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was kept in bed for about ten days, no medical advice was sought
until three other members of the family had become affected, the
other children, though having free intercourse with the patient,
continuing to attend school (the Brettenham Road Board School)
until they themselves became ill. The existence of the disease
in this family was discovered on February 14th (the day following
the onset of the disease in the first two secondary cases
in this family.) On February 13th two other children (both
girls) attending the same school developed symptoms, and within
the week following two other primary cases occurred among the
children attending this school.
Early in March, in consequence of a communication made to
me by the School Board's attendance officer, I was led to visit a
family, and found two cases of scarlet fever in the desqumating
stage, the first of which failed on January 30th. As this child
also attended the same school the case may fairly be referred to
this group.
In March no less than nine other primary cases occurred
among the children attending this school, besides a group of cases
which in the first instance was probably an offshoot from it, and
which may be named the Langhedge group. It consisted of four
primary cases and of seven secondary infections in the houses in
which they arose. The removal of the first of this series would
in all probability have prevented the occurrence of the remainder,
but there was no vacancy at Enfield at the time.
During April and May some further cases occurred among
the children attending this Brettenham Road School, and in July,
August, and September the series was continued by a succession
of house-to-house infections in the Brettenham Road and roads
immediately adjacent thereto, which was continued down to
November, while in December a recrudescence of school cases
took place at this same school, which at the close of the year did
not appear to have entirely ceased. I should regard it as extremely
probable that one or more unnotified cases occurred in
the Brettenham Road district in June, as in one of the instances
occurring in July the disease was not discovered till it had been
in the house some weeks.
In order to give a better idea of the numerical importance
of this group of cases I have added the following table:—