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35
the district from whence it came. My colleague reported that after investigation
he had found nothing to criticise in the sanitary condition of the depot or its
arrangements for handling the milk. I might add that there had been no cases
of scarlet fever in this institution previous to this outbreak and that only one
succeeded it, which was notified on December 23rd, and was also an Enfield
child. Two of the notifications are not in our register, as they were transferred
to Wood Green. Further observation of the 15 cases showed that in 7 of them
the diagnosis could not be confirmed.
Diphtheria and Membranous Croup. The latter, membranous
croup, is only an old-fashioned phrase for diphtheria, presenting symptoms
mostly confined to the larynx. I received notifications of 131 cases during the
year, compared with 136, 43 and 52 in 1912-11-10, and they represent an
attack rate of 1.97 per thousand of the population. The cases occurred in
74 streets and 113 houses. One case occurred in 98 houses; two cases in
10 houses; three cases in five houses. The cases removed to hospital numbered
125, being 95.52 per cent, of those notified. There were 15 deaths, giving a
death-rate of 0.23 per thousand of the population, and a fatality of 11.45 per
cent, of those notified. One case was doubly notified. 15 of the cases were
secondary ones.
Return Cases.—See " Hospital Section."
There were three cases notified where subsequent observation did not
confirm the diagnosis; they are not included in the above figures.
During the last three months of the year the number of cases were excessive,
numbering 36, 21 and 16 in October, November and December, respectively,
tor some months previously the number of cases had been below the average,
and for the whole year only 5 more cases were notified than in 1912. However,
the Local Government Board requested a report on this subject, which I sent
hem on the nth December, and also a copy to the County Council. All
suspected cases were swabbed by the medical practitioner in attendance, my
deputy or myself, and the cultivation from the swabs examined in the Council's
laboratory. Antitoxin in curative doses of 4,000 units and preventive doses of
1,000 units is supplied free to the practitioners any time during the day or night
either from the Town Hall, or our fire-stations.
Enteric Fever. Eight cases were notified, as against 3, 12 and 34 in
1912-11-10. This is equal to an attack rate of 0.12 per thousand of the
population. These cases occurred in eight houses and eight streets. All cases
occurred in separate houses. All were removed to our hospital—an isolation
percentage of 100.00 here were two deaths, giving a fatality of 25.00 per
cent, of the cases notified, and a death rate of 0.03 per thousand of the
population,