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27 cases were returned from hospital as not suffering from
scarlet fever.
The accompanying chart shows the prevalence of the disease
in each of the 52 weeks under report. The average notifications
for the past ten years are shown in green.
There were 9 deaths, which gives a case mortality of 1-6 per
cent., against o-68 per cent, in 1913. The disease, as in recent years
was of a mild type. The attack rate per thousand inhabitants
was 4·6, against 5·9 in 1913.
In 32 cases the source of infection was attributed as follow :—
Previous cases in house or family or neighbouring
houses 17
School infection 2
" Return " cases 13
In the 13 cases classified as " return" cases the source of
infection was some other member of the family or occupant of the
same house who had returned from hospital after an attack of
scarlet fever within a fortnight previous to the second case occurring,
in this case the source of infection in the second case is presumed
to be the child recently returned from hospital. The following
statement on the subject is reprinted from my Annual Report for
1907 : —" A good deal of attention has been given to these so-called
"return" cases on the part of the laity, and also by medical
authorities, the former generally being inclined to attribute it to
premature discharge from the infectious disease hospital. As stated
however, in previous reports, facts do not support this view, because
in the first place the cases are very few compared with the number
discharged, and in the second case it is sometimes those children who
are detained months over the usual time and that cannot be considered
to have been prematurely discharged who produce the
disease.
"The micro-organism which produces scarlet fever has yet
to be discovered, and the probability is that when this is made it
will be found it behaves in a somewhat similar manner to diphtheria,
and will be found to exist in the noses and throats of the patients
who either have not got the disease at all, or who have recovered
from an attack some considerable time previously. Those patients
who have suffered from complications leading to pathological
discharges from nose, throat and ears are more liable to spread the
disease than simple, uncomplicated cases."