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The methods adopted for dealing with cases of this disease, and
for prevention of its spread, are prompt isolation of the patient, exclusion
of contacts from School, at the same time keeping them
under observation, thorough disinfection, inquiries respecting absentees
from School, and instructions to parents.
In regard to the case at Orpington in March—that of a child 12
months old—the circumstances point to its being a "return" case,
i.e., contracted from another child in the family who had returned
from the hospital.
A sister of the patient was admitted to the Bromley and Beckenham
Joint Hospital with Scarlet Fever on December 21st, 1910, and
was discharged on March 4th, 1911. No cases occurred in the
family (or in the whole parish during this interval or throughout
the year) until March 15th, when the baby commenced.
The extreme incubation period is, I am aware, only 6 or 7
days, but it by no means follows that the discharged patient communicated
the disease at once; and the instructions very properly
given by the Hospital Authorities to the patient on leaving, viz.,
to go to a convalescent home or "keep" apart from other susceptible
members of the family for a fortnight, tends to prevent—and
I daresay in some cases, to actually prevent—spread of infection,
and is certainly likely to postpone it. The reliable investigation
of several hundred return cases showed that about half developed
within a week, one-quarter in the second week, and about 11% in
the third.
As regards the remaining cases up to December, there is nothing
calling for special comment.
Three of the cases in December occurred in one family at
Knockholt, and it is probable that these children (who were in the
peeling stage when notified) communicated the disease to others.
The mother pleaded ignorance of the nature of the complaint.
Sixteen cases were treated in Hospital.