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In the majority of instances, the secondary cases occurred because the
primary case was isolated at home, or was not promptly notified and removed
to hospital.
Return Cases of Scarlet Fever.
Of the secondary cases of scarlet fever, five were "Return" cases, i.e.
cases which occurred in a house soon after the return home of a patient from
hospital. These included two cases apparently infected by a patient who had
returned home to a tenement on the same floor of a large block of dwellings,
and had discharge from the ear. There had been no other case of scarlet
fever either in the dwellings or at the school for many weeks.
Errors in Diagnosis.
During the year 13 patients were returned home from the Metropolitan
Asylums Board Hospitals reported as not suffering from scarlet fever; four of
them on the same day or day following their admission, and the remainder at
various periods from one to seven weeks.
Recommendation for Local Government Board Inquiry respecting
Scarlet Fever.
At the latter end of the year, the Metropolitan Asylums Board passed the
following resolution
" That in view of the continued prevalence of scarlet fever,
notwithstanding the extensive isolation accommodation which has
been provided, the Local Government Board be asked to cause an
inquiry to be instituted into the cause of this disease, and whether
any, and if so, what further means can be adopted for its
prevention.''
This resolution was approved by the Guardians of the Poor for St. Gilesin-the-Fields
and St. George, Bloomsbury, and afterwards by our Council.
There unfortunately has been an increased prevalence of scarlet fever
during the past three years; the London rate per 1,000 having increased from
2.7 and 2.9 per 1,000 in the years 1903, 1904 respectively, to 4.2, 4.3 and 5.4
in the years 1905-6-7 respectively.
I may, however, point out that these high rates have, during the past 18
years in which notification of infectious disease has been enforced, in the
following years, been even higher, viz. :—8.4 in 1893, 6.4 in 1892, 5.8 in
1896, 5.1 in 1897, 4.5 in 1895 and 4.2 in 1894.
In connection with this matter, I prepared the following statistics,
dividing the 18 years into two equal periods of nine years :—