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individual to infection by the hæmolytic streptococcus which might in
various persons set up other reactions such as sore throats. Although,
then, a child at school cannot be found to be a contact of another school
child suffering from scarlet fever, it could well be possible for him to
have contracted the infection by the streptococcus at school from a
child who might be a symptomless carrier, or may be reacting in one of
the other ways to his infection by the streptococcus. Whether that
actually is the case is unknown. What is known, however, is that contrary
to what at one time seemed common experience, namely, that a child of
school age suffering from scarlet fever was often found to have been
associated with the previous case in the same school, in this district
for yet another year it has to be reported that school attendance seemed
to have played little if any part in the transmission of this infection.
There have certainly been groupings of cases in departments, and it may
be that infection might have spread from one child to another in a different
class, though associated in the school, even though in that event the
original patient did not seem to have infected his classmates. Had this
occurred at all, though, it must have been on a very small scale. In each
of six weeks, there were two cases in one school. On one occasion there
were three cases in the one school. Apart from these groupings, there
was usually only the one case from a department in any one week, and
no case in that department in the preceding or in the following week.
SMALLPOX.
It is only exceptionally these days that there are any patients in this
country suffering from smallpox. Occasionally cases occur secondary
to the landing in this country from abroad of a patient. In such cases,
the contacts are listed, the health authorities of the areas to which they
are proceeding are advised, and the contacts are visited up to the limit
of the incubation period of the disease. Air transport has added to the
risks of importation of this infection, and has considerably swollen the
numbers of persons who have to be kept under observation.
The National Health Service Act removed the compulsory element of
the Vaccination Acts. Instead of the practice being obligatory, except to
those exempted under the conscientious objection clauses, it is now left
to the parents to decide about having their children vaccinated. If they
wish this done, they can have it carried out free of cost by any of the
doctors who have entered into the arrangements of the County Council to
do this work, but it cannot be done by the family doctor under the County
Council's arrangements if this doctor has not agreed to take part in the
scheme.
In recent years only about one child in three has been vaccinated.
It may be that the removal of the compulsory element will result in this
proportion being increased. On the other hand, smallpox to-day in this
country is not the real risk to a child that diphtheria was until a few
years ago, so it is improbable that as many will have their babies
vaccinated against smallpox as are having them protected against
diphtheria.