View report page

82
was 0.65. This was the smallest number of cases for any one year for
the combined district, the previous lowest being 125 in 1955. The
incidence over the years ranged from this figure of 125 to the highest, 707.
Although there is a preventive against scarlet fever, it is not used to any
extent, and the fall in the number of cases of this disease cannot be
ascribed to such measures as active immunisation. As contrasted with
diphtheria, where the fall in the country as a whole had been steady,
the incidence of scarlet fever is most erratic and cannot be foreseen.
Fortunately, although there have been the variations in the invasiveness
of the streptococcus which causes scarlet fever, variations which have
accounted for the altered prevalence of the disease, there has not over
recent years in this country been any marked variation in its toxicity, so
that whether the incidence of the disease has been high or low it has not
caused much serious damage. Nevertheless, just as there have been these
changes in the invasiveness of the organism, there must always be the
possibility of a variation in toxicity, with the risk of the strain becoming
toxic and then causing a severe type of disease.
The 76 cases were fairly evenly distributed throughout the year, the
average weekly notifications for the four quarters being 2.0, 1.3,1.4 and 1.4.
The prevailing type continues to be mild, and there were very few
deaths in the whole country from it. The last fatal contracted case in
this district was in 1937.
It is becoming quite exceptional for a patient suffering from scarlet
fever to be removed to hospital. Of the 76 notified cases, only four were
removed to hospital, all but one being to the Hendon Isolation Hospital.
Although there were so few cases of scarlet fever this year, there were
five households in which there were secondary cases, in each the primary
case being nursed at home. The interval from the onset of the infecting
case where there was only one secondary case was five days in two instances,
six days in one and in the other 21 days. In one household there were
two secondary cases who fell ill on two consecutive days. This led to the
recognition that a third child had had an attack ten days before and by
the time the illness was recognised in the other two, the patient was in
fact peeling.
There were no return cases this year.
There was only one occasion when it seemed that school attendance
might have accounted for the illness in some children. A case in an
infants department one week was followed by another case in the same
department in the following week; after a week with no cases, there were
then three cases in that same department. This organism was especially
invasive; apart from causing the disease to spread in a school (or possibly
by contact of the children outside the school), it was responsible for the
secondary cases in two households, including the one in which there were
two in the one household.
SMALLPOX
Although it is now rare for there to be a case of smallpox in the
country, each year much work has to be done in following up the contacts
of cases who have come into the country by aeroplane or less common
by boat. Any such contacts are visited up to sixteen days from the a