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26
The distribution of the disease in Clerkenwell has been fairly
uniform. There have not been any marked groups of cases, as not
infrequently occurs in Scarlet Fever. In only ten families was
there more than one case in the family. Disinfection has been
regularly carried out in all cases, and isolation to hospital whenever
possible. Every case has been promptly investigated and it
has been found that the patients attended about twenty different
schools and obtained their milk-supply from upwards of 40 different
milkshops (more than 40 of the patients using condensed milk).
The two common channels of Scarlet Fever infection, schools and
milk, cannot therefore be held so largely responsible as in previous
years. There have been, as far as could be observed, no "return
cases " of Scarlet Fever from the fever hospitals.
The only "outbreak" of Scarlet Fever occurred at Muswell Hill.
During October 12 cases were notified in this detached portion of
the District. The first intimation received was the notification on
October 3rd, of three children belonging to one family living in
Muswell Avenue. The last notification was received on October
27th. In all seven families were involved. In the first nine cases
either the patient or some member of the family attended the same
elementary school, and other cases attributed their infection to
another school. Neither of these schools came under our
supervision.
Like Measles, Scarlet Fever falls most heavily on children under
five years of age (eight of the ten cases of death quoted above
occurred under five years of age) and this points to the importance
of protecting such children from exposure to infection. It is not
only in the infants' departments of schools, nor only through the
milk supply that Scarlet Fever is conveyed. Children, especially
in crowded localities, play together, in the streets, courts, yards,
and gardens, wear one anothers scarves and jackets, lend each
other whistles, trumpets and toys, and in a hundred different ways
come into close personal contact with each other. The unrecognised
cases in whom the rash has not come out, may by these
means, spread infection far and near. Such conveyance is
almost entirely beyond control. But there is another point where
considerable control may be exercised. When a case is notified