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39
prevalence, but that the number of cases of scarlet fever increased progressively
from the first quarter to the fourth. It should be noted that no fewer than 11 (3.9
percent.) of the 287 scarlet fever cases occurred in persons over the age of 25 years.
True scarlet fever is essentially a disease of childhood, but recent work has shown that
the clinical condition is not nearly so definite as was thought some years ago, and as a
result, scarlatiniform rashes in adults, when accompanied by certain other signs, have
not infrequently to be reckoned as true manifestations of scarlet fever. As was the
case during 1935 the disease continued to be a mild one; no deaths occurred from this
cause during the year.
Of the 223 notified cases of diphtheria the diagnosis was subsequently revised
in respect of 47, so that the total accepted cases for the year was 176—which gives a
true attack rate of 2.06 per 1,000 of the population. The number of deaths in these
176 diphtheria cases was 5, which gives a death rate of 0.06 per 1,000 and a case
mortality rate of 2.84 per cent. compared with a case mortality of 3.6 per cent. for
1935. Of the 223 patients, 6 (2.7 per cent.) were over the age of 25 years. The
reduction of the incidence and mortality of diphtheria is welcome, as the disease
is one of the most serious of childhood. In previous reports I have explained the
necessity for action during inter-epidemic periods, and the fact that the disease can
be very effectively prevented by artificial immunisation.
A noteworthy feature of the history of infectious diseases in various areas during
recent years is the prominence achieved by dysentery bacilli of the Sonne type.
Although the organism has long been known it was only in 1926 that the first outbreak
of an illness due to this cause was described. Nowadays the disease appears
to be almost endemic in certain areas. During the year 1936, 51 cases occurred
in Shoreditch. A further discussion of these cases appears on page 46.
Attention should be directed to the fact that in 10.8 per cent. of the notified cases
of scarlet fever and in 21.1 per cent. of the notified cases of diphtheria the diagnosis
was subsequently altered. These percentages may appear to be high, but it should
be remembered that the London County Council requires every case to be certified as
suffering from one of the notifiable diseases before the Council will remove the patient
to one of its infectious hospitals. The result is that the weekly figures of notifications
are unduly swollen by the inclusion of patients who obviously require observation in
hospital, but who are possibly not suffering from one of the notifiable diseases. It
should be noted that during the year 64 per cent. of all notified cases of infectious
disease were removed to hospital. When measles cases are left out of consideration
this figure becomes 89 per cent.