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were admitted into hospital, both proving to be cases of glandular
fever. Bearing in mind that the natural stimulants to immunity
have now virtually disappeared, as judged by the absence of any
form of diphtheria organism in the routine bacteriological examinations
of throat swabs, it is all the more necessary to maintain the
immunity of the population by artificial means.
SCARLET FEVER.
This disease remains of a very mild type and only 46 cases
were notified as compared with 68, 80, 90 and 149 in the previous
4 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 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 it is now proposed that contacts
should normally continue at school 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, 58%
being in this group in 1955 compared with 15% under school age
(nearly half of whom attended Day Nurseries or Nursery Schools),
and 19% older school children. Three cases occurred among
adults.
Almost all schools in the District, including a few private
schools, had one or more cases, the maximum in any one school
being four.
Relatively the hospitalisation of cases increased, 39% being
admitted compared with 22% last year. Of the 18 cases admitted
in 1955, (Wandle Valley 4, Bletchingley 7, Queen Mary's 1 and
Waddon 5), a third were sent in by one doctor.
On the available facts this tendency would not appear to
be justified. In only one instance did a secondary case follow
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