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18
vious cases had been reported. In the remainder of the cases I was
unable to trace the source of infection.
This disease caused one death (a person of 80 years of age) and was
an indirect cause of the death of two children, who succumbed to Rheumatic
Fever, following an attack of Scarlet Fever.
The majority of the cases were of a mild type.
Diphtheria. During the year 32 cases were notified from 21
houses as against 83 in the preceding year (when an epidemic occurred in
Southgate) and 26 in 1898. These 32 cases were notified from the
different localities as follows:- 18 from Southgate, 5 from New Southgate,
5 from Winchmore Hill, and 4 from Palmers Green and Bowes.
In 7 cases sanitary defects were found and subsequently remedied.
Seven cases were secondary ones, the infection having been taken from
previous cases in the same houses.
In the remainder of the cases I was unable to satisfactorily trace
the direct origin of infection, but have little doubt that school attendance
was a potent factor. Of the 18 cases which occurred at Southgate,
14 were children attending school. The important part played by
school attendance in the spread of Diphtheria was clearly shown in my
last annual report.
In that report I also pointed out the difficulty there was in effectually
checking the spread of Diphtheria, owing to the fact that the germs
of the disease may remain in the throat for a long time after
the person affected is apparently quite well (in exceptional cases
it may be even as long as six months) and so be communicated
to other susceptible persons. You decided, therefore, early hist
year, on my recommendation, that as far as Southgate was concerned,
school children who had Diphtheria, or who came from infected
houses, should not be allowed to return to school for three months after
the date of notification, so as to ensure as far as possible that such children
were quite free from infection before mixing again with other children. This
measure has, I am sure, been a very beneficial one, and was an important
factor in bringing the epidemic of 1899-1900, to an end, and preventing
its recrudescence. I would now recommend that this measure be
extended as far as possible to the whole District, and to all persons
affected, but with this modification, that if before the expiration of the
three months a report is received by me from the Jenner Institute of
Preventive Medicine, or other responsible source, that a bacteriological
examination of secretion from the throat shows that the case is no longer
infectious, then, and not till then, the person affected may be allowed
to mix with others Until such a report is received, infected persons
should not be allowed to mix with others for the full three months. In
illustration of the length of time the throat of a person affected with
Diphtheria may remain infectious, I will mention the following case