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14
Enteric (Typhoid) Fever.—Two cases of this were notified.
One of them contracted the infection outside the Borough.
The origin of the other case was not ascertained.
Diphtheria.—There were 189 cases of this disease notified
during the year. The cases were scattered and not related to a
milk supply. Diphtheria is almost always a case-to-case infection,
and is spread by missed cases and carriers. One small
outbreak occurred at Campsbourne School, and swabs were taken
from the noses and throats of all suspected children in the school.
Out of the number swabbed two were found to be carriers. The
exclusion of these two children from school resulted in the
prompt abatement of the disease there. In all cases where diphtheria
occurs in a house where there are school children one of
the school nurses visits and takes swabs of the contacts. By this
means several missed cases have been brought to light. In all
houses where there has been a case of diphtheria the most careful
disinfection is done, the drains are tested and insanitary conditions
are abated. In my opinion there is a definite relation, the
nature of which is uncertain, between diphtheria and scarlet
fever. I have known of cases of scarlet fever which apparently
gave rise to diphtheria, and during the scarlet fever outbreak of
last year many of those cases admitted to the Isolation Hospital
were found to have the microbes of diphtheria in their throats and
noses.
Scarlet Fever.—During the autumn of this year our Borough
shared with Middlesex and London in a considerable outbreak
of a mild type of scarlet fever. We had altogether no less than
591 notified cases; but, in addition to this, I am convinced that
very many children suffered from so mild an attack that they
remained undiagnosed, untreated and not isolated. I myself
found in the schools more than a dozen children apparently well
who were desquamating—a sure sign of a recent attack of scarlet
fever. To deal with a considerable outbreak of this nature taxed
my staff to the utmost—the office staff, the district inspectors
and the disinfectors were working at high pressure for several
weeks. The whole problem of this outbreak of scarlet fever was
made the subject of a special report to the Health Committee
in November. As with diphtheria, this disease is propagated by