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20
Of the 45 cases of diphtheria, notified since my last
report in November, 22 occurred in a private school for girls.
I visited the school and was informed that the first sore
throat occurred in a maid who had recently visited some
friends in an adjoining district. I communicated at once
with the Medical Officer of Health of that district who replied
that no case of diphtheria had been notified from the address
given.
It is not clear whether the maid infected pupils or a pupil
infected her.
I communicated with the Medical Officers of Health of
the various districts throughout the British Isles from which
affected pupils came, and in no case was there any history
of diphtheria connected with their home during the year. 1
ascertained that the milk supply of the school is beyond suspicion
; also that no charwoman or casual worker had been
engaged from Harrow. I was assured that no person in the
house had visited any home in Harrow in which a case of
diphtheria had been.
The mode of introduction of the first case is therefore
not apparent. 1 consider it probable that the sudden fall in
temperature which occurred previous to this outbreak, and
which was accompanied in many districts by a crop of tonsillitis
and other forms of sore throat lighted up dormant
diphtheria uacilli in one. of the early cases. If this be admitted
the intimate contact of school life explains the occurrence
of the remaining cases."
The most careful treatment of an epidemic does not
affect its prevalence; no matter what panaceas we cry up
or down—no matter how many scapegoats we drive into
the wilderness, one year will produce more cases than another.
Of the conditions social or other which combine to
standardise 'an infection which must continue to take toll of
human life until in the course of time a new equilibrium is
established, we have no exact knowledge.
Scarlet Fever :—Harrow, in common with London and
many other localities in England and Wales, had a larger
incidence of scarlet fever in 1919 than in the preceding year.
But the figure for the district in 1918 was exceedingly low.
In 1916 it was 32, ana in 1913 it was 89. At no time during
the year 1919 did it assume epidemic form.
I cannot speak too highly of the whole-hearted assistance
given me by the head teachers of the Roxeth Hill
and Welldon Park Schools in my routine work of dealing
with these infections in the pupils of their Schools; and most