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in 1930. It was not unusual to be called to cases of
acute nephritis, which gave a history of mild Fever, with
sore throat, but no history of rash or peeling. I believe,
too, it was the experience of cases in hospital that the
mild case not infrequently gave rise to increased complications
such as enlarged glands, discharging ears, etc.
Further in 1930 many cases were retained in hospital because
of nasal and aural discharge of an infectious nature.
There can be no doubt that although this type was mild
in regard to severity of symptoms, the infectivity was increased.
This may be the explanation, that, because of the
mildness of symptoms of onset, cases were untreated and
not isolated, but allowed to mix with the susceptible, and
so increased the spread of the infection. Nevertheless 1930
was the expected year of the apex of the five yearly incidence
curve of Scarlet Fever in Bromley, brought about
mainly by the increase in virulence of the infecting germ,
and by an increase in the number of the susceptibles.
The average number of Scarlet Fever Cases in Bromley
over the past forty years since 1890, is 62 per year. During
1930, 163 were notified, giving an Incidence Rate of four
per 1,000 population compared with 1.9 of the previous
year.
Home isolation is not the general practice—125 of the
163 cases being removed to the Isolation Hospital, i.e., 76
per cent. This has been the adopted practice for many
years, and generally speaking appears to be the wiser
practice, provided hospital accommodation for acute
Measles and Whooping Cough is not prevented by the
occupation of beds with uncomplicated Scarlet Fever.
Diphtheria.
There was a fall in incidence of Diphtheria in 1930,
54 cases being notified as against 72 in the previous year.
The attack rate for 1930 is 1.3 per 1,000 population compared
with 1.7 for 1929. There were no deaths in 1930,
whereas there were three deaths in 1929.
Since 1890 Diphtheria follows an incidence curve with
six year intervals, with one intermission in 1923, when a
rise in incidence did not eventuate. Since 1890 there does
not appear to be any lessening of the Diphtheria Rate in