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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 notified cases of scarlet fever remained
high for the second year in succession, there being 149 such
cases in 1950 and 138 in 1949, compared with 78 and 62 in
the two preceding years. As the waves of this disease which
occurred in this District in 1920-21, 1928-29, 1934-36 and in
1943 only lasted about 2 years, a reduction in incidence can be
hoped for during the next few years.
The disease remained very mild in type, and as a result
was more widely and easily spread. A number of the local
outbreaks were commenced by children attending parties when
suffering from slight catarrhal symptoms.
As usual it was almost entirely limited to young children,
only 3 cases being notified among adults. More than a quarter
of the children were 6 years of age and four-fifths between 3
and 8 years. Scarlet fever can thus be regarded as a disease
now associated with the first direct or indirect contact with
school life.
On considering the individual cases it is obvious that
frequently the spread has been associated with school, parties,
or similar congregations of children of the most susceptible
age. On the other hand it is interesting to note how few cases
may occur even when there are apparantly ideal conditions
for encouraging dissemination ; for example, an outbreak occurred
at a large residential school at which there were 8
children of about 7 years of age in the same dormitory as the
first case and 20 in contact with the third case of 8 years
of age, yet only a total of 4 children developed scarlet fever
in the whole of this institution. Doubtless many more were
affected by the germ without producing a rash, but very many
more typical cases might have been expected to result.
Slightly less than half the cases in the District were treated
at their homes, but 82 were distributed among 9 hospitals.
47 going to the Wandle Valley at Mitcham, 17 to Bletchingly,
5 to Croydon, 4 to Cuddington, 3 to Dorking, and the others
to The Grove, The Western, Redhill and Bromley hospitals.
Of those treated at home, 24 were the only children in the
house. On the other hand, in 38 instances there were brothers
or sisters in the house at the time, yet in only 5 of these did
secondary cases occur. Furthermore, as two pairs apparently
contracted the disease simultaneously from a common source,
or the second occurred before the first case was diagnosed, treatment
at home could not have been a contributory factor.
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