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With regard to .missed. cases the report runs as follows,
and shows how much work is necessitated in order to stop the
infection spread by means of those cases, which by their very
nature are so mild as to be frequently overlooked, but which
may infect another child with the gravest form of the disease:
.In the administrative control of such notifiable
diseases, therefore, action must start with the Medical
Officer of Health. In a well.organised and efficiently
worked sanitary district each notification by a medical
practitioner of a case of one of the notifiable diseases
should form the starting point for a prompt and full
investigation of the possibilities of infection. As
stated in Article 18 (2) of the Local Government Board's
Regulations as to Medical Officers of Health, it is the
duty of the Medical Officer of Health .to inquire into
and ascertain by such means as are at his disposal the
causes, origin and distribution of diseases within his
district and with this object in view he will regard
each case of notified disease as possibly connected with
other cases of the same disease, which owing to their
mildness, or the absence of some of the characteristic
symptoms, have been overlooked by the parent, or the
teacher, or both. The investigation of such missed
cases is indispensable to effective administration. A
portion of this investigation may need to be undertaken
at the patient's home; it is incomplete unless an equally
thorough inquiry has been made into the condition of
the children who have been in contact at school with the
scholar who has fallen ill. This inquiry should be shared
by the Medical Officer of Health and the School Medical
Officer, if these offices are not held by the same official.
It should include the recent history and present condition
of children who have recently returned to school
after an interval of absence, and be followed by careful
watching of the children who have been in contact with
the infectious case..
There have been three return cases of Scarlet Fever; in
one case the patient was not discharged until after 67 days, the
lengthened period of detention having been due to an abscess
in the neck.
These cases will occur from time to time even with the best
administration, and compared with the records of other towns
Dr. Clapham is to be congratulated on the excellence of the
administration of the hospital under his control.
Diphtheria. Notifications of 90 persons suffering from
this disease were received during the year, the attack rate being
1.5 per thousand of the population. This rate is .2 below last
year, and the highest with three exceptions (1902, 1907, and
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