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20
The incidence was fairly uniform for the first half year when there
was an average weekly rate of 6-7. In the third quarter the rate was
rather less but rose to a weekly average of 9 in the last three months of
the year.
Place of Treatment.
Of the 334 cases notified, 73 or just over 21 per cent, were treated
at home at the election of the parents, a slightly lower proportion than
usual. It seemed that 30 per cent, of the cases removed might well
have been treated at home. The figures of 15 per cent, where the reason
for removal was the presence of other young children at home, 13 per
cent, because there was no bedroom for the patient to be nursed in, 12
per cent, where the patient was an adult and 10 per cent, where there
was crowding, are much the same as previous years. The increasing
extent to which mothers are out working is reflected in the larger number
of cases in which it was the fact that there was no one at home to nurse
the patient that determined the request for removal. In five instances,
in two of which the cases were actually diphtheria, the reason for
admission was the clinical condition of the patient.
Secondary Infection.
Secondary infections occurred in 23 households, in 18 there being
only the one secondary case, in three 2, in one 3, while in one home there
were altogether 5 cases. In seven instances the original patient was
treated at home. In five of the instances in which the original case was
removed to hospital, the onset of illness of the secondary preceded the
date of the removal.
Return Cases.
Return cases occurred in seven households, in most only one patient
being infected but in each of two homes two patients. Apart from
these there were three households in which the onset of illness in another
member of the family preceded the return home of the original case.
Schools and Scarlet Fever.
In the Christmas term there was a grouping of cases at four separate
schools, in each the infants' department where it seemed in some way
that the infection was related to school attendance, though in no instance
was the distribution of cases in time or amongst the different classes
more than to lead to a fear of association. In one school in September
there were nine cases but only two of these were members of the same
class. During the rest of the term there were four more cases, again
amongst different classes, though two of them were those which had
had single cases earlier in the term. Another small infants' department
had six cases over three weeks, three of the cases being children attending
the one class. From the middle of October to the first week in December
14 cases occurred in another school, four in one class and two each in
two other classes. In the last school in which there was any suggestive
grouping, in the three months September to November there were
altogether 21 cases, but of the 12 classes involved only one had as many
as three cases, and these were spread over many weeks.