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While it is very satisfying to consider the saving of life, ill-health,
manpower and money which the continued absence of any confirmed
case of diphtheria implies, it must be emphasized that, to retain this freedom,
the percentage of the population who are sufficiently immunised must
not be allowed to decrease.
Scarlet Fever.
The number of cases of scarlet fever during the year increased
sharply from 78 and 62 in the two previous years to 138, but fortunately
the type of case remained mild, there being no deaths from this cause
during 1949. Waves of this disease have been previously noted to have
occurred in this District in 1920-21, 1928-29, 1934-36 and in 1943, hence
the onset of a further wave was not unexpected. The mildness of the
present form of the disease has, as explained in earlier reports, made
its control more difficult, while the increased number of examinations
of throat and nose swabs for hæmolytic streptococci of the pathogenic
types has shown the dimensions of the problem.
As an example the following are the results of the examination of
17 such swabs taken from the staff and scholars of a local school in which
there were a large number of cases of tonsilitis of a peculiar clinical
type in March:—8 swabs were positive for hæmolytic streptococci
Group A, 2 swabs contained pneumococci and 5 H. influenza. None
of the children were ill at the time and only a few convalescent. while
only 1 case of scarlet fever occurred in that school about a month
before and none for weeks after the swabbing.
It has often been shown that an appreciable proportion of the
population are carrying haemolytic streptococci during times of prevalence,
and it is' obviously illogical to emphasize unduly the proportion
who produce a rash and other symptoms justifying the diagnosis "scarlet
fever," while more or less ignoring the carriers not showing these signs
and symptoms. In practice the only aims which have a hope of success
are the prevention of known carriers of a virulent streptococcus from
infecting large numbers of residents either by direct contact or by the
infection of food, etc., intended for public consumption.
An analysis of the cases which were notified during 1949 confirms
previous observations that during recent years at least this disease primarily
affects children below school leaving age. In almost all the
cases the sufferers were children attending or related to children in attendance
at schools, nursery schools or day nurseries. (Nearly half the
cases were 5 or 6 years old and cases over 9 years of age were uncommon.)
This year only 3 cases had left school, but it was frequently found on
investigation that, coinciding with the case, older relatives experienced
sore throats which were frequently shown to have been caused by the
same organisms as those producing scarlet fever in the younger children.
These findings justify the exclusion of those adult contacts who are
food handlers from their work, while they have any symptoms, and
possibly the admission to hospital of cases with which they are in contact.
It would not, however, appear necessary to admit the vast majority of
cases to hospital, and particularly those in which there are no other
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