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increase woud occur, through scarcely so suddenly.
Probably the most important factor
influencing the rate and extent of the-spread of this
disease was the mildness of its character. The term "Scarlet
Fever" is applied only to those casus exhibiting a rash in
addition to the other symptoms associated with a streptococcal
infection, i.e. malaise, headache, feverishness, aching limbs
or back., sore throaty etc. In this epidemic the rash was often
atypical or so transient that it was frequently overlooked. In
addition a very appreciable proportion of the population had some
of the symptoms indicating streptococal infection but without
the rash, or else were found to be carrying the germ without
apparent inconvenience. Neither of these groups being notifiable
under the present Infectious Disease Regulations, there was no
hope of limiting appreciably the spread by isolating known cases
of infection.
It was noted in this epidemic that the percentage of
school children and even more of pre-school children affected
was increased, the proportion of adults being greatly reduced.
Owing to the large numbers of notified cases in this
and surrounding Districts the infectious disease hospitals were
unable to accept more than a proportion of the cases and as far
as possible thc.se were selected on the grounds of special
physical or social heed.
It is generally accepted that when the home conditions
permit the treatment of these cases in their own houses it is to
their advantage, as, the risks, of cross infection and subsequent
complications are thereby diminished. One difficulty arises,
however, which is often overlooked, viz. that of providing
medical attention for then in their homes. General
Practitioners who are also doing midwifery are naturally very
reluctant to visit cases of streptococcal infection. Ideally
therefore a bountiful provision of cubicle wards at infectious
diseases hospitals is most desirable but in times of epidemic
even what is normally very adequate bed accommodation is apt to
prove insufficient. At such times the provisions of S.l77 of
the Public Health Act 1936 do not meet the circumstances
completely as the cases treated at home are by no means limited
to "the poorer inhabitants" of the District, in fact they are
chiefly those in better financial circumstances. As previously
stated the recent epidemic was fortunately of a r±ld type, hence
this problem was not so acute as it might well become in a
severer type of infection.
A point re-emphasised by this outbreak is the importance
of early isolation and treatment, not necessarily in hospital,
of those cases who during their convalescence after Scarlet I over
develop colds with nasal or ear discharges and, to a less extent,
those contracting sores on exposed parts of the skin. Quite an
appreciable number of secondary cases contracted the infection
during the year through failure to recognise the risk caused by
these convalescent carriers.
ERYSIPELAS.
By contrast with Scarlet Fever, although Erysipelas is
also caused by streptococci, only 5 cases of this disease "ere
notified during the year, this being the lowest number for 14
years. In 1941 and 1942, 27 nd 22 cases were recorded. Of
the 5 eases, none of which were inter-connected, 2 occurred in
one of the mental hospitals. All recovered.
PUERPERAL FEVER.
Similarly although the cause of this Fever is often a
streptococcal infection, only 5 cases of puerperal fever were
notified; this being about the same as in recent years. It is
a tribute to the standard of midwifery locally that more cases
did not occur, as well might ???e happened with less rigid
aseptic techni??/ae.
All three cases were admitted to the Isolation Hospital
where they recovered.