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the institution who had taken the disease in so mild a form, that it
had not been recognised, and a careful examination was, therefore,
made of all the children and all the staff. No evidence of scarlet
fever could be discovered, nor could the most careful enquiries in
other directions elicit any information that threw light on the
source of infection.
The medical examination of the inmates of this institution was
repeated on each of the three following days, but nothing could be
found to explain the cause of the outbreak until September 1st, by
which time seven additional children had been attacked. On
September 1st during the daily medical examination of the inmates,
a boy, T.M., was found to be desquamating. He had been carefully
examined every day since August 29th, and it was not until
September 1st that he showed the slightest sign of desquamation,
or of anything else that suggests scarlet fever. It appears that this
boy returned to school on August 16th, and that he was not then in
robust health, having suffered during the holidays from what was
thought to be "bronchitis." I examined the boy before he was
removed to the isolation hospital, and I have no doubt that he was
peeling after an attack of scarlet fever, and that he was the cause of
the outbreak.
By the time this boy was discovered to be infectious the
disease had got a good grip on the school, and further cases
occurred, the total number being 39, all the patients being scholars
of the school. The total number of scholars at that time was 62,
56 boys and 16 girls, so that nearly two.thirds of the whole were
attacked. School outbreaks of infectious disease, due to unrecognised
cases, are of common occurrence, but it is rare even in
boarding schools for so large a proportion of the children to be
attacked as was the case in this outbreak. In the great majority
of the cases the disease took a mild form and no case was fatal.
The following is a list of the patients with dates of onset. The
onset in the case of those patients whose initials are printed in
italics was not definitely ascertained. These patients had indefinite
symptoms, for which they were isolated in an isolation ward during
the early part of the outbreak, and it was not until they had begun
to desquamate that a diagnosis of scarlet fever could be made.