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DIPHTHERIA.
For the seventh year in succession no case of diphtheria
occurred in the District and for the second consecutive year no
suspected case was admitted into hospital. As a result it is
probably all the more necessary to maintain the immunity of the
population by artificial means, bearing in mind that the natural
stimulants to immunity are declining rapidly, as judged by the
rarity with which any form of diphtheria organism is reported
during the routine bacteriological examination of throat swabs.
SCARLET FEVER.
This disease remains of a very mild type. It is therefore not
surprising that more cases were notified, viz 118, as compared with
80, 90, 149, 138, 78 and 62 in the previous six years.
To what extent the number of these known cases represents
the degree of infection in the District it is impossible to say.
There is a good deal of evidence to show that while the disease
remains so mild a number of missed cases occur, the mildest often
not coming to the notice of the doctors or being regarded as due
to other causes; moreover it is well known that for every case
exhibiting a rash, others suffer from a temporary sore throat or
slight upset without producing a rash, although they have been
infected with the same organism.
The question naturally arises whether all known cases of
streptococcal infections should be notified, or alternatively whether
the notification of scarlet fever and the measures associated therewith
should be dropped. It is thought that wider notification would
cause a great deal of inconvenience without materially affecting
the spread of the infection, but on the other hand, in view of the
tendency for scarlet fever to gradually vary in its severity, it is
considered that it would be unwise to give up the present practice
completely. Modifications in procedure have, however, gradually
been introduced. The mildest cases are, for example, allowed to
return to school earlier if they are normal clinically, though a
mimimum exclusion of fourteen days is probably desirable in case
complications arise. Similarly normal contacts return after a
week irrespective of whether the case is being treated at home or
in hospital.
The disease has for some years been mainly associated with
school children and particularly the 5-8 year old children, 64%
being in this group in 1953 compared with 15% under school age
and 20% aged 9-15 years. Only two cases occurred among adults.
Almost all schools in the District, including a number of
private schools, had one or more cases, the maximum in any one
school being fifteen. Attention has been focussed on the examination
of contacts at school and in general this policy appears
justified, bearing in mind the factors mentioned above which foster
the spread of this usually mild infection.
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