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to be one of the chief causes of heart disease in later life, but
this can hardly be said to be the case to-day. This is interesting
in view of the fact that heart disease from other causes appears
to be increasing.
The recent addition of prontosil and other members of the
sulphanilamide group of drugs to the resources of the doctor has
already produced important results in the treatment of streptococcal
infections (e.g. puerperal fever and streptococcal meningitis),
and reports are coming in of the efficacy of these drugs in
such diverse conditions as cerebro-spinal meningitis, pneumococcal
meningitis, typhoid fever and bacillus coli infections.
It will be seen, therefore, that modern methods of prevention
and treatment are tending both towards diminished incidence and
more intensive treatment of infectious disease.
Diphtheria.
During the year under review, 138 patients were admitted,
compared with 142 during 1936. Twenty-six patients remained
under treatment at the end of 1937. Taken as a whole, the prevalent
infection was not of a high order of virulence, although
several cases of infection with the gravis type of organism
occurred. The number of deaths was five, giving a mortality
rate of 3.6 per cent. compared with 3.4 per cent. in 1936.
The cause of death in the cases noted above were:—
(a) Faucial diphtheria with secondary laryngeal involvement.
Tracheotomy was performed and relieved the obstruction.
The patient died, however, 36 hours later from cardiac
failure.
(b) Three cases of toxic myocarditis following severe faucial
infection. One of these cases was of the haemorrhagic
type.
(c) Nasal diphtheria, broncho-pneumonia and whooping-cough.
Diphtheria played only a small part in causing this death,
which is attributed to it in accordance with the RegistrarGeneral's
Classification of the Causes of Death.