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as dangerous as severe ones from the point of view of spread of infection; probably they are even
more dangerous because the absence of marked indisposition results in the patients moving about
in public amongst other peopie who are thus exposed to risk. When a patient is severely ill with
scarlet fever he is confined to bed, the doctor is called in, the disease is diagnosed and isolation is
enforced at an early stage of the illness.
In many cases the parents thought their children were suffering from colds, and it was not
until the appearance of desquamation that the true nature of the illness was made clear. I saw a
number of cases which had not been detected and of these two were children who had attended
school regularly for a period of three weeks during which they had gone through the acute stages
of scarlet fever and had become convalescent.
The mildness of the epidemic is reflected in the low death rate from the disease; there were
only five deaths in Kensington during the whole year from scarlet fever, representing a case
mortality of 0.81 per cent. The deaths in the three preceding years being 3, 7 and 2. The five
deaths in 1920 occurred before the end of August and, from September 1st to December 31st,
during the height of the epidemic, there was not one Kensington death due to scarlet fever.
Twenty cases notified as suffering from scarlet fever were found, after admission to hospital,
not to be suffering from any infectious disease at all, with the result that they were returned home.
Immediately on receipt of a notification at the Town Hall, the home is visited by the District
Sanitary Inspector for the purpose of investigating the source of infection; children are excluded
from school and a pamphlet is left at the home advising that a doctor should be called in if any
other member of the family becomes unwell, suffers from a sore throat or develops a rash.
Disinfection of the home and any articles likely to be infected is carried out on the day
following the admission of the patient to hospital, or, in the case of a patient nursed at home, on
the receipt of a medical certificate that he is free from infection.
A child of school age is not allowed to resume school attendance until a fortnight has elapsed
since his discharge from hospital or, in the case of a child nursed at home, a fortnight after the
doctor's certificate of freedom from infection has been received.
Diphtheria.—With the outbreak of scarlet fever in epidemic form there was an increase in the
number of diphtheria cases throughout the Metropolis, but it cannot be said that there
was an epidemic of this disease. Three hundred and thirty-nine cases were notified during the
year, 322 of which were removed to hospital. The cases notified in the three previous years were
146, 163 and 274.
A pamphlet of advice is left with the parents after a case has been notified and, on discharge
from hospital or on becoming free from infection if the patient is nursed at home, a school child is
excluded from school for a further period of fourteen days.
Home disinfection is carried out as in the case of scarlet fever.
The number of Kensington deaths was 24, representing a case mortality of 7.08 per cent. In
the three preceding years the deaths were 9, 11 and 16.
Nineteen notified cases admitted to hospital were returned as not suffering from diphtheria or
any other infectious disease.
In marked contrast to the mild wave of scarlet fever being experienced in the country,
diphtheria of a severe type is presenting itself at the present time and, therefore, it is most
important to secure an early diagnosis in order that appropriate treatment can be commenced
without delay, particularly in view of the fact that the later in the course of the illness suitable
treatment begins the more likely is the result to prove fatal.
Owing to the degree of accuracy which has now been secured by bacteriologists in the
diagnosis of diphtheria, it is customary to take a that swab for bacteriological examination in all
suspicious cases, and for some years past the Council have undertaken to pay for such examinations
performed at the Lister Institute on behalf of Kensington patients.
Sterile swabs are obtained from the Town Hall, and until last Spring local medical practitioners,
after inoculating these swabs from patients' throats, sent them by post to the Lister Institute, where
they arrived on the following day. The swabs were then incubated, and the results of examination,
which were determined on the second day after the throats had been swabbed, were communicated
by the Lister Institute to the doctors by telephone or letter.
It will be seen that there was always a delay of thirty-six to forty-eight hours or more before a
medical man obtained information as to the result of the swab examination, and in a disease like
diphtheria, where an early diagnosis is of such importance, this was serious.
In order to reduce the interval which occurred from the time the doctor took the swab to the
time he obtained the result, arrangements were made during the year for medical men to leave
inoculated swabs at the North Kensington Tuberculosis Dispensary, 119, Ladbroke Grove, before
3.30 p.m., or at the Town Hall, before 4 p.m., on any day (Saturdays, Sundays and Bank Holidays
excepted). Swabs so left are collected by one of the Council's messengers, who delivers them at
the Lister Institute before 5 p.m. on the same day, and the results are telephoned to the doctors on
the following morning. On Saturdays, Sundays and Bank Holidays medical men can send swabs
direct to the Lister Institute before 5 p.m. and obtain an equally speedy result.
This scheme enables medical men to learn the result of the swab examination 24 or more hours
before the answer could be obtained under the old arrangement, and it has proved of inestimable
value to doctors and their patients.
During the year 366 throat swabs were examined at the Lister Institute at the expense of the
Council, and of these 88 gave a positive diphtheria result.