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remembered that at such times the district is already
badly infected, and that there are probably many
ambulatory and " missed " cases acting as foci for the
spread of the disease. So provided these discharged
cases are kept under observation and the parents or
guardians are given written instructions and information
regarding such possible infective complications as
nasal discharge, otorrhoea, etc., they will have very
little influence on an epidemic which is already well
alight. Furthermore, as regards Scarlet Fever, although
in normal times the function of our Isolation Hospital
is to prevent the spread of infection, in bad epidemics
there is not sufficient accommodation for all the
cases that occur, and the Hospital is best used by
selecting for admission only those cases that require
special treatment or who cannot be properly attended
to at home.
The attack rate from Scarlet Fever for the past
year per 1,000 of the population was 0.42.
2.—Diphtheria. Beyond the "epidemic periods" no
noteworthy fact as to spread of infection was noted. Antitoxin
is supplied free of charge by the Council for the use of
Chiswick doctors, and the cost of this necessary medical
requisite for the year 1925 was £8 3s. 2d. Particulars of the
work carried out in the Council's laboratory are set out below.
Throat swabbings are taken for examination from all
Elementary School children needing operation for Tonsils and
Adenoids prior to them attending at the Chiswick General
Hospital. It is also customary to swab all contacts where
cases have occurred in crowded houses. By reason of the
persistent recurrence of the disease in one particularly large
family repeated and careful swabbings were taken of both
parents and children. Finally, the mother was proved to be
the " carrier," and was treated for this condition at home.
The necessity for the early diagnosis of this disease
cannot be too strongly impressed upon the Public, both from
the point of view of efficient treatment and the prevention of
spread of infection. A sore throat with enlarged glands in the
neck must always be viewed with suspicion and a swab should
be taken for bacteriological examination. Such is the invariable
custom in the Council's Clinics, and cases of Diphtheria