14  Thornton,  Brit.  M.  J.,  Lond.,  1908, 1,  495,


CARRIERS  AND  MISSED  CASES  109

was  noticed.  Mader  x  observed  9  typical  and  12  very  atypi-
cal cases  in  an  outbreak  in  a  home  for  epileptics.  Ewart,2
from  an  examination  of  8000  school  children  at  Middle-
borough,  estimates  that  there  must  be  at  least  3  missed  cases
annually  for  each  1000  children.  True  "  carriers,"  that  is,
perfectly  well  persons,  are  sometimes  reported.  Thus  I
have  noted  an  instance  where  a  woman  apparently  in  this
way  carried  scarlet  fever  to  her  child.  She  had  been  taking
care  of  another  child,  and  after  an  entire  change  of  clothing,
bath  and  shampoo,  visited  the  first-named  child,  who  was
taken  sick  two  days  later.  Newsholme  reports  what  he
thinks  are  possibly,  or  even  probably,  similar  cases.  New-
man,3 of  Finsbury  (London),  noted  5  carriers  among  school
children,  three  of  whom,  though  they  had  never  had  the
disease,  transmitted  it  to  others.  Kerr 4  also  reports  5  such
cases.  When  a  diphtheria  patient  discharged  from  a  hospi-
tal carries  scarlet  fever  home  to  his  family,  he  must  in  most
instances  be  considered  a  true  carrier,  for  it  is  unlikely  that
symptoms  of  scarlet  fever  would  often  escape  notice  in  the
hospital.  Ten  of  this  sort  of  return  carriers  are  reported  by
Simpson,5  30  by  Cameron 6  and  44  by  Turner.7

Smallpox.  —  There  is  still  doubt  as  to  the  specific  cause
of  smallpox.  The  claims  that  have  been  advanced  in  favor
of  this  or  that  micro-organism  have  not  as  yet  been  substan-
tiated. Hence  there  is  no  "  laboratory  "  evidence  that  car-
riers of  this  disease  exist,  nor  is  there  much  clinical  evidence

1  Mader,  Cor.-Bl.  f.  schweiz.  Aerzte,  1908,  XXXVIII,  169.
2  Ewart,  Pub.  Health,  Lond.,  1910-11,  XXIV,  275.
