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case arose within 10 days, and both were then removed to
hospital owing to lack of nursing facilities. In another
home nursed case a second case arose six months after
freedom of isolation of the first case; it is possible a new
infection arose in this case. All other home nursed cases
had an uninterrupted recovery without secondary cases
arising and with an average isolation period of 31 days.
On the face of it it would appear that irrespective of the
care taken against return cases occurring, whether
hospital nursed or home nursed, the infectivity of the
patient cannot be satisfactorily controlled. Routine
swabbing of children for the presence of Hiemolytic
Streptococci (Scarlet Fever strain) has further added to
the complication of administration; the child being found
to be negative or positive at irregular intervals over long
periods. Nevertheless what knowledge we gain should be
and is used so that precautionary action may be taken to
prevent spread of infection. The mild missed case is the
main cause of spread of infection through susceptible children.
Schools are frequently blamed and the public demand
their closure, but in my experience even if congregation
of children in schools was the main cause of spread of
infection, closure of the school would not have any
appreciable effect on the spread of infection. Even now
when contacts are excluded they are found in Sunday
schools, cinemas and other places, or playing with the
child on the streets after school hours. Parental control
is not fully exercised in this direction and until it is so
one must expect a certain number of needlessly infected
school children.
Diphtheria.
Twenty-nine cases of diphtheria (0.6 per 1,000
population) were notified against 12 in 1932, and all but
one case were admitted to Hospital. There were no
deaths.
There is still too great a tendency to depend upon
bacteriological examination before admission of patients to
hospital. In epidemic times this becomes a dangerous
practice as it delays the administration of anti-toxin—the
only method of cure.