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firmed. One case was also admitted to the Park Hospital. Of
these cases, three were non-paralytic and three paralytic. On
such occasions as this, theories as to the spread of the disease
are many and varied, but there are none which stand the test
of rational argument better than the old-fashioned one, that the
complaint is spread by healthy carriers in crowded communities.
This would seem to be the only explanation of the fact that more
than one case in a family is the exception rather than the rule.
In this feature it differs entirely from, e.g. Measles, which if
picked up by one child in a family, usually affects all the rest of
the household who have not been immunised by a previous
attack. It is known that the virus which causes the disease can
be found in the Naso-pharynx and in the stools of infected
persons. Hence the importance of hygiene in the handling of
food.
In view of our comparative ignorance of the spread of this
malady, preventive means are naturally difficult, but I did think
it worth while drawing up a short letter, which was handed to
all known contacts, advising them of the reasonable precautions
open to them. The local doctors were also circularised, and a
film showing the most recent advances in the diagnosis and treatment
of the disease was shown at Beckenham and all the local
general practitioners were invited to its showing.
An interesting point which has arisen recently is the discovery
of a new virus disease which has been designated
"lymphocytic Chorio-meningitis." This condition is not fatal,
but is similar in its symptomatology to abortive anterior poliomyelitis
and may have accounted for some of the pre-paralytic
cases of anterior poliomyelitis which were notified.
SCARLET FEVER.
139 cases were notified, 71 of which were home nursed and
68 treated in hospital. The infection continued to be mild in
type, and it does appear that this disease is no longer the acute
disease of a few decades ago. The mildness of the infection, however,
tends to " missed " cases, and consequently leads to spread
of infection.
DIPHTHERIA.
Only one case—in an adult—of this disease was notified
during the year.
The continued low incidence, in fact the rarity of the disease,
requires some explanation other than that it is solely due to
immunisation. It has been known that in Bromley, diphtheria
had a peak wave every seven years between the years 1890 and
1919. Following 1919 the incidence fell rapidly and remained