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The reports of medical officers of health show that prosecutions for the wilful exposure of
a scarlet fever patient in a public place were successfully instituted in Holborn and Mile-end Oldtown.
The medical officer of health of Westminster reports that two unnotified cases of scarlet
fever were brought to his knowledge by the librarian of the public library, and that the patients
were scaling freely at a time when they were borrowing books. The medical officer of health of
Fulham states that a medical man was fined two guineas for failing to notify a case of scarlet
fever.
The following references are made to "return " cases—
Paddington—There were 11 cases of scarlet fever following the return home of patients
sent to hospital for isolation. The cases were visited by the medical officer of health in company
with Dr. Simpson, who was making inquiry into the subject generally for the Metropolitan
Asylums Board. Dr. Reginald Dudfield states that "In connection with the return cases of scarlet
fever, the most frequent feature appears to be the occurrence in the home-coming patient of nasal
catarrh, usually associated with cracks round the nostrils, and enlargement of the glands of the
neck. In several cases the patients appear to have had colds immediately after their return. It
would appear that the infection was derived from the nose and throat rather than the desquamation."
Fulham—In 14 instances the disease recurred within 10 days of the return of a child who
had been discharged from one of the hospitals of the Metropolitan Asylums Board.
Shoreditch—In four instances the disease recurred after the return of a patient from the
hospitals of the Metropolitan Asylums Board. In one of these cases there was strong evidence that
the later case was due to infection by the earlier. In. the other cases the evidence did not amount
to more than suspicion.
Scarlet fever and elementary schools.
Reference to the subject of infection through school attendance is found in the reports relating
to the following districts—
Paddington—The medical officer of health gives account of the distribution of cases of
scarlet fever, and refers to a series of cases occurring among children attending the Harrow-road
Board School, concerning which he gives particulars. The cases, 19 in number, occurred at
intervals extending over 10 months, and were almost entirely limited to the girls' and infants'
schools, only two cases occurring among children attending the boys' school.
Chelsea—The medical officer of health states that "The fall in notified cases following the
closure of the schools (Board Schools on the 21st July) was well marked, especially in the last
three weeks of August.
Stoke N ewington—Of 146 cases occurring in 109 houses school infection was ascribed as the
origin in 16 cases.
Hackney—There were 23 cases of scarlet fever notified among the children attending the
St. James' Parochial School. The medical officer of health states: "The outbreak appears to me to
be a typical instance of school influence in the spread of the disease. The first cases were notified
in the second week of May, and subsequent cases of one to four a week during the following eight
weeks. The school closed at the end of July, 'with the satisfactory result of causing the disease to
disappear from the school.'" The medical officer of health reports that he found " That all the
standards were in one room and seated in the following manner: The 1st and 2nd standards were
seated at four long desks, made to accommodate 10 each; the 3rd standard were seated at desks
made for four each; and the remaining standards at desks to accommodate five each," and he expresses
the opinion that in each school each class should have a separate class-room, and each child
a separate seat and desk, with a space between each seat of about two feet, and the floor space for
each scholar should not be much less than 15 square feet.
Lamleth—A private school with an average attendance of 25 children was closed in May on
account of scarlet fever prevalence among the children.
Reference is also made to the following outbreaks of this disease in schools in which the
children were resident.
Bethnal-green—Among the notified cases in the east district were 20 at the Children s
Home in Bonner-street.
Wandsworth (Wandsworth)—An outbreak of 117 cases of scarlet fever in the Royal
Patriotic School is reported. Four cases were recognised between the 19th and 21st November
occurring in different dormitories. At the end of December 42 children were found to be desquamating,
and later a number of other children, the medical officer of health coming to the conclusion
that 110 cases must have been infected on or about the same day. Inquiry was made as to
the milk supply, with negative results, beyond the fact that of 12 farms from which milk was received
shortly before the outbreak, scarlet fever had occurred in the neighbourhood of one of them,
but not on the farm, or among the farm servants. The milk had been subjected at the asylum to
a temperature of 180 degrees Fahrenheit for 20 minutes before being given to the children, and the
medical officer of health, who came to the conclusion that the milk was the cause of the outbreak,
attributes the exceptional mildness of the outbreak to the partial sterilization of the milk by the
cooking process. He made the practical recommendation that the managers of the asylum should
be daily informed of the farm from which the milk is obtained.
As in previous reports, I have shown in diagram VIII. the number of cases of scarlet fever
appearing in each weekly notification list in relation to the mean of the year in three age-groups,
viz0—3, 3—13, and 13 and upwards, these age-groups representing generally the pre-school age,
school age, and post-school age. The summer holiday of the London School Board schools began