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49. 223 cases, or 92 per cent. of notifications, (were
removed to hospital, compared with 83, 89, 89, and 81 per
cent. in the four preceding years. A certificate of efficient
home isolation was given in 3 cases (30 in 1907, 7 in 1908,
1 in 1909, and 1 in 1910).
The case mortality was 5.4 per cent., compared with
5.7, 6.3, 5 5, 10.4, and 3.4, in the five preceding years,
and 8.3 in London.
In several cases there were no throat symptoms, but
discharge or soreness of the nose. Such cases rarely have
medical attendance, and would escape detection if other
cases in the family or school did not lead to a search for
the source of infection. The search for, and detection of,
these nasal cases is one of the most important duties of the
Public Health Department.
50. Outbreaks occurred in the Autumn among children
attending St. Mary's, and Wood Street Schools. I reported
fully on the former and attributed the outbreak partly to
insufficient provision of windows in the Infants' Department,
and failure to keep open the windows which existed. During
both outbreaks, daily lists of absentees were otained from the
School Mistress; these were visited, and, where any suspicious
symptoms existed, parents were urged to obtain medical
advice. When they were unable or unwilling to do so, your
Medical Officer of Health examined the children. In this