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32
this time to the end of the year there was a steady fall in the notifications,
with the exception of a rise in the month of November. At
the end of the year the incidence had almost reached its normal
point. These facts are shown graphically in the accompanying
chart.
The special feature connected with this outburst of scarlet fever
is its relation to schools and school attendance. The outbreak may
be said to have begun in the first week in June, steadily increasing
until the last week in July, when a considerable fall took place,
which was continued until the last week in August, after which
the disease rapidly increased as described above. The period of
remission during the month of August corresponded very closely
with the summer closure of the schools, and the subsequent increase
with their re-opening. Other evidence pointing to this outbreak
being largely due to school attendance is forthcoming in the fact
that not a few cases of desquamation were found amongst scholars
still attending school— the discovery of such cases usually following
the notification of some case of scarlet fever. An examination of
the chart seems to show that the outbreak began before the Midsummer
holidays, but that these holidays were insufficient to stop
the course of the outbreak. From the point of view of preventive
medicine, I think this outbreak affords an illustration where the
medical inspection of scholars prior to the resumption of school
work would have been of immense value in preventing the spread
of infectious disease. One is constantly meeting with this rise in
the incidence of infectious disease immediately after the long
summer holidays; and in this particular case I am of opinion that
if it had been possible to examine all the children attending the
infants' departments at the opening of the schools, the outbreak
would not have assumed the proportions it did. In private schools,
after long holidays, no child is taken back unless provided with a
certificate that the child is free from infectious disease and has not
knowingly been exposed to such during the holidays. I do not
think it is practicable to apply this system to the Council's schools: