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12
SCARLET FEVER.
As will be seen from the preceding Table, 35 cases
of this disease were notified, as compared with 18 in the
previous year. Twenty-seven of these were removed to
the Isolation Hospital of the Hendon Rural District
Council under the arrangement in force between that
Council and yourselves for the treatment of these cases.
Three cases were imported into the district from outside,
the disease not having been recognised in time to prevent
this. In another instance 3 cases occurred in one family,
the infection spreading from the first case to the others.
But in all cases where early notification was made and
the case promptly removed the infection was stayed.
There were no " return cases." It was found extremely
difficult to trace the source of infection in the great
majority of cases. " Overlooked cases " must, I believe,
have been the source of infection in many instances.
None were found to be due to polluted milk or water, or
other sources capable of extending the disease in a wide
circle.
We are compelled to regard school attendance as
one of the factors in spreading the disease, and probably
the " missed " or overlooked cases play the most important
role in doing so. The great stress laid upon average
attendance has much to do with this, for parents are so
worried if they keep the children at home that they often
feel compelled to send them, even when unwell, instead
of keeping them at home under observation until they
see what develops. Measles and Small Pox break out
in epidemics which, after they are over, leave an interval
of complete freedom from the diseases ; Scarlet Fever
also breaks out in epidemic form, but in the intervals
sporadic cases occur, so that districts that are at all
populous are hardly ever free from the disease for any
length of time.
Until a greater knowledge is obtained of the natural
history of the disease, and the specific germ isolated, it
will be impossible to give an explanation of the persistence
of sporadic cases. The cases were distributed
amongst 16 roads and streets dispersed generally through
the district, and not confined to any particular part of
parts.
DIPHTHERIA.
The number of cases of this disease notified was 4
only as compared with 13 in 1907. The first occurred in
April, and the next was not certified until October. All
were promptly removed to the Isolation Hospital and did