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with the spread, but it was not until July 2nd that a "missed" case
was found. He had attended school throughout his illness, and
immediately after his removal the outbreak subsided. At other times
a "missed" case was found in the house, and the same phenomenon
was observed, but as the number of susceptible children was smaller,
the spread was not so extensive. In February, a school card was
received, intimating that some children were absent from Gloucester
Road, and an examination of the inmates of the house revealed the
fact that there were four persons on the premises suffering from Scarlet
Fever. A similar state of affairs was noticed in a house in the
Parade, where four children were found suffering from the disease.
Altogether 34 secondary cases were notified, but with 5 exceptions
the first and subsequent cases in the house were notified together;
in 3 instances, the patients were nursed at home, and in 2. the first case
had been removed to Hospital. In one of the latter it is doubtful
though, whether the second case was infected from the previous cases
in the house, as the first patient had been removed to Hospital three
weeks before the second developed any symptoms. In 3 houses
there were 4 cases notified from each, in 5 houses 3 cases occurred in
each, and 2 cases occurred in each of 17 houses.
There were 3, which in all probability were "return" cases. Two
of these occurred at one house in Gunnersbury Lane. The "infecting"
case had been in the Isolation Hospital for 12 weeks, and was discharged
on August 28th. Two sisters had been staying at Hawley,
and returned on September 9th; one of them developed symptoms on
September 12th. and the other on October 1st. 1 was on my holidays
when the first child was discharged from the Hospital, and could not
make an examination of the child until September 18th. On my return,
I examined the "Infecting" case, and though it was stated that
the child had had a small sore on his nostril since his discharge from
the Hospital. I could detect nothing which could give rise to infection,
except the presence of adenoid growths at the back of the throat.
There had been no running from the ears during the course of the
illness, and the skin had finished peeling some time prior to his discharge
from the Hospital. It is impossible to state positively what was
the cause of the prolonged infection, but it is probable that the germs
■were retained in the throat, owing to the abnormal condition of its
lining.