My attention was first attracted to the question by observing the marked contrast in the tracings of the cases and deaths due to scarlet fever and diphtheria in Baltimore. The record of cases reported of such diseases was available for only a few years, commencing with the year 1891 and ending with the year 1909, making a period of nineteen years.
Previous to 1891, the death-record alone gives us any information, and this has been reproduced in the tracings for the two diseases as far back as 1875, when our burial law requiring death certificates to be filed at the health department went into effect.
If, now, we consider the tracing for diphtheria (including croup) we find the number of deaths in 1875 was 238, which increased almost steadily to 929 in 1882. Then the number decreased year by year until the low number 206 was reached in 1889.
JONES CH. WHAT CAN HEALTH DEPARTMENTS DO TO CONTROL SCARLET FEVER?. JAMA. 1910;55(7):576–579. doi:10.1001/jama.1910.04330070030010
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