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The excess in St. Olave's was mainly due to an outbreak of scarlet fever in Parish Street
Workhouse. The outbreak consisted in all of 18 cases, and occurred in Ward 27 of the Workhouse,
which is devoted to small children. It occurred in two parts, separated by an interval of
a little over a month. Part one commenced on May Ist, when K. G., female, 6 years of age,
developed scarlet fever. The source is quite obscure since she had been an inmate here since,
February 14th, 1902, and had not been visited recently. This case was followed by two more on
May 3rd, one May 13th, and one May 18th.
The second part of the outbreak began on June 21st, and the following account after
special investigation was given to the Public Health Committee on July 14th: —
"A second small outbreak has occurred among the children in Parish Street
Workhouse. The last case of the previous outbreak occurred on May 18th, and on this
date the children were moved from the infected Ward, No. 27, to Ward No. 41.
" On -June 11th they were moved back to No. 27, and on Sunday morning, June 21st,
J. 8., 1 3/12 years, took ill with what subsequently proved to be scarlet fever. He was
removed to hospital on June 25th. This case was followed on the 24th and 25th by
two other cases, and up to July 3rd there have been 13 cases in all. On the occurrence
of this second outbreak the children were again moved to Ward 41. I visited the
Workhouse on July 2nd, and investigated the outbreak. It seems that visitors who
had been excluded from the Workhouse owing to the previous attack were again
admitted on Sunday afternoon, June 21st, from 2 to 4 p.m.
"As this first case evidently sickened in the morning of that day, the outbreak
cannot be considered due to the visitors.
" On visiting Ward 27 in which the first outbreak occurred, I found it had been
sulphured in the usual way, the bed and bedding disinfected in the Council's disinfector,
and the floor washed with soap and water. I found, however, in it a large mat, several
waterproof sheets, a number of small boots, and various articles in the cupboard, which
had not been subjected to steam disinfection, and could not be considered adequately
disinfected by sulphur.
"As the outbreak occurred 11 days after the children were moved into the ward, I
considered that these articles may have been the source of infection in the second
outbreak.
"Instructions were consequently given to have the room again fumigated,the mat
disinfected by steam, the other articles in question destroyed, and the furniture and
floors thoroughly soaked in a 2 per cent, solution of " miscible " carbolic acid.
" The last case, which occurred on July 3rd, died suddenly at the beginning of the
illness, before removal. The body was immediately wrapped in a strong solution of
carbolic acid, and removed to the mortuary, Parish Street, pending burial, There are
eight contacts still under observation, and so far no other cases have occurred.
No more cases followed this one.
Out of the 400 cases notified there were 25 deaths, making a case mortality of 6.25 per cent,
against a case mortality of 3.7 in 1902. Thus the cases in 1903, if fewer in number, were more
severe in type.
The attack rate per thousand living was 3.08, as compared with 3.8 in 1902.
As regards the distribution in time the greatest number, as seen by the accompanying
chart, occurred in the first and third weeks of March, and the third week of June, otherwise the
distribution was fairly even.
As sources of infection the following table is the result of enquiries by the inspectors : —
45 from previous cases in family.
21 from school playmates.
6 from cases recently returned from hospital.
2 from playmates.
1 0patient came from barracks at Portsmouth where several cases had occurred.
The percentage of " return " cases (that is, cases due to, or rather, occurring within 14
days of the return of a brother or sister from one of the Board hospitals after recovery from
scarlet fever) appear to be diminishing. The percentage alleged to be due to this cause was
3 per cent, in 1901, 2'2 per cent, in 1902, and 1.5 per cent, in 1903.
The following notes from my diary of the origin of a-case of scarlet fever illustrates the
difficulty of finding out the source of infection, and at the same time emphasise my view that a
,great many cases of infectious disease originates from mild unrecognised attacks (vide report on
typhus fever): —
"On December 9th, 1903, I was requested to see E. S. (f.) 17 years of age, with a
scarlet fever rash. I found her on this date with high fever, sore throat, and wellmarked
rash, and on enquiry as to the origin, was given the following history:—
"November 10th, 1903, (Tuesday). B. S., 5½ years, male, took ill with shivering;
Wednesday, lay about, with loss of appetite, thirst, sore throat (" ulcerated," according
to the mother, who examined it). This lasted 8 or 4 days. Skin looked " muddly,"
as if there were a rash under it, but no distinct rash was visible, skin itched. After
recovery nose was sore ; whole illness lasted about 10 days. On December 12th hands
were skinning.
" November 30th, 1903. W. S., 12 years, male, took ill at school, was sick and
shivering all day, lay about, languid and heavy, " ulcerated " throat a few days. Skin
" muddly," loss of appetite, sores about mouth. On December 12th, when I saw him,
looked ill, and some skinning about the fingers.
December 2nd, 1903. H. S. 2½ years, female, had sore throat, loss of appetite,
no appearance of rash, but seemed to have same symptoms as others, diarrhoea came
on later and still continues.
December 5th, 1903. E. S., 17 years, female, well marked, attack of scarlet fever.
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