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In other words, 897 cases of scarlet fever occurred in 694
houses, two or more members of the same family or persons living
in the same house being infected. In a large number of cases the
source of infection was traceable to the presence of a mild, unrecognised
case. The difficulties of diagnosis was greatly increased by
the markedly mild type of infection, giving in the early stage very
slight symptoms, which was a characteristic feature of a considerable
number of cases occurring in Battersea in 1913 ; and this was
undoubtedly an important factor in the manner in which the
disease was spread.
An outbreak of scarlet fever occurred at the Royal Masonic
Institution for Girls, St. John's Hill, in November, ten cases being
notified between the 20th November and 4th December. The
outbreak occurred in the Senior School. Owing to the excellent
arrangements for isolation prevailing at the Institution and the
prompt steps taken to limit the spread of infection, the course of
the outbreak was rapidly checked—a very satisfactory result,
having regard to the large number of children resident in the
Institution. Careful inquiries failed definitely to trace the source
of infection. It is probable that the infection was introduced from
without, but in what manner it was impossible to ascertain.
"Return cases," i.e., cases infected by a patient recentiy discharged
from; hospital, were slightly less than in the previous year,
the percentage of ''return cases'' to total cases being 3.4, as compared
with 3.5 in 1912. The number of cases sent back from
hospital notified as scarlet fever, and in which the diagnosis was
found to be erroneous, was 52, or 5.4 per cent., as compared with
7.5 per cent, in 1912.
In the next table are shown the case-rate per 1,000 of the
population and the case-mortality (i.e., the proportion of deaths
to attacks) in 1891 and subsequent years:—