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63
The child R. D- was discharged from hospital on the 6th
April. Between the 10th and 16th April four cases, and on the
20th a fifth, were notified and removed to hospital. In view of
the recent return of the first case attacked, R. D-, special
enquiries were made. She was found to have, in addition to
some late "peeling," a sore mouth. The hospital authorities
were communicated with and information obtained that, on "the
morning of her discharge, she had a slight crack at the angle
of the mouth, which had come on in the uninfected block." The
recent arrival of this child at her home, taken with the
condition of the patient when discharged from hospital, and
four days subsequently the occurrence of the first of the second
group of cases was a highly suspicious circumstance. It should
be stated, however, that one of the last group had attended school
on the 10th April, two days previous to the commencement of her
illness, and it was not, therefore, possible to exclude the school
as a possible source of infection. Of the other four cases none
attended school, amongst these latter being the first case attacked.
Four cases occurred amongst two families occupying a house
at Stockwood Street on the 15th and 16th June—two in one
family and one in another. On making enquiries into these cases
it was ascertained that another child in the latter family had been
removed to the infirmary a day or two previously, supposed to be
suffering from Rheumatic Fever. The Medical Superintendent
was immediately communicated with and the history of the case
given to him, and he at once notified the case and had the patient
removed to the M.A.B. Hospital, where she was detained until the
5th August. This case had probably infected the three other
patients.
In practically all instances in which multiple cases have occurred,
the source of infection is due to this cause. Most of these
cases occur in the poorer quarters of the Borough, where, owing
to the frequently inadequate housing accommodation and the inability
(financial) of parents (and in many cases carelessness) to call
in timely medical assistance. In such circumstances, it is not difficult
to understand in times when epidemic disease is prevalent the
incidence of such disease rapidly rises, and entails an expenditure