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next week. On two occasions four cases occurred distributed
through three consecutive weeks. Twice three cases occurred in
one department in the same week, and on another occasion three
cases in one week were followed by one in the next week. On
one occasion three cases in one week had been preceded by one in
the previous week, and were followed by one in the next week.
Such groupings at the time of their occurrence are suggestive
of school infection, but this is discounted when no subsequent
cases occurred. It will be appreciated that these groupings are of
cases occurring in the same department of a school and not in the
same class. It is improbable that many of these infections were
due to school attendance.
The following notifications from children attending the same
department were received in successive weeks:—1, 5, 0, 0, 0, 0,
3, 1, 2, 0, 0, 1. In the infants' department of this school during
the same weeks the following number of cases occurred:— 1, 1, 2,
1, 1, 0, 0, 0, 0, 0, 1, 1. The five cases occurring in one week
suggested a school infection, but no suspects were found on
examination. The probability is that the last four were infected
from the first patient as the onset of the illness in the case of all
four was distributed over only two days. The smouldering in two
departments suggests rather an infection due to outside contact.
A similar smouldering occurred in an infants' department of a
school of the older type of building in which the following numbers
occurred in successive weeks:— 3, 0, 1, 0, 2, 2, 0, 1, 2, 0, 0, 1, 1,
1, 1, 0, 0, 1. The cases, while occurring in the same department,
were scattered irregularly through the different classes comprising
the department.
In a new school building on the edge of the district a number
of cases occurred in the autumn. Of the 11 children affected 10
lived in the neighbouring district. The cases were spread over
some 10 weeks, and five separate classes were affected.
In February four cases were notified amongst the children
attending a private school. Examination of other pupils showed
that five in attendance at the school were missed cases. One of
these cases further infected another three patients not at the
school.
During late October and November a total of seven cases of
scarlet fever occurred in a private school of some 76 pupils. The
October case was last in attendance on the 25th and his onset was
given as the 26th. The onset in the next case was the 6th November.
Then followed two more cases and then three with their onsets of
either the 15th or 16th November. The school was closed for a
week and on reopening another case occurred with the onset of 29th
November. A number of classes were affected, none of these
apparently mixing inside the school. Apart from one boy who
showed some roughness of the skin no other suspects were found.
The relatively high incidence of cases amongst pupils attending the