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inanimate objects contaminated by the exhalations of the infectious
patients might be infective. If this procedure were necessary to eliminate
this infectiousness, then the abandoning of the practice should have
resulted in an increase in those secondary infections not the result of
direct infection from the patient in his infective stage. Also it probably
would have resulted in an increase in the number of return cases. Secondary
infections this year are on much the same scale as other years, and,
as has already been pointed out, can be assumed, because of the relationship
of the onset of the secondary to that of the primary case, to be mostly
attributable to infection by the original patient.
Return Cases.
Return cases are those which occur in a household, to which has
returned a patient discharged from hospital in which he has been treated
for scarlet fever within 28 days of that return. The period is a purely
arbitary one. It is assumed that the vast majority of these infections
occur because of the infectivity of the patient who returned home. In
very many cases it is found that he has, since his return, developed some
abnormal state, mostly a nasal discharge, though occasionally an
otorrhoea. Though more common in epidemic times the rate remains
fairly uniform, and seems to be unrelated to the hospital régime. This
year there were no return cases.
Schools and Infection.
Scarlet fever is another of those diseases which might be spread in
schools by an undetected carrier. Sometimes a group of cases in a class
will by examination of all the pupils lead to the detection of a suspect
whose exclusion is followed by an abatement in the incidence. In other
cases a study of the register to detect absentees might throw suspicion
on a child with a doubtful history. Most often, though, in spite of there
being suspicious groupings of children attending the same class falling ill
about the same time no carrier can be detected. Detection is of course
very much more difficult in the case of the large school of to-day, with the
meetings of children in places even in that school other than the classroom,
apart from their meeting outside in Sunday schools, clubs or cinemas.
On the other hand, even a succession of one case in each of four consecutive
weeks such as occurred in an infants' school in the spring term, assumes
less importance when it is realised that in that department there are
hundreds of children, and more particularly when different classes are
involved. In the summer term the eight cases spread over eight weeks
in Roxbourne school were the only suggestive grouping. In the autumn
term there was again only one primary school involved, namely, Pinner
Park. Three cases of the last two weeks in October were followed by a
clear week, but this by the occurrence of six cases. One in the following
week was followed by another three in the next week. Many, but by no
means all, of the children were scholars of one class. Inspection failed to
detect any but one child suspected of developing the disease. Two weeks
of freedom was then followed by one case.