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Report of Medical Officer of Health.] 19
isolated on the 13th. She remained there until she went to a convalescent home. There was no
idea that the girl was ill with scarlet fever, and it was only after a considerable amount of
persuasion that the advice given to completely quarantine her was acted upon. After her removal
to a convalescent home for scarlet fever patients she desquamated freely.
D. C., another boarder, but not of the same house as F. C., visited F. C. during the early days
of the latter's illness. D. C. sickened with well-marked scarlet fever on November 10th, and was
removed to hospital on the 13th.
L. W., a day scholar, had been absent from school for some unexplained reason from November
2nd to 6th. She then attended until the 9th. She was taken ill with scarlet fever on the 11th
and certified on the 12th. She was kept at home, but gave rise to no other cases. This child
was taught in part by M. H. (the next case), and it was thought also by D. C.
M. H., a pupil teacher, residing in same house as D. C., sickened between November 12th and
14th (the onset was too vague to secure an exact date), and sent to hospital on the 15th.
K. F., a day scholar, was reported ill with scarlet fever on the 16th, but was subsequently
found not to have the disease.
R. W., a housemaid at house where D. C. and M. H. lived, sickened on the 16th and was sent
to the hospital on the 18th. This patient visited the room where one or both of the previous
patients were lying whilst waiting for the ambulance. Such visits were paid in defiance of orders.
E. C., a pupil teacher, sickened on November 26th, and went to the hospital on the 30th.
She had taught L. W., but the interval was too long to warrant any presumption that that child
was the source of infection.
S. I., a day scholar, sickened November 27th. She had not attended school since 9th of that
month, but had received examination papers from the school. One of her usual teachers was
E. J., who sickened on November 30th. This patient acted as secretary to the school, and the
opportunities for contact with any of the other patients were numerous.
M. W., a boarder in same house as all the cases except F. C., was certified to be ill with scarlet
fever on December 3rd. This case was discovered in consequence of a general examination made
on request of the Medical Officer of Health. The girl had had an ill-defined illness about November
15th, but, although isolated and watched, a diagnosis of scarlet fever could not be made.
The steps taken to limit the spread of the disease included
(a) Removal of each case to hospital, and subsequent disinfection of room and contents.
(b) Quarantine of all girls in contact with each patient.
(c) Disinfection of all school-rooms.
(d) Temporary closure of school for a fortnight, afterwards continued, without re-opening,
until after Christmas vacation.
(e) Careful examination of all persons residing in the houses.
Fortunately only 2 cases occurred outside the school premises.
The origin of the outbreak could not be traced. There was ultimately no room to doubt that
F. C. had a mild and unrecognized attack of the disease, and there was strong presumption that she
caused the earlier of the reported cases. How F. C. became infected is not known. There was a
history of vague illnesses among the teaching staff, supposed to be of the nature of influenza, for
same months previous to the occurrence of F. C.'s case. It is possible that F. C. contracted her
illness in the crowd when out to see the C.I.V. Previous experience has indicated the possibility of
such an occurrence.
The outbreak is of interest in another respect. All the patients had passed the age when scarlet
fever has hitherto been most frequent. The youngest patient was 8 years of age, and the eldest 28.
There seems to be reason to suspect that when an individual is protected from an attack of this
disease in extreme youth, an attack at a subsequent age may present unusual features. It seems
almost as if the disease in elder patients does not develop in so characteristic a form as it does in
young children. In certain of the cases in the outbreak under review the symptoms were very