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42
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 second 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
two 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 203, of which 61, or 30.05
per cent., were subsequently not regarded as being cases of diphtheria. The actual
number of cases for the year was thus 142, which gives an attack rate of 1.77 per
1,000 inhabitants. In 1937 the number of cases was 125 and the attack rate was
1.52. The age, seasonal incidence and ward distribution of the cases are given in
Table No. 27 on page 37. The number of deaths was 4—of which 2 were females.
This gives a death rate of 0.05 per 1,000 inhabitants and a case mortality of 2.82.
The deaths occurred in the following age groups:—
2-5 years, 2 ; 5-10 years, 2.
The following table gives particulars regarding diphtheria for Shoreditch,
London, and England and Wales for the last ten years:—