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33
It is difficult to say what effect treatment in Hospital has exercised.
During the 24 years the number of cases removed to hospital has varied
from 87.5 to 98 per cent, with an average of 94 per cent. Hospital
isolation does not appear to have had any effect upon the prevalence, but
probably has had some influence on the occurrence of complications and
thereby helped to reduce the mortality. In this connection it would be
of interest to ascertain whether the increased attention given to school
children in recent years especially as regards adenoids, enlarged tonsils
and defective teeth, has had any effect in reducing complications such as
otitis, and on the number of septic cases and " return " cases.
The Ministry of Health is carrying on an enquiry throughout the
country on all the factors affecting Scarlet Fever.
Diphtheria..This disease contributed a larger number of cases in
1924 than in the previous year, but fewer than in the years 1921 and 1922.
St. John's Ward had 132 of the 237 cases and Victoria Ward 56; 27
cases ended fatally (10 males, 17 females), all in children under 15 years
of age.
The history of many of the cases emphasises the need for better
methods of control, such as I have referred to in previous Reports.
This is essentially a disease which is spread by personal contact, and
if its spread is to be checked, 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
by the officers of the education authority in the schools, but it ought
also to be done in the homes. 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 for doing so,
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 the members of other families
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. The school medical officers co-operate as far as
they can, but were they 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 obtained
in the dissemination of infection than we at present possess. By the
use of antitoxin passive immunity can be conferred on other members
of a family for 3 to 5 weeks during an outbreak. It is now possible to
ascertain whether a person is susceptible or not to diphtheria by the