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Report of the Medical Officer (Education).
123
the cases in the district to the various houses and again on examining the occurrence in the houses,
there is either this family tendency, or else a remarkable tenacity of infectiousness in the house or
family. This point was dealt with some years ago, but is worth reverting to.
In the district considered there were 225 houses ascertained to be invaded, 133 had school children
sufferers, 78 had school children excluded but no school child suffering, and 14 had no school children
affected. In the 133 with school children as sufferers there were also 197 children excluded as contacts.
In 17 cases it was ascertained that the first sufferer in the house was not attending school. Of the
78 with 172 school children excluded but not suffering, the first case was ascertained in 42 instances, 33
being infants and 9 adults. Of the 14 houses with no school children affected 9 were cases of infants
before school age, and 5 adults. As regards Winchester-street School, 62 houses were affected. In
14 the first case was a baby and in 3 an adult, in the remainder it was presumed to be a child of
school age. 41 houses had the 51 sufferers attending Winchester-street and also 27 contacts excluded.
These 51 sufferers included 15 excluded from school for "sore throats," more than a quarter of the
sufferers, who, but for the school, would have been largely missed, 21 houses had no Winchester-street
children as sufferers but had them excluded as contacts. The single house, however, did not always
affect a single school, in one instance it affected seven schools. There were single exclusions of child
contacts from houses in 41 cases, and single sufferers in school children in 59 cases, of whom 18 were
"throats.''
There were 49 double exclusions either exclusions alone, 34 children, or sufferers alone 4, of
whom a pair were throats," or a sufferer and a contact paired, covering 60 children. In 123
instances three children were excluded, 16 sufferers and 53 contacts, and in 47 instances 4 or more were
excluded. These groups of children went out of various schools in many cases. In 174 houses the
children attended one school, in 32 two schools, in 5 three or more schools.
In these 225 houses in this area there were 145 school children sufferers and 344 contacts, a total
of 489 school children directly affected ; whilst in the schools shown in the area the children affected
numbered 184 sufferers and 455 contacts, a total of 639 children affected. The difference of 39 sufferers
and 111 contacts drawn by the schools from a much wider surrounding district shows how the disease
outbreak was chiefly confined to the small area in question. The tendency of the disease to recur in
families or cling to houses, discussed in a previous report, is shown in this district by separate house
records and dates given below as compiled from the school notifications.
House A. House B. House C. House D. House E.; House F. ,
18.7 Sufferer. 23.5 Contacts. 3.4 Contacts. 28.4 Contacts 11.5 Contacts. 20.6 Sufferer.
18.7 Sufferer
18.7 Contacts 7.12 Contacts. 9.10 suspicious 7.6 Contacts. 26.9 Sufferer. 18.9 Sufferer.
" throat " case 28.9 Contacts. 22.9 Sufferer.
17.11 Contacts.
17.11 Sufferer.
House G. House H. House I. House J. House K. House L.
25.9 Sufferer. 14.3 Contacts 28.7 Contacts. 19.5 Contacts. 4.4 Contacts. 6.9 Contacts.
25.9 Contacts
27.9 Sufferer. 25.9 Sufferer. 29.8 Sufferer. 7.11 Sufferer. 27.10 Sufferer. 13.10 Contacts.
25.9 Contacts. 13.11 Contacts. 27.10 Contacts.
26.10 Contacts. 31.10 Sufferers.
House M. House N. House O. House P. House Q.
20.2 Contacts. 24.4 Contacts. 29.9 Sufferer. 16.6 Sufferer; 19.7 Sufferer.
16.6 Contacts. 21.7 Contacts.
5.9 Sufferer. 1.6 Contacts. 7.11 Contacts. 12.7 Sufferer.
5.9 Contacts. 1.12 Contacts, 19.9 Sufferer.
14.12 Sufferer.
14.12 Contacts.
The most noticeable facts, on a general review of the district and the records, are the comparatively
low infectivity of the disease, its want of severity which has been a feature now for many years, its
domesticity in relation to houses and the absence of class infection in schools. It presents a sharp
contrast to measles, which is infective days ere illness declares itself, and which formerly generally
showed class infection, as it often does yet, whereas in scarlatina the child may be covered with a rash
and yet apparently not infect. In many cases discovered peeling in school, sometimes in attendance
during the whole course, as shown in previous reports, infection arising in the school from such cases
is not only uncommon but a rarity.
The reasons for the disease presenting an exacerbation commencing with comparative suddenness
and ceasing almost as suddenly it is impossible at present to determine. It may depend to a considerable
extent on such variable factors as atmospheric temperature, humidity, or prevalence of dust, but
is almost certainly due to an accumulation of a certain proportion of non-immune persons in the community,
who have not hitherto been tested by exposure to the infection and abundant opportunities of
close contact. This want of immunity, and the exposure to risk of infection are the two great factors
to be followed up. The first depends partly on inheritance and partly on depressed vitality from
defective nutrition, poor ventilation, bad housing, and generally debilitating conditions during infancy.
The second is also related to the want of living room which when seen in aggravated conditions is
called overcrowding.
With the school information alone these subjects cannot be followed out, but the enquiry is
feasible and of value. It would require a continued watching for some four or five years of such a
12532 Q 2