during 1909-13 averaged 19.7, during
1914-18, 19.5, and were in 1919 and 1920, 20 and 21.
After corrections for errors, the average annual numbers for the two quinquennia were—
1909-13, 23; 1914-18,10, and for the two following years—1919,8; 1920,15, the corrected total
for 1921 being 9. No case was notified from Queen.s Park Ward, and the elimination of the
errors cleared Harrow Road and Maida Vale Wards.
Bacteriological Verification.—Resort to bacteriology as an aid to diagnosis was had in
8 instances, the results being negative in 4. Of the 4 positive, 2 showed the presence of
the "enteric organism," one each the "Para-A" and "Para-B."
Sex-Age Incidence.—The 13 cases notified included 4 among males and 9 among females.
Of the cases among males, 2 (ages 6 and 73) have to be ignored as errors, and the other two
were "para" cases. Last year attention was called to the freedom of males from this disease,
a phenomenon new since the war. As far as men of ages above (say) 26 are concerned, a
very large proportion are more or less protected by inoculation. Males at younger ages have
not had that advantage, and it remains to be seen how long attacks among males will continue
to be rare. The uncorrected numbers reported at the ages mentioned during the years 1914-21
are set out below.