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who had been immunised 6 or 8 years previously. The illness which
resulted was not severe and the patient recovered in hospital.
In addition to the above, 3 children, members of one family, who had
previously been well immunised, were found to be carrying diphtheria
organisms as a result of routine swabbing for streptococci, which one
of them had been carrying for several weeks. As a precautionary measure
they were all removed to hospital, but were only carriers of the germ, not
being ill themselves, and were not included among the notified cases of
diphtheria. Similarly one member of the Forces was admitted to hospital
with tonsilitis.
When the history of diphtheria in the District is reviewed it is found
that from 1915-1937 there was an average of 30 cases per annum notified
and 31 deaths occurred. On the other hand, since 1937, the year in which
diphtheria immunisation clinics were commenced in this District, there
has only been an average of 12 cases per annum and a total of 2 deaths.
In these 10 years not only has there been a saving of 12 lives compared
with the preceding 20 years, but 18 cases per annum have not required
treatment with all that involves in the way of expense, manpower and
resultant ill-health.
The complete absence of any cases among the child population in
1946 inspires the hope of even better records in the future providing the
immunity of the children is maintained at its present high level.
Scarlet Fever.
During 1946 there were 93 notifications of scarlet fever, which was
an increase of 26 on 1945, but only slightly above the average for recent
years. The disease remained mild in type and was most prevalent among
school children. Altogether 71 cases were removed to Hospital but no
deaths occurred.
Waves of increased prevalence of this disease occurred in 1920-21,
1928-29, 1934-36 and in 1943, but while there has been a tendency in
recent years for the average number of cases to be rather higher than in
the earlier years, the reduced severity of the disease has been its most
marked feature. Between 1915 and 1932 there were 13 deaths from this
cause in the District, whereas since 1932, in spite of an increase in the
average number of cases, no deaths have occurred.
The milder nature of the symptoms have, however, produced increased
difficulties in control. With improved methods of bacteriological diagnosis,
it has been possible to demonstrate the large percentage of the population
which is carrying the germs of the disease at any one time. Of these a
proportion suffer from slight symptoms from time to time, though to
what extent these result from the streptococci or from other germs also
present in the throat it is difficult to state. A much smaller proportion
still show the typical rash which alone requires notification. W'ith
this background it will be appreciated that it is impossible to eradicate
the disease by isolation which can, however, be helpful in reducing contact
with cases when they are in their most infective stages. It is fortunate
that while preventive measures can thus of necessity only be
partially effective, so long as the disease remains mild in type, there is
no great cause for anxiety.
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