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now number very few indeed. The reduction has been so considerable
that the death rates for individual years are now of little
value except to show broadly that deaths have been few.
A comparison of these local figures with the rates for the
country as a whole shows that the decline has been very comparable
in the two areas. Only in the period 1906-1910 is there any indication
that there was some excess mortality in the local rates.
There has been little difference in the death rates for the two sexes
in the country as a whole. The local figures are based on so few
deaths that a definite statement on this point is hardly warranted,
but the figures suggest that mortality in males in this area is
somewhat higher than in females.
The case mortality has shown a corresponding decline in
the last fifty years. In the period before 1890 scarlet fever was a
serious disease which was fatal in about ten per cent, of cases.
Between 1890 and 1910 there was a considerable decline in
fatality, but an even more marked decline occurred during the
war period. The mortality at the present day is less than a tenth
of what it was in the "eighties."
The fatality rates for individual years being based upon
small numbers of deaths are liable to misinterpretation.
The figures which I have given for this area present very
emphatically one aspect of the problem of scarlet fever. There is,
however, a more sinister aspect. This condition was equally mild
three centuries ago, and at that period the most famous physician
of the day referred to it contemptuously as "this name of a
disease." Yet about a hundred years later scarlet fever
occupied a high place among the causes of death. Although it is
to be hoped that the present low mortality will continue, false
optimism should not be encouraged. The serum treatment of the
condition has given the physician a weapon which was unknown
to our ancestors, but the lesson of diphtheria shows that the introduction
of a new and very virulent strain of an organism into the
community will tax the resources of even the most modern methods
of treatment.
DIPHTHERIA.
The number of cases of diphtheria notified during the year
was 503, as compared with 468 in 1936 and 771 in 1935. Of the
503 cases, 246 were males and 257 were females. The case rate
127