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duration of the stay in hospital of these 19 cases was 21 days, as against
23 in 1908. Five cases on discharge from M.A.B. hospitals were stated
to be still suffering from otorrhœa or rhinorrhœa, the same number as in
1908. So far as is known, none of these cases were the means of
spreading infection after return to their homes. During the year there
were 5 instances of possible " return " cases of scarlet fever, the intervals
elapsing between the return home from hospital of the infecting case and
the onset of the disease in the secondary case being respectively 2, 6, 8,
10 and 14 days.
Milk Epidemic.—Twenty cases of scarlet fever occurred in Chelsea
in June, 1909, which formed part of the extensive milk epidemic of scarlet
fever, which affected some of the boroughs and some of the western and
south-western suburbs of London. All the Chelsea cases derived their
milk from one retail dealer in the Borough, whose supply was received
from the same farm in Wiltshire, that was subsequently proved to be
the cause of the outbreak. The onsets of 2 of the Chelsea cases were on
the 15th June, of 10 on the 16th, of 5 on the 17th, of 1 on the 18th, of 1
on an unknown date, and of 1 on the 26th. This latter case was probably
secondary to 2 others in the some house, which were not recognised as
scarlet fever until the 30th June.
The Chelsea milk retailer received 5 or 6 churns daily (about 400
quarts) from the Wiltshire farm, and had a large milk round in the
neighbourhood of his dairy, supplying from 200 to 300 customers. This
supply was stopped on the 18th June, on representations made by me to
the manager of the dairy that there was reason to believe that an infective
quality attached to the milk. The local investigations into the cause of
the outbreak made by the Medical Officers of Health of the Counties of
London, Surrey and Wiltshire, failed to identify any human source of
origin of the disease on any of the farms, but an ulcerated condition of
the udders of some of the cows on the farm to which the infected milk
was traced, was believed to have some causal connection with the
outbreak. From a perusal of the report on the outbreak compiled by
Drs. Hamer and Jones, it would appear to be impossible to exclude the
possibility of the milk being infected from a human source; and the
evidence pointing to the diseased conditions of the udders of certain cows
as being causative of the epidemic is very far from conclusive.
The average duration of the stay in hospital of 11 milk scarlet fever
cases, of which the records are to hand, was 46 days, as compared with
the general average of 59.5 days for all cases. This fact would seem to
indicate that the milk cases were of quite a mild character. The longest
stay of any case in hospital was only 63 days.
Diphtheria.—In 1909, 97 cases of diphtheria (including 3 of
membranous croup) were notified in Chelsea, equivalent to a case-rate of
12.9 per 10,000 of population, as compared with 181 in 1908. In the
first quarter of the year 22 cases were notified, in the second quarter 30,
in the third quarter 16, and in the fourth quarter 29. The percentage
of cases of school ages (3 to 13 years) of the total number in the Borough
was 68, as against 70 in 1908. In North Chelsea 48 cases were notified,
and in South Chelsea 49.