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80
Scarlet fever is still a communicable disease, and in nine households
there was a secondary case. In four of these, removal to hospital of the
first patient as soon as he was recognised to be suffering from this infection
would not have avoided the infection being passed on to the other
patient as this second patient had already been attacked by this time
and in fact in two instances both patients were diagnosed together. In
three cases removal of the primary case would probably have avoided
the infection of the other patients in the house because in these instances
the interval between the onset of the infections were longer than the usual
incubation period, being ten, nine and fourteen days. In the remaining
two households where there were secondary cases the intervals between
the onsets of illnesses in the two sets of patients were forty-six and thirtytwo
days. In neither instance was there any person who gave a history
which might suggest that he was a missed case, and so provide a link
in the two cases in the household.
Occasionally a child succumbs to the infection some days after the
return home of another child who had been removed to hospital suffering
from scarlet fever. Where a second child falls ill within twenty-eight
days of the return home this is classed as a returned case, the patient
being presumed to have been infected by the returning child. There
was one such case this year. The primary case had been admitted to a
hospital for some other condition and there developed scarlet fever, so
she was transfeired to an infectious diseases hospital. Ten days after her
return home her mother succumbed to an attack of scarlet fever.
It is quite exceptional these days to have an outbreak of scarlet
fever amongst pupils at a school where it is accepted that the infection
must have been contracted at the school. Nevertheless, groupings of
cases do occur which suggest this possibility. This is the more marked
where there are over a period a number of cases amongst pupils at a school
quite out of proportion to the incidence of infection in the district as a
whole. These groupings might be of one of two patterns. The one is
the occurrence of a number of cases over a short space of time. The other
is the occurrence of small numbers of cases, one or two each week,
spread over a number of weeks. This disproportionate distribution of
cases amongst pupils of a school is suggestive, but becomes much less
so when the cases are broken down into the various classes the children
attend. It is then so often found that there is no undue incidence amongst
those attending any one class. There was last year one instance of the first
type of grouping. This occurred at Priestmead School in the last three
weeks of the summer term; in the Infants' department there were five
cases, in the Junior, two. There were two instances of the drawn-out
grouping, both occurring in the Autumn. Over a period of eight weeks
there were five cases of scarlet fever amongst children in the Infants
department of Pinner Park School and over the same period four amongst
those in the Junior department. The other occurrence was at Vaughan
Road school where, over a period of eight weeks, there were seven cases,
two occurred in one week; there were no notifications at all in each of
two weeks and one notification in each of the other weeks.