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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. In addition, a new
method of drug treatment by one of the sulphanilamide group became more popular
during the year and is now used extensively in various fever hospitals. This group
of drugs is not only effective in cases of scarlet fever but also in many other diseases
due to the streptococcus such as, for example, puerperal sepsis and epidemic sore
throat. From the administrative point of view the problem of scarlet fever is now
largely one of correct diagnosis and the search for missed cases.
The effect of seasonal incidence was not marked during the year. There was a
slight increase in the incidence of the disease in both the first and fourth quarters.
During the year all the notified cases except one were removed to hospital. This
high hospitalization rate seems worthy of special mention.
Return cases.— "Return 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
three cases were considered to come in this category.
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 at present 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 169, of which 44, or 26.04
per cent., were subsequently not regarded as being cases of diphtheria. The actual
number of cases for the year was thus 125, which gives an attack rate of 1.52 per
1,000 inhabitants. In 1936 the number of cases was 176 and the attack rate was
2.06. The age, seasonal incidence and ward distribution of the cases are given in
Table No. 27 on page 43. The number of deaths was 3—of females. This gives a
death rate of 0.04 per 1,000 inhabitants and a case mortality of 1.52. The deaths
occurred in the following age groups:—
2.5 years, 1; 5.10 years, 2.
The following table gives particulars regarding diphtheria for Shoreditch,
London, and England and Wales for a period of years:—