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of the disease, occurring among members of the same family or
contacts. Great difficulty has been experienced in tracing cases of
this nature, and the time of the Sanitary Inspectorial Staff has
been much taken up in this important duty.
The Public Elementary Schools have been largely concerned
in the spread of infection. This also has been mainly due, there
appears to be little doubt, to the presence of mild, unrecognised
cases in the schools or occurring in the homes of children attending
the schools. It has not been an easy task to definitely or
satisfactorily associate the schools with the spread of infection, in
a great many instances in which there has been a strong suspicion
pointing to them as being the source of infection; but in
a few instances it has fortunately been possible, after excluding
every likely source of infection, to definitely trace and prove the
origin as being due to this source. It has been found necessary
in such cases to take action either by the exclusion of children
showing evidence of suspicious illness (sore throat, vomiting,
head-ache, malaise), or by closure of certain class rooms. Such
action has in most cases been followed by satisfactory results in
checking the further spread of infection.
Among other probable sources of infection, there were reasons
to suspect the out-patient departments of hospitals. Several cases
attending as out-patients at these Institutions for other ailments
were attacked by the disease. In such cases special enquiries
were made, and after excluding every other possible source of
origin, it was impossible to dissociate the hospital from responsibility.
When a child, absent from school for some affection
which necessitates treatment at the out-patient department of one
of the largely attended hospitals, after paying several visits, is
brought into contact with other patients in a crowded patients'
waiting-room, and kept waiting its turn to be attended to, frequently
for long periods of time, it is not difficult to surmise,
during periods when Scarlet Fever is prevalent, that considerable
risk of infection is likely in this manner to arise.
Carelessness of parents and others having charge of children
has again to be referred to as one of the causes responsible for