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24
She had a sore throat and was sick in school on December 1st.
She did not attend school after the appearance of the rash, but four
girls from the same class-room contracted the disease. This early
infection is consistent with the views now held of the mode in which
the disease is propagated. It is generally held that the infection lies
in the throat, nose and mouth. When a person is sick, the
epithelial layer of the mucous membrane is denuded and the vomit
is almost certain to be infectious. It is important to recognise the
possibility of this early infection for disinfection purposes. Where
disinfection has been faulty or incomplete, often it may be due to
something which has been exposed to infection prior to the
appearance of the rash, and not subjected to any form of disinfection.
Other instances might be given which point to this early
infection. It is within the experience of most people that cases will
crop up one after the other in a class-room, though no "missed"
cases have occurred, and the children have not attended school after
the appearance of the rash. But some of them had attended school
with a sore throat which proved to be the precursor of the other
symptoms of Scarlet Fever. When the outbreak ceased in a class,
sometimes it is found that the last cases had a rash on a Monday or
a Tuesday and the sore throat commenced on a Saturday or Sunday.
Another factor which may affect the spread of the disease
amongst school children is the possibility of prolonged infection.
This aspect will be discussed more fully when dealing with return
cases and the recurrence of Scarlet Fever after prolonged periods in
houses, but an instance may be given of the persistence of the
disease in a class due in all probability to a prolonged period of
infectiousness in a child. J. B., of Clovelly Road, was notified of
Scarlet Fever on June 29th, and removed to hospital on the same
day. He was in the Hospital until September 3rd. He suffered
from no complications, but the reason for his prolonged detention
was the presence of enlarged tonsils and adenoids.
Five days after his discharge from the Hospital his brother was
notified of Scarlet Fever. J. B. was examined on September 8th,
and the probable conditions which would give rise to a "return"
case, were the enlarged tonsils and adenoids. There was also a
slight discharge from the nose, but no abrasion. At the end of three