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were detected among the scholars, the difficulties which are attached
to the prevention of Scarlet Fever have been referred to in previous
reports. It is now held that the sore throat, rash, temperature,
peeling, &c., are simply the reactions of the individual to
the invasion of the streptococcus, and that anyone of these symptoms
may be absent, but doctors are chary of notifying unless most
of them, or at any rate the rash, are present. It can therefore
be appreciated that during the prevalence of Scarlet Fever in a
neighbourhood there may be a certain number of cases which will
escape notification.
Among other vagaries of the streptococcus is its power
occasionally to persist in an active state in the individual for prolonged
periods, and we have return cases when a person resumes
his ordinary role in life after isolation. Unless complications occur
at the present time a patient is kept in hospital for about four weeks,
and in the . majority of instances at the end of that period he is
found to be free of infection. Occasionally, when a patient is
discharged from hospital another case occurs in the family within
a short period of the patient's discharge; the subsequent case is
called a " return " case and the discharged patient is called the
" infecting case." We know some of the conditions under which a
patient remains infectious for a prolonged period and liable to give
rise to " return " cases, and avoid discharging the patient until
these symptoms have cleared up, but there are others which give rise
to " return " cases in which there are no visible signs or symptoms
in the patient to account for the persistence of the infection.
Last year six cases gave rise to one return case each, and in
2 instances three cases occurred in each of the families following
the discharge of the patient from the hospital.
MEASLES.
There were ten deaths from Measles in 1936, compared with
no deaths in 1935. Last year was an epidemic year in Acton.
During the past quarter of a century, Measles has made its appearance
in Acton in a fairly regular manner every other year. Measles
is a disease which fulfils with remarkable accuracy the conditions
of an epidemic cycle ; its waves of prevalence, with their respective
rises and falls, are interspersed with periods of complete absence.
We say that it occurs with explosive violence, and then completely
disappears from the district. 1932 was an epidemic year with 12
deaths, followed in 1933 an interepidemic year with one death.
1934 again was an epidemic year with 11 deaths, followed in 1935
with no deaths.