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114
Medical Officers of Health Annual Report.
of an infectious nature. Inclusive of the above case,
31 notifications were received between March 6th and
18th, and 13 deaths resulted, a percentage of nearly 42.
The first case which was the cause of the outbreak
proved fatal, and of the 11 cases primarily infected by
this 7 died. In seven cases the first symptoms appeared
on the evening of March 4th, and of those 6 died; in
four on March5th, with 1 death; and in four on the 6th,
with 1 death. These 15 cases were all infected at school
on March 2nd, 3rd, and 4th, and, as might have been
anticipated, were the cause of other cases, not only in
the same households, but in others. One monitor, a girl
aged fourteen years, was infected on March 5th, as on
that date in school she nursed one of the previously
infected cases who had turned ill, and the first symptoms
appeared on March 8th. The type of disease in the early
cases was more virulent, but the secondary and tertiary
cases were of a milder type. In all, twenty-five households
were infected, but, owing to prompt diagnosis,
notification and isolation, the outbreak did not last long.
The disease was so virulent and the symptoms in the early
stages were so definite that prompt isolation was at once
carried out, with the result that in these households only
two had secondary or tertiary cases. The school was
closed on March 8th for twenty-one days, and after that
date thirteen cases were notified, but of these four cases
occurred in households previously infected. An analysis
of the other nine cases showed that two in whom the first
symptoms appeared on March 9th had been at school on
the 5th and 8th, while the remaining seven were all
ascertained to have come in direct contact with some of the
previously notified cases. The last notification from this
part of the district was received on March 22nd, the first
symptoms having appeared on the 20th. and the outbreak
subsided almost as rapidly as it had commenced. In nine
of the houses where cases occurred sanitary defects were