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19
It is most difficult to attribute the spread of Scarlet
Fever to any main source, and evidence seems to point to
the infectivity varying considerably in different instances.
It would appear probable that the disease is most
infectious during the early period of sore throat, rash and
fever; yet in spite of this a child was found in the late
peeling stage, possessing a very definite history of an
attack of Scarlet Fever, living in rooms, with six young
brothers and sisters, none of whom contracted the disease.
These children had never previously suffered from the
•disease, and they had all been quite well during, and some
time before the patient was attacked.
Again, in 1924, a child contracted Scarlet Fever whilst
one of a party of 45 girls of St. Peter's School, who were
together at Broadstairs. This child was not diagnosed as
Scarlet Fever until the third day of the disease, and had
been in close contact with the others, yet no further case
occurred. Further similar instances might be quoted, but
I am of opinion that the disease is usually most infectious
during the period of sore throat and fever.
One is also led to suspect that the disease is spread by
" missed " cases, and those not recognised until late in the
disease. From time to time children are discovered in the
peeling stage at school or at the Clinic, and many cases
are not notified until desquamating, no medical practitioner
having been summoned until this stage is reached, the
parents regarding the original vomiting, etc.t as a
bilious attack. "
In spite of this failure to recognise the disease or late
diagnosis, these cases have not formed a nucleus of any
outbreak, and therefore it is very doubtful whether
"missed " cases aid in its spread to any marked extent.
Over the period under review, no definite evidence has
been forthcoming that healthy carriers are the cause of the
spread of the disease.
Occasionally, the source has been suspected in a class
at school; and during 1925 three cases occurred in one
class at St. Paul's Infants' School. All the children were
medically examined, and three infants were excluded, as
they had sore throats and had vomited. These infants were
kept under observation, but none of them developed a rash
or showed any signs of desquamation subsequently.