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at the earliest ages. This may not necessarily be the case with tetanus
vaccine which is incorporated in a triple vaccine which affords protection
against diphtheria, pertussis and tetanus. The occasional case of
poliomyelitis which seems to be associated with a previous inoculation
may lead to some modification in the use of those preparations used for
inducing immunity to diphtheria.
SCARLET FEVER
The number of cases of scarlet fever in this district has ranged from
707 to 125. The lowest figure in 1955 was followed by one almost as
low, 128 in 1956. The rate per thousand population was 0.60; the
corresponding rate for the country as a whole was 0.78. In only one
week, that of week ending March 17th, were double figures of notifications
received. The weekly average of notifications in the first quarter was 4.2
and in the succeeding ones 2.5, 1 .7 and 2.5.
The prevailing type of scarlet fever is very mild and causes very
few deaths. The last fatality from scarlet fever contracted in this district
was in 1937.
Because of its mildness, parents are quite willing to nurse the patients
at home. During the year, of the 138 notified cases only 14 were removed
to hospital, all but one being to the Hendon Isolation Hospital. In
spite of the mildness of the prevailing type of infection, scarlet fever is still
an illness not to be treated too lightly. Even mild cases have been known
to develop kidney trouble as a complication which makes it desirable
that sufferers should not be considered to have recovered at too early
a stage. The fact that the causative organism might be of a less toxic
strain does not imply that it is less invasive. The clinical mildness of an
attack does not mean that less needs to be done to reduce the possibility
of spread of infection. It should be remembered too that an attack in a
contact is not necessarily as mild as that in the infecting case. The
possibility of the disease reverting to a virulent type is indicated by the
outbreak in Minnesota in 1953 where infection with a particular strain
°f the streptococcus resulted in a number of patients suffering from acute
nephritis.
There were only four households in which secondary cases occurred.
In each case the primary case was nursed at home. In two of these
instances though, the secondary case (in one household two secondary
cases) was recognised at the time the illness of the primary case was
diagnosed. In one of the other cases, the interval separating the onset
of the illness in the primary case and the other case was six days; in the
other 15 days.
There were no return cases this year.
Each year groupings of cases occur amongst the pupils at a school,
sometimes in the same department and occasionally even in the same class.
Although these groupings suggest a spread of infection in the school,
his can very rarely be proved and most often attendance at school is
felt not to be a factor as most frequently the cases occurring in the same
department are not amongst pupils in the same class. Sometimes there
is a co.existent tonsillitis which probably is due to the same organism as
causes the scarlet fever in those affected. This happened at Stag Lane