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scarlet fever.

In 19 instances 2 or more cases were reported in the same household on the same day»
viz., 2 cases from 17 families (out of 35) and 3 cases from 2 families. In 7 houses the
infection spread to a second family occupying the same house, and in 6 other instances
the secondary cases were due to discharged patients.
As to the 2 houses with 6 cases each:—
One was an institution in which the three first patients sickened on 18th Nov., the fourth on 19th Nov., the
fifth on 23rd, and the sixth on the 20th. The fourth case was the first diagnosed as scarlet fever.
In the other household two families (Bu. and Ba.) were infected. The sequence of the cases is indicated
below:—
m. 4 (Bu.); sickened 9 ix.; to hospital 16 ix. m. 6 (Bu.); sickened 15 ix.; to hospital 16 ix.
f. 4 (Ba.); „ 14 ix.; „ 16 ix. m. 29 (Ba.); „ 10 ix.; „ 17 ix.
f. 1 (Bu.); „ 15 ix.; „ 17 ix. f. 1 (Ba.); „ 25 ix.; „ 26 ix.
The delay in isolating the first case was undoubtedly the cause of all the others.
In the following instances second attacks of the disease were reported, with the usual
symptoms of rash, &c.:—
W.H., m. æt. 20; sickened October 17th, 1904; to hospital October 20th. This patient was said to have
had an attack "17 years ago,"but the complete history of that attack could not be obtained.
R.N., m. act. 9; sickened May 4th, 1904; to hospital May 5th. Previous attack March 14th, 1903 (when a
sister and brother had the disease); to hospital March 17th; discharged May 8th.
M.S., m. set. 11/12; sickened October 22nd, 1904; to hospital the same day. Previous attack January 29th, 1904
(a sister also attacked then) at age of 6 weeks; to hospital January 30th; discharged March 7th.
A.W., f. æt. 7; sickened March 11th, 1904; to hospital March 14th. Previous attack January 17th, 1902;
treated at home.
As regards the first and last cases the accuracy of diagnosis in the earlier attacks could
not be verified. The diagnosis of the second attack was confirmed in each case after
removal to the Asylum Board's Hospital. In the other two cases the diagnosis was confirmed in
both the first and second attacks. The case of M. S., who had two attacks of the disease in
the first year of his life, is very remarkable. One attack of the disease is generally held to
confer complete immunity for many years, if not for life.
During January and February outbreaks of the disease occurred among the inmates of
the Workhouse Infirmary, 9 cases being reported. The particulars are given below;—
C.D., m. æt. 3; admitted to Infirmary Jan. 11, 1904 ; removed to hospital Jan. 14.
C.O., f. æt. 25 ; on Staff; „ Jan. 14.
R.W., m. æt. 8/12; admitted to Infirmary Sept. 5, 1903; „ Jan. 21.
R.K., f. æt. 10; „ Sept. 14,1903; „ Jan. 21.
L.M., f. æt. 5; „ May 20, 1903; „ Jan. 21.
C.P., m. æt. 4; „ Jan. 14, 1904; „ Feb. 1.
A.B., f. æt. 3; „ Dec. 7, 1903; „ Feb. 8.
H.P., f. æt. 1; „ Aug. 27,1903; „ Feb. 8.
B.K , f. æt. 4; „ Sept. 19, 1903; „ Feb. 8.