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to have been two days after she had left Port on her way home
to England, so that the source would appear to have been the
country from which she embarked.
Diphtheria. There were only two cases of Diphtheria
during the year. This has broken last year's previous record
of three, as last year's figure beat the figure of 5 which was the
previous record. Neither of these cases was immunised. Both
these arose as part of a small outbreak among the children
travelling by special bus to the L.C.C. Special Schools. The
search for the source became very complicated by reason of
children being picked up at various points and by the necessity
at one stage of changing from one bus to another. Eventually
it was necessary to swab the whole of the children going to
these schools. This could only be done by the co-operation
of the L.C.C. School Medical Service, which was very generously
given. In one of the families there were 5 other children of
school age immunised and one not immunised ; all these others
escaped.
Scarlet Fever, There were 187 cases of Scarlet Fever
notified during the year. 88 of these, or nearly half, arose in
the Morden Ward, and as 73% of all cases are of school age,
it is not surprising that a large number of cases in the Ward
were school children, and as the majority of children in this
Ward attend one school, attention was naturally focussed on
this school. Obviously, opportunities for infection by contact
occur throughout a school child's day, and the contact during
play is perhaps much closer than during study. None the less,
while we cannot take any very effective steps to limit the opportunities
for spread by contact outside, in the school we can and
a concentrated effort was made to secure that the opportunities
for spread were kept to a minimum.
Of all the measures taken my impression is that there are
four primary aims to achieve in such circumstances.
1. To exclude other suspected infections. This is not always
easy, the mother whose child has been sent home without
being labelled with a familiar complaint is often very
dissatisfied, and in these days when so many of them go
out to work it is not unknown for them to send them back
to school again accompanied by some unflattering observations.
2. Follow up the cases discharged from hospital so as to
see them on their first day back in school. In the interval
between their discharge quite well from hospital and their
return to school a considerable proportion develop nasal
discharges, and less frequently other recurrences of
infectivity.
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