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member of the family or occupant of the same house who had returned from hospital after an
attack of scarlet fever within a fortnight previous to the second case occurring. In this case
the source of infection in the second case is presumed to be the child recently returned from
hospital. A good deal of attention has been given to these so-called "return cases" on the
part of the laity, and also by medical authorities, the former being generally inclined to
attribute it to premature discharge from the infectious disease hospital. As stated, however,
in previous reports, facts do not support this view, because in the first place the cases are very
few compared with the number discharged, and in the second case it is sometimes those children
who are detained months over the usual time and that cannot be considered to have been
prematurely discharged who produce the disease.
The micro-organism which produces scarlet fever has yet to be discovered, and the
probability is that when this is made it will be found it behaves in a somewhat similar manner
to diphtheria and will be found to exist in the nose and throat of the patient who either have
not got the disease at all or who have recovered from an attack some considerable time
previously. Those patients who have suffered from complications leading to pathological
discharges from nose, throat and ears are more liable to spread the disease than simple
uncomplicated cases.
Measles.
The number of deaths for 1907 was 51, against 94 in 1906 and 59 in 1905.
The annexed table gives the number of notifications received from schools, the number
of " contacts " excluded, and the number of deaths in fortnightly intervals : —
Fortnight ending.
Patients.
"Contacts."
Deaths.
January 12th
16
8
2
January 26th
13
10
1
February 9th
18
11
2
February 23rd.
21
12
6
March 9th
26
22
6
March 23rd
41
33
2
April 6th
26
23
3
April 20th
11
13
2
May 4th
30
20
4
May 18th
30
25
-
June 1st
34
33
3
June 15th
46
24
8
3
June 29th
40
27
July 13th
12
9
-
July 27th
10
6
2
August 10th
Schools closed.
1
2
August 24th
September 7th
34
26
-
September 21st
1
6
October 5th
-
1
5
-
October 19th
6
1
7
November 2nd
7
4
1
November 16th
28
21
-
November 30th
1
-
1
1
December 14th
-
-
December 28th
-
-
-
452
345
51
There has been a lull both in the attack and the deaths from measles during the year
under report. It is a disease which is liable to return in epidemics every two or three years.
I lie explanation of this is that an epidemic comes and uses up all the susceptible material
m the district, i.e., the young children, and when it has exhausted this it leaves the district for
a year or two until fresh births supply more susceptible material for another outbreak. It is
unfortunately one of those infectious diseases which is little amenable to those ordinary
measures which are commonly adopted for the prevention of infectious diseases, viz., isolation
and disinfection. Isolation 'has proved useless because the disease is infectious before the
characteristic symptoms appear, and disinfection was tried in this Borough for some years
apparently without effect. Last year no attempt was made to disinfect except after a death,
and the mortality was the lowest there has been for some years.
I did not find it necessary to close any schools or classes on account of this disease
during the year, the only precautions adopted being those detailed in the regulations of
the London County Council, the main principle underlying which is the exclusion of susceptible
"contacts."
One of the methods of lowering the mortality of measles consists not so
much m preventing children getting it as in suitable nursing and treatment when they have got
it. Ine usual leaflets containing precautionary measures were sent during the year.