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The figures of incidence of scarlet fever show a range from the
minimum of 181 to the highest figure of 707. These prevalences were much
those of the country as a whole. The numbers of deaths show how this
disease has passed into a phase of absence of malignancy. After all these
years of freedom from deaths from illness contracted in this district,
the figures are reminders that not so long ago scarlet fever was a killing
disease ; though the nine deaths out of the 621 cases in 1934 themselves
indicate the marked change from the type of disease prevalent in the
latter part of the last century which had a case mortality of 15%. That it
is even now not a spent force is shown by the single deaths in 1940 and
in 1949. In neither of these cases was the illness contracted in this
district. The 1940 death was that of a boy of eleven months who had
shortly before been evacuated from the district ; he was apparently quite
well when he left here. The 1949 case similarly was a child who for some
time had lived out of the district, though his parents' home was here.
Although there is an active preventive against scarlet fever, it is not used
much. The illness for most is mild ; not only does it not kill, but it
rarely leads to complications or sequelae. As long as the disease remains
of to-day's mild clinical variety there is little point in using to-day's
rather cumbersome preventives to ward off possible infection.
In the Report for 1939 the paragraph about diphtheria starts : " There
were only 85 cases of diphtheria notified during the year. This is the
sixth consecutive year in which a low incidence has been recorded." The
incidence since has been low and was so before any substantial proportion
of the population had been immunised against the infection. Immunisation
was started here in 1936, but it was not until the campaign was
launched by the Ministry towards the end of 1940 that large proportions
of the population were treated. The incidence, though so much below
that of the general rate for the country, had been erratic from year to
year ; in fact the notifications for 1936 were below those of 1942 and 1943,
by which time many children had been immunised. But while the
incidence in the district had been low before this could be attributed to
immunisation, there is no doubt that the virtual extinction of the disease
must be attributable to the effects of the immunisation campaign. 1948
was the first year when there was no case of diphtheria in the district.
It is quite possible that this district can claim to be the first in this country
of one of a population of 200,000 being free from this disease in any
one year. The only cases of the disease here in the last six years have been
a nasal infection in 1949, and a mild faucial infection in 1950.
The incidence of measles and whooping cough in the earlier years of
this period are not known as these diseases were not notifiable in this
district until the latter part of 1939. The annual notification figures for
measles do not bring out the fact that measles in urban districts is essentially
a biennial infection. It starts towards the end of one year, building
up to a peak in the Spring of the next. The notification figures, then,
though showing a beat, to-day do not indicate that the wave of incidence
is then followed by a long period of freedom from infection until the
start of the rise of the curve of the next outbreak. In point of fact this
area has not yet developed this characteristic biennial beat. The numbers
of deaths show that even over this period measles is becoming less of a