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Parish of Clapham. 45
a percentage on the cases of 2.58. The death-rate per
thousand of the population was 0.075, and for the whole
of London it was but little more, 0.078.
The hospitals were largely made use of, 97 cases
being removed, or 62 per cent, of the total, which,
however, is a slightly smaller proportion than in 1899.
But little can be said as to the cause of these numerous
cases of Scarlet Fever. It is not common to find persons
infected by reported cases, though of course a certain
small proportion of this recognisable infection does occur.
The largest number of cases notified cannot be traced
to a known pre-existing case, so that one is driven to
the opinion that the evil really is that unrecognised illness is
the main cause of its spread. Of course the extreme
mildness of the disease is the great reason for cases
being missed, because it often involves no very marked
bodily illness, and may be passed over as a severe cold,
as has been the case in my experience. The rash may
be apparent only for a few hours and may not have
been noticed, and consequently no medical man called in.
Then the child, after perhaps a few days at home, goes
back to school, and other cases occur. It does not
appear that our present system of prevention is able to
cope with these circumstances, and if it is worth while
to stamp out the disease it appears that the only way
would be to appoint medical inspectors in connection
with elementary schools, whose duty it would be to
visit any child absent from any illness, and whose
certificate should be necessary before the child is allowed
to return to school. The enormous sum spent annually
in disinfecting, and in isolating reported cases does not
lead to the result that was hoped for, so that the question
is being raised as to how far the expenditure is justifiable.
The answer of course is that a very great control is, even
with our present means, obtained over the spread of