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milder form than it used to do, the time seems opportune for an enquiry
to be made. It is admitted that isolation in hospital has not controlled
the disease in large towns, and there is always a risk of cross-infection.
The experiment recently made of only admitting serious and complicated
cases should afford some evidence which may be helpful in deciding
whether the practice should be continued as a regular procedure, and if
so, it might be possible to economise in the amount of hospital accommodation.
Greater use might be made of the treatment at home recommended
by Dr. Milne, viz., the application of eucalyptus oil to the body
and carbolic oil to the mucous membranes of the mouth and throat,
whereby it is claimed that persons suffering from scarlet fever need not
be isolated even in their own homes for more than a couple of days.
In several cases this method has been adopted in Westminster, and no
secondary cases have occurred in the families.
Five deaths occurred, 1 between the ages of 2 and 5, 4 between 5
and 15.
Diphtheria also increased, and 248 cases were notified. No restriction
was placed upon the admission into hospital of cases of this disease, but
occasionally on account of want of room some delay occurred, in such
cases medical men were supplied with antitoxin free for all cases of
diphtheria. 55 bulbs were so supplied. 28 persons died from diphtheria;
11.2 per cent. of the cases notified. Swabbings from 431 patients were
submitted for bacteriological examination.
This is essentially a disease which is spread by personal contact, and
if its spread is to be checked it is essential that as many persons as possible
who may have been in contact with known cases should be examined and
swabbings taken from their throats for bacteriological examination.
This is done in schools by the officers of the education authority, but it
ought also to be done in the houses. In a number of instances the medical
man attending has had the rest of the family examined, but in the majority
of cases it is not carried out. In the first place the medical practitioner
can hardly be expected to do it as he receives no remuneration, and in
the second place it is often impracticable for him to do so, as the patient
may be seen at his surgery or at a hospital. Then in a tenement house
he cannot be expected to examine all the inmates. There is no one on
the staff of the public health department who could undertake this work
systematically.* The local authority might pay medical practitioners to
do this and in times of epidemic might retain a medical man specially.
Were the school medical officers attached to the local authorities as
assistant medical officers of health they would be able to follow up suspected
cases discovered in the schools and a greater check would be