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The following references were made to scarlet fever in the reports of medical officers of health—
Paddington—Analysis by the medical officer of health of the cases occurring in this
district shows that 24 were imported from without, and that apart from these and "return
cases," 269 were primary cases in households and 67 secondary. There were 200 houses with
one case, 36 with two, 8 with three, 3 with four, and 1 with five cases.
Battersea—The medical officer of health discusses a prevalence of scarlet fever in this
parish in the last three weeks of November, during which 60 cases were notified. The
disease was in the main especially incident on two districts of the parish. School attendance,
milk supply, or other common cause, failed to explain this incidence.
Plumstead—The number of cases of scarlet fever in this district was largely in excess of
the number in any year since the disease was notifiable. The case rate was ll.l per 1,000, as
compared with 4.0 per 1,000 in London as a whole. The medical officer of health, Dr. Davies,
presented to his authority a special report on the cases of scarlet fever, 76 in number, occurring
in Plumstead during the three weeks ending the 22nd February. In this report, a copy of
which was received by the London County Council, he states that the cases did not appear to
be associated with any special school or schools. He was unable to exclude milk supply from
the possible causes of the disease, one firm of wholesale vendors, supplying retail vendors
in the district, practically refusing to tell him the source of their supplies. He recommended
that the attention of the Local Government Board and the County Council should be directed
to the necessity for milk contractors being compelled to declare the sources from which they
receive their milk, and the Vestry of Plumstead in a letter to the Council endorsed this view.
In his annual report he writes that he is " still inclined to suspect that milk infection gave a
fresh impetus to the prevalence already existing at the commencement of 1899, as was also
the case eight years ago," and that the cause of the excessive prevalence during the year " is
probably to be looked for in the milk supply, and the opportunities for infection afforded by
the large Board schools."
The occurrence is discussed of " return cases," i.e., cases occurring in houses shortly after
the return home of a previous case treated in hospital. In Paddington there were nine such
cases, and the medical officer of health, Dr. Reginald Dudfield, states that in five cases the
child who was first attacked suffered from discharge from the nose, sore or crack in the nostril
or enlarged glands. The medical officer of health of Kensington, Dr. T. Orme Dudfield,
reports the occurrence of four cases of scarlet fever, following the return from hospital of an
antecedent case, a girl, who had been in the hospital for fourteen weeks. She returned in
good health, except that she had a nasal discharge. In Falliam ten, in Westminster
several, and in Stoke Newington three " return " cases occurred. The medical officer of
health of Newington discusses the subject, and thinks some special provision should be made
for the isolation of cases having nasal discharge, and that the medical officer of health should
be informed of their return home, in order that they may be watched. The medical officer
of health of Plumstead reports that 14 cases occurred within less than two weeks of the
return of an antecedent case, nine of which were within seven days of such return. " Eight
of the returned patients had either discharge from or sores on the nose; one had sores on
the face and fingers, one had a rash, and one was desquamating on thethighs."
Scarlet fever and elementary schools.
The relation of scarlet fever prevalence to elementary schools is discussed in the annual reports
relating to the following districts—
Paddington—Enquiries as to school attendance led the medical officer of health to the
conclusion that there was a greater incidence of disease on Board school children than upon
children attending other schools.
Stoke Newington—Of 178 cases of scarlet fever, "school attendance was ascribed as the
origin in 17 cases."
Wandsworth (Wandsworth parish)—An outbreak of scarlatina in the Royal Patriotic
School, which occurred at the end of 1898, was continued in the early part of 1899.
Reference to this outbreak will be found on page 21 of my report for 1899. (Putney)—The
medical officer of health gives account of an outbreak of scarlet fever affecting 55 children
in the months of May, June and July. He writes, " most of the cases occurred in the Flossstreet
and Sefton-street district among children attending the National school on the Lowercommon.
Through information I received from private sources we were able to trace one source
of infection to a child, whose skin, on examination, I found to be desquamating freely. No
sort of restriction was placed on the movements of this child, who therefore mixed freely
with the other children in the same district. It turned out that the child had been out of
sorts about a week before, but no medical man had been called in to see her, and no precautions
taken. Only a few days before she was taken ill, another child had been removed from
the flat above suffering from scarlet fever."
Woolwich—The medical officer of health states that "with the exception of 15 instances
patients or other children in the house were in attendance at school," and he shows the
number of children suffering from scarlet fever who had previously attended each of several
schools.