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58
rarity it was. It is of course understandable that if a patient is to be
admitted to hospital soon, practitioners leave this to be done at the hospital.
The greatest benefit is probably in the case in which the diagnosis
is in doubt but where the disease really is diphtheria. Reliance on the
swab for the making of a diagnosis which involves a lapse of time is harmful
if nothing is done in the meantime. It is in such cases that it is felt
that if there is sufficient suspicion on clinical grounds to warrant an examination
of a swab, anti-toxin should be administered.
Many cases admitted to hospital prove not to be diphtheria. The
admission of doubtful cases is a practice to be encouraged where facilities
are available. One encouraging feature in regard to the administration
of anti-toxin by general practitioners is that when injected it is now given
in adequate doses.
During the year, 35 lots of anti-toxin were issued, totalling
280,000 units.
Schools and Spread of Infection.
Diphtheria is one of the diseases which might cause outbreaks of
infection in schools, most commonly arising perhaps from a nasal carrier.
There were no cases this year in which there was any suggestion that
infection had been contracted in school.
SCARLET FEVER.
Incidence.
In the case of 8 of 278 cases notified as suffering from scarlet fever
the diagnosis was amended, in three to tonsillitis and in another three to
food rash. The net figure of 270 is an incidence rate per 1,000 population
of 1.41, compared with the rate of 1.89 in the country as a whole. The
local rates during the years 1934 to 1944 had ranged from 1.06 to 4.70.
The incidence was fairly uniform through the year with a weekly
average of nearly 6 for the first quarter, just under five for each of the
next two, and just over 6 for the last quarter.
Deaths.
No deaths occurred in this district from scarlet fever.
Places of Treatment.
Of the 265 cases, 115 or 43 per cent. were treated at home at the
election of the patients. Of those removed it seems another 20 per cent.
might have been so dealt with. In 22 per cent. the reason for removal
was the presence of other children at home, in 5 per cent. the patient was
an adult ; in the same number that there was a baby at home was the
reason. In three cases only was the reason for admission to hospital the
clinical condition of the patient.
Over the 12 years there have been marked fluctuations in the extent
to which removal to hospital of scarlet fever cases has been requested.
The proportions were entirely unrelated to the prevalence of the infection.
For the six years 1934 to 1939, the average percentage of home treated
cases was 26, though this included a figure of 41 in 1936. In the succeeding
years the numbers were 25, 21, 30, 31, 43 and 43. Of those removed