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form. I made frequent visits to the schools in the district, and received
valuable help from Mr. Bovev and the School Board Officers, Messrs.
Lambert and Shute.
HOW THE DISEASE IS SPREAD.
1. Sometimes the disease is kept a secret, no Medical Practitioner
being called in.
2. The disease may be so mild as to escape the notice of the
relatives, and their attention is only called to the child when desquammation
has set in.
3. Ignorance of the parents as to the nature of the illness and
neglect to call in medical advice.
4. In three or four instances children were found peeling freely and
playing in the streets with other children, and in one case a child had
been sent to Sunday School peeling freely. On being censured the
parents invariably pleaded ignorance as to the nature of the illness.
5. Return Cases.—During the year there were good grounds for
belief that the infection in two instances was communicated by patients
who had been'recently discharged as free from infection, from the Willesden
Isolation Hospital. This is a rare occurrence, for every possible effort,
in my belief, is taken to prevent it, but the circumstance is worthy of
note by parishioners, who will always do well to isolate children for at
least a few days after their return home.
In my report of November, 1898, to the Council on these return
cases, I mentioned that possibly the micro-organism that caused the
disease might remain in the throats of the patients after apparent
convalescence. The following is Dr. Klein's report to the Local
Government Board, which I have copied from the British Medical
Journal of January 21st, 1899
" Microbes Association with Scarlatina.—Dr. Klein makes a further
report on the streptococcus, named S. scarlatinas or conglomeratus,
isolated by him from the throat and nasal discharge of patients suffering
from scarlatina. It is not found in the desquammating skin, urine, or
aural discharge. Dr. Klein expresses the opinion that it is the
persistence of this organism in the throat of patients discharged as cured
which gives rise to the 'return cases.' "