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22
Deaths.
No deaths occurred in this district due to scarlet fever.
Place of Treatment.
Of the 618 cases notified, 195 or 30 per cent. were treated at home at
the election of the parents. Of those removed, it seemed another 44
per cent. might have been so treated. In 22 per cent. the reason for
removal was the presence of other children at home; in 4.5 cases there
was no room for the patient to be nursed in; in 6 per cent. the patient was
an adult, and in a further 6 the homes were crowded. In one instance only
was the reason for admission the clinical condition of the patient.
Secondary Infection.
Secondary infections occurred in 32 households, in four of them
there being two cases but in the remainder only one. In twelve instances
the original patient was treated at home. On 8 occasions the onset of
illness of the secondary case preceded the removal of the first patient
to hospital, while in a further 5 the onset was on the day of removal.
There were two instances of simultaneous onset in two children.
Return Cases.
Return cases occurred in 14 households, only the one patient being
affected in each home. In one instance the onset of the illness in the
presumed infected child was on the second day from the return home
of the primary patient, in another the sixth, and in another the eighth
day. The onsets in the case of two were in the first half of the second
week and of five were in the latter part; of one in the third, and of five
in the fourth week. The condition of all but four patients who returned
home was normal; of these four, three developed a nasal discharge
and one epistaxis. In addition there was one household in which the
onset of illness in another member of the family preceded the return home
of the original case.
Schools and Infection.
In the Easter term there were no groupings of cases in the schools to
suggest that school attendance played any part in the spread of infection.
In the summer term many cases occurred in one department in the six
weeks June to mid-July, the 23 cases notified being distributed through
8 classes, in one of which there were 9 cases spread over six weeks, not
more than two cases occurring in any one week. At another school in
the early part of this term one case in each of three consecutive weeks
was followed by four in one week, while later in the term at another
school two cases occurred in each of three successive weeks.
In the last term of the year, particularly when the infection was
more prevalent, many schools had groupings of cases not at any time
reaching large dimensions, but smouldering with sufficient activity to
suggest that school attendance influenced the onset. Some such grouping
on a greater or smaller scale was found during this term in ten schools.
Of those with limited groupings are included : (1) a school where 5 cases
were distributed in 4 weeks—1, 2, 1 and 1 cases ; (2) one with an incidence
of 3, 1 and 1 ; (3) one with a 2, 0, 1 and 2 distribution ; (4) a school where