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first place one must remember that such "return cases"
are so designated only because of a chronological sequence.
It is almost impossible to be satisfied as to the origin of
any further case in a family. The figures do show, however,
that the number of return cases in the families was very
similar, whether the primary cases were isolated at home or
in hospital. This again must not be taken as weighing
against the value of hospital isolation of cases of scarlet fever,
rather does it mean that if hospital or home isolation be
chosen with due discretion there may be little additional
spread of the disease.
In particular, it must usually be wrong to allow a case
of Scarlet Fever to remain at home if there be an imminent
confinement in the family; and if there be a possibility of the
infected environment causing spread of the disease by allowing
the contamination of milk or other such like foods to
take place, of course the case should go to hospital.
DIPHTHERIA.
With only 37 cases during the year the incidence of
Diphtheria has been very small. In the previous year 95
cases were notified.
In connection with this disease attention must be drawn
to the Council's scheme making available Active Immunisation
against Diphtheria. From the following figures the
scheme would not appear to have received a very extensive
acceptance.
DIPHTHERIA IMMUNISATION.
1935. 1936.
Number submitted to Immunisation treatment 107 303
Number of these under 5 years of age 31 97
Number submitted to Schick Test:—
(a) Prior to Immunisation Treatment Nil 15
(b) After Immunisation Treatment Nil 20
It is to be noted that in 1936 only 97 of those treated
were under the age of 5 years, while the optimum age for
immunisation is certainly nearer the third year of life. The
number submitted to the Schick Test after immunisation was
also low. Without this test being performed it is impossible
to tell if the patient has been effectively immunised, and after
65