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all that it should not revert in this way, and become again one of the
killing diseases which at one time filled the cemeteries with so many
children from the one family as it did towards the end of the last century.
Even as recently as in the first year of the newly created district of Harrow,
there were nine deaths from this disease. Today there are means both of
prevention and of treatment of the declared case, means which were not
available when the infection was last virulent, and means which in ordinary
circumstances are hardly worth using when dealing with today's mild
complaint. When such a reversion does occur, it is to be hoped that there
will be sufficient hospital beds and sufficient staff trained in the nursing of
communicable diseases to enable the sufferers to be treated.
As contrasted with the position of only a few years ago, when most
of those suffering from scarlet fever were removed to an isolation hospital,
today very few are admitted. Last year there were only four.
There were four households in which secondary cases occurred, one
case in each of three, two in the fourth. The interval between the onsets of
the illness of the primary and of the secondary cases was long enough in
each instance for the secondary infection to have been prevented had the
primary case been diagnosed sufficiently early and been adequately
isolated. In one of the cases the interval separating the onsets was as long
as fourteen days and in another twenty-six days.
There was only one instance where the grouping of cases amongst
pupils of the same department of a school suggested that school attendance
might have played a part in the communication of the disease. The number
of pupils of this school, who fell ill in consecutive weeks in the summer
termwere:- 1, 0, 1, 3, 0, 1, 1, 0, 1.
SMALLPOX
On most days throughout the year there are no cases of smallpox
in this country. Most of the few cases that do occur are in persons who
have contracted the infection abroad. If the disease in that person is not
recognised in time, he might pass on his infection to others who might
have become so advanced in the incubation of the infection that vaccination
carried out at that time is powerless to prevent the development
of the disease. There might then develop from the first person a small ring
of secondary patients. However, by the time the infection in the first
person has declared itself and has been recognised, while it may be too
late to prevent the development of illness in the secondaries, vaccination
of those who have been in contact with them will usually prevent the
development of the disease in those contacts of the secondaries. While
then a patient coming from abroad might cause the infection of a small
number of persons, there is little risk of a widespread outbreak. Circumstances
might be different when the disease in the first patient is atypical,
either because of the variety of smallpox or because the rash has been modified
by previous vaccination carried out sufficiently long ago for some but not
all of the immunity to have been lost. There is a mild variant of smallpox