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Another centre for infection was discovered through the notification
of a case the first week in August. This patient had been doing
daily work at a small general shop close by, and I there found a girl
twelve years old peeling profusely from Scarlet Fever, the commencement
of her illness dating from the middle of July.
Again during August, September and October, a considerable
number of cases in the late stage of the disease were notified, as discovered
in school, or as the result of enquiries. Two of these cases
contracted Scarlet Fever in a mild form when away for the holidays,
one in Southampton and one at Weston-Super-Mare.
The prevalence of Measles during summer was undoubtedly a
contributing cause in the spread of Scarlet Fever.
Several instances came under notice in which cases of Scarlet
Fever had been nursed up at home under the impression that they
were cases of measles—medical advice not being sought.
With these numerous unrecognised centres of infection the difficulty
experienced in eradicating the disease will be appreciated. The
remarkable circumstance is that only 145 cases were notified; one
would reasonably expect a much larger number of cases in our
population of over 15,000, containing as it does an unusual number of
children at a susceptible age. In accounting for this low incidence,
allowance must be made for the fact that the notified cases by no
means constituted the whole number of those attacked. What this
figure was cannot be ascertained, but all the circumstances go to show
that it must have been very much higher than was apparent. There
are other influences as well, especially age, closeness of contact,
previous attack, and so forth, which renders Scarlet Fever less liable
to transmission than Measles and Whooping Cough for example.
Allowing for these minimising influences, however, it must be conceded
that the preventative measures adopted by the authorities concerned
were instrumental in limiting the outbreak to a certain area ;
and thus preventing an epidemic.
In this connection it is impossible to speak too highly of the
benefits which accrued from the systematic examination of the
children in the elementary schools.
The great value of this measure was in the discovery of unreported
cases, and I think there can be no question that had it not
been carried out we should have had an extensive outbreak on the
north side of the District.
Diphtheria and Membranous Croup.
Nineteen cases of Diphtheria and Membranous Croup were
notified, as compared with 18 for 1903. Of these, 10 were males
and 9 females.