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In 53 cases the source of infection was attributed as follows: —
Previous cases in house or family
31
From friends (visiting)
5
" Return " cases
15
Playmates
2
In addition to the above, in 10 cases there was history of sore throats in the family
previous to the case of scarlet fever, but there was no proof that these originated the scarlet
fever or, in other words, that they were mild cases of that disease, and in 8 cases there was a
history of a patient having returned from hospital recently in the same building or street. In
these cases the connection between the returned case and the fresh case was too indefinite to
draw any conclusion.
By " return " case referred to in above table is meant a case caused by a return into a
family of a case recently convalescent from scarlet fever. These cases have been the subject of
a great deal of investigation. The first investigation on a large scale was by Professor Simpson
on behalf of the Metropolitan Asylums Board. This was followed by another by Dr. Cameron
in the same connection, the results of which for some reason or other have not been yet
published by the Board. More recently, the matter has been investigated by Dr. Newsholme,
of Brighton, who has the advantage of being both Medical Officer of Health and Medical
Superintendent of the fever hospital of Brighton.
When this source of infection was first brought into prominence, it was thought to be
a hospital phenomenon, and it was surmised that on cases being sent to hospital they returned
home in a more infectious condition than if they had been nursed at home, i.e., that if a mild
case, which would soon get rid of the infection, is put into a ward along with severe cases it
harbours the infection of the severe case in its throat or nose; this aggravates the inflammation
in these parts, so that when the case is sent home it immediately infects others. Different plans
have been tried from time to time to obviate this, such as keeping the convalescent children in
wards by themselves for some time before sending them out, sending them away to convalescent
homes and treating mild and severe cases in separate wards. Notwithstanding all these efforts
" return " cases still occur and will probably continue to occur until the infective microbe of
scarlet fever has been discovered and a ready method of proving its presence or absence has
been found. Unfortunately there are at present no reliable statistics on "return" cases in
private practice, though such do undoubtedly occur. The whole matter, is still
sub judice, and at the present time the opinion seems to be that the source of infection in these
cases is not the peeling, but that the poison lingers in the throat, the crypts of the tonsils and
other hollows or sinuses of the nasal passages and that under certain conditions, as the occurence
of sore throat, cold, nasal catarrh, in the patient, it again becomes active and liable to
infect others. In the cases which occurred in Bermondsey this is borne out by the fact that in
no case did the parents state definitely that they found a discharge from the nose or ears when
they went to the hospital for the child, and that in those cases in which a discharge occurred it
came on after the child had been home some time. In one case infection appeared to be caused
by a small abscess in the tear duct, which burst a couple of days after the return of the patient.
In some cases no discharge of nose or ears was visible at any time in the case which was
supposed to cause the infection.
The percentage of these "return" cases to the total notifications is small in any case, the
numbers being, 1901, 3 per cent.; 1902, 2.2 per cent.; 1903, 1.5 per cent., and 1904, 3.3 per
cent.
Whatever will be found to be the ultimate explanation, I am quite convinced that it is
not due to carelessness or premature discharge from the Board's hospitals, and that the Medical
Superintendents are doing everything in their power to prevent their occurrence.
Extra precautions were taken by me during 1903 to prevent the occurrence of these
cases.
The Board, at the request of the Society of Medical Officers of Health, furnish us with
the names and addresses of patients about to be discharged from their hospitals, a day or two
before they are sent out, and I am in the habit of sending by post a letter, advising that the
patient should not be sent to school for 14 days after return, that he should sleep alone, and
during the day be in the open air as much as possible.
Enteric Fever.
73 cases of this disease were notified in 1904, being 42 for Bermondsey, 29 for
Rotherhithe, and 2 for St. Olave's.
This is a slight diminution on 1903 when the number notified was 76. of the 73 cases
notified, 7 were returned from hospital as not suffering from that disease, making the actual
number of cases 66, which is one more than the actual number in 1903.
On inquiries being made by the inspectors the sources of inspection attributed mostly by
the patients were as follow : —
(a) 1 patient had eaten oysters recently.
(b) 1 „ mussels and whelks.
(c) 2 „ cockles.
(d) 3 „ fried fish.
(e) 1 " tinned salmon.
(f) 1 " frequently went to Borough Market, where he obained quantities
of unwholesome fruit.
(g) 1 „ complained that at Whitechapel Station where he is employed
the platform became foul with the liquid from fish trunks.
(h) 8 attributed to previous cases.
(i) 3 „ a doubtful illness occurring in the house before, which may have
been a mild form of enteric.