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been given at intervals of a fortnight, the dosage being 0·1 + c.c.,
0·3 c.c., and 0·5 c.c. It is as yet too early to make any comments
on the results of this new procedure, but early re-Schick tests are
proving promising. It will be noted that the first dose is marked
0·1 + c.c. The reason for this is that in certain children a drop
or two of the prophylactic is liable to run out through the needle
puncture, and in order to ensure that a full 0·1 c.c. remains in the
body, it has been the practice to give a little extra, in fact nearly
0·2 as the first injection.
Only by patient work and careful observation can the very best
possible protection be given to children, and all work at this clinic
is directed to the determination of what is actually best, both in
the immediate future and after a lapse of years.
Scarlet Fever.
The number of cases of this disease notified during 1936 was
722, as compared with 605 in 1935. Only 72 of these patients were
treated at home, the remainder being removed to the London
County Council isolation hospitals for treatment. Twenty of these
patients were subsequently discharged from hospital certified as
not suffering from this disease. The number of return cases was
20. A "return case" is one which occurs in the same household
within 28 days of the discharge from hospital of a patient certified
to have recovered from this disease. Multiple cases in one house
are not frequent and during 1936 there were 34 such cases
reported. There were 2 deaths. It is generally accepted that a
haemolytic streptococcus is the causative agent of the disease
known as Scarlet Fever. A typical case of Scarlet Fever with the
characteristic history of onset, the changes in the throat and tongue,
the presence of a scarlatiniform rash followed by typical desquamation
is easy to diagnose. Frequently, however, cases are met where
some of the cardinal signs and symptoms are absent, thereby
presenting a doubt as to diagnosis. These patients may be infectious,
and it is desirable that they should be isolated in a separate room
with the attendant on the patient taking precautions to prevent
any spread of the disease.
Enteric Fever (including Paratyphoid).
One case of typhoid fever and 5 cases of paratyphoid fever were
notified. All of these patients were removed to hospital. There was
one death.
In the case of epidemics of typhoid or paratyphoid fever it is
usually easy to trace the infection. Sporadic cases on the other
hand present great difficulties. These cases frequently occur from