View report page

33
The number of cases in Shoreditch was less than in 1933, in which year there
were 567 cases with an attack rate of 6.06.
The disease continued to be of the mild type which is now prevalent in this
country. This mildness has changed the whole problem of scarlet fever. In past
years it was a killing disease, comparable in severity with diphtheria, and treatment
in hospital was therefore very desirable. Yet the disease still tends to produce
lasting effects as a result of complications—though these, fortunately, have been
reduced by the adoption of serum treatment in suitable cases. From the administrative
point of view the problem of scarlet fever is now largely one of correct diagnosis
and the search for missed cases.
A noteworthy feature of scarlet fever during the year was the fact that there
was practically no seasonal incidence, the 409 notified cases being distributed almost
equally over the four quarters of the year.
During the year all the notified cases except 15 were removed to hospital.
Return cases.—Returned cases are defined as "cases occurring in the same
house or elsewhere within a period of not less than twenty-four hours, or not more
than twenty-eight days after return or release from isolation." During the year
26 cases were regarded as return cases, giving a rate of 7.1 per cent.
Although a skin test for scarlet fever (the Dick test) is now well established, and
although specific immunization can now be effected with considerable success, these
procedures are more suitable for hospital experience than for use in the general
population. This is due largely to the fact that, although scarlet fever is a specific
disease, it is difficult to differentiate it from certain other conditions which are due
to closely allied organisms. Consequently specific immunization is not as useful
as it is in diphtheria. During the year there was no clinic for this work in the Borough.
Diphtheria.
The number of cases notified during the year was 362, of which 74, or 20.4 per
cent., were subsequently not regarded as being cases of diphtheria. The actual
number of cases for the year was thus 288, which gives an attack rate of 3.8 per
thousand inhabitants. In 1933 the number of cases was 286 and the attack rate
was 2.1. The age, seasonal incidence and ward distribution of the cases are given
in the table on page 29. The number of deaths was 13 of which five were males
and eight females. This gives a death rate of 0.14 per thousand inhabitants and a
case mortality of 4.51. The deaths occurred in the following age groups:
Up to 2 years, 2 ; 2-5 years, 4 ; 5-10 years, 7.