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60
home, where I found a brother to be suffering from the disease, and
two days later two other members of the family were attacked.
The teachers kindly supplied me from time to time with lists of
children absent from school suffering from "sore throat," or from
some other suspicious illness. I visited the homes of such children,
and where no doctor was in attendance I examined the patient. In
this way and by making other enquiries I was able to discover no
less than nine cases of Scarlet Fever. In none of these cases had a
doctor been called in, nor had any attempt been made to isolate the
patient. In some of the cases the patient had been attending school
while in an infectious condition.
These cases illustrate the difficulties met with in dealing with
infectious diseases, and they help to explain the comparative
ineffectiveness of our present methods for the control of such
diseases by isolation and disinfection. For the success of these
methods it is necessary that the sanitary authority should be made
aware of the existence of practically all the cases of the disease it is
endeavouring to control as such cases arise. For this purpose
compulsory notification was instituted, but it has now been
abundantly proved that compulsory notification of identified cases,
though useful, is not an adequate safeguard. In addition we
require some method of discovering those patients who at present
do not come under medical observation. In the outbreak of Scarlet
Fever at West Hampstead I received very valuable assistance from
the teachers of the school chiefly affected, and there is no doubt
that in the prevention of communicable disease much could be done
by a more intimate co-operation between the education and sanitary
authorities. The prompt notification by teachers or school attendance
officers of all cases of illness among school children, and the
examination of all those patients so notified who were not already
medically attended are measures that would lead to the discovery of
many cases which now escape observation and consequently spread
disease. The general adoption of such a scheme would greatly
increase the work of the Health Department, but such an increase
is inevitable if we wish to exercise a really effective control over the
spread of communicable disease.
Diphtheria and Membranous Croup.
The number of cases notified in 1906 was 97 as compared with
63 in 1905, the attack-rate or number of cases notified per 1,000