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As usual a number of children were not known to be
suffering from the disease until peeling was noticed, when a
medical man was called in. This is not surprising when it is
realised that in a mild case it is only possible to make a satisfactory
diagnosis during the acute stage (which may not last
more than a day or two), and when desquamation commences
a week or so later. If the child is seen in the meantime it is
impossible to give a definite opinion.
Several of what are known as " missed " cases were found
in consequence of the arrangement made between the Education
and the Public Health Authorities whereby the Head
Masters and Mistresses notify to me all children sent home
from school, when found unwell either by the School Medical
Officer, nurse, or teacher. The house is then visited and the
parents advised to call in their own medical attendant, and
in all suspicious cases to keep the children at home, and
isolated as far as possible for periods varying according to
the circumstances. The disinfection of the rooms, bedding,
etc., is then carried out by the Sanitary Authority.
There have been several return cases (that is, cases of
Scarlet Fever which occur in a house after the return of a
patient from the hospital, or, if isolated at home, after his
or her reception again as one of the family); these occur in
all towns and from all isolation hospitals in a varying degree,
and it is generally admitted that they cannot be entirely prevented,
even though the period of detention be prolonged to
many weeks, the chief difficulty encountered being that there
is no certain indication when infection ceases. Formerly it
was thought that when completion of desquamation was
reached infection had terminated, but it is now recognised
that in many instances the infectivity has disappeared before
this stage, whilst in others it remains long after. The discharges
from the nose and ears are found very infectious, and
in some instances persists for several months, it being impossible
to say just when this ceases.
It is also probable that occasionally secondary cases arise
owing to some of the patients' toys, books, or clothing having
been put away instead of being handed over for disinfection,
which are, on the child's return, brought into use.
Diphtheria.—Notifications of 94 persons suffering from
this disease were received during the year, the attack rate
being 1.7 per thousand of the population. This rate is .1
above last year, and the highest with one exception (1902)
since the year 1891. The attack rates in the various wards
were as followsDundonald, .61; St. John's, 1.08; St.
7