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There were 29 houses with two cases of scarlet fever, and in all but
4 instances the patients were members of the same family; 10 houses
had 3 cases in each, in 4 instances 1 of the patients was of a different
family to that first affected. Of the 36 second cases, 22 were notified
simultaneously or within a week of the first case, 4 between the
fifteenth and thirtieth day after the first case, and 12 at intervals of
from three to nine months after, of these last 4 occurred within a few
days of the first patient's return from hospital. Of the 10 third cases,
5 were simultaneously or within a few days of the first case, 3 of the
second case, and 2 within ten days. There is no doubt that school
infection was the means by which the disease was spread (see p. 43).
Scarlet fever occurs nowadays in such a mild form that cases are not
recognisable, having often no rash. These mild undetected cases go
about and infect others ; it is only when a susceptible person is infected
and develops the disease in a typical form that a doctor is called in and
the case is notified.
Diphtheria.—186 cases of diphtheria were notified during 1903, equal
to a rate of 10'3 per 10,000 inhabitants, as compared with 15.4 in 1902,
with 16 0 the rate in the ten years 1892-1901, and with 16.7 the rate
for all London for 1903. There were 16 deaths, equal to a mortality of
8.6 per 100 cases, as compared with 10 per cent. in 1901, and 11 for
1902. The London rate for 1903 was 9.8 per cent.
Bacteriological Diagnosis.—The arrangements made with the Jenner
Institute for the bacteriological examination was taken advantage of
with regard to 39 persons who were suffering from throat affection or
had been exposed to infection; 44 examinations and re-examinations
were made by the Jenner Institute, but many others were made at
hospitals and in private laboratories. In nine of the above instances
the bacillus was found, and in one the pseudo-diphtheria bacillus (a
modified, less virulent organism) was present on first examination;
five subsequent examinations were made in cases treated at home,
and a positive report was obtained in one instance, negative in
four. The organism sometimes persists for long periods in patients