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The deaths were 9, compared with 3, 6 and 7 in the 3 preceding
years.
The death-rate was 0.08 per 1,000, and for the three preceding
years 0.03, 0.05 and 0.06 respectively.
The rate of mortality for England and Wales was 0.3, for the 96
great towns 0.04, for the 148 smaller towns 0.03,for the County of
London 0.03 per 1,000.
Four hundred and forty-three of these cases were removed to
hospital, and previous records show that the percentage of deaths is
much lower if the patient is treated in. hospital than if nursed at home.
Prevention of Scarlet Fever.
The procedure by the Health Department for the prevention of
the spread of scarlet fever in the borough has consisted of systematic
weekly visits by the Sanitary Inspector to the houses where cases were
isolated at home. Reports were made on receipt of each notification
to the Medical Officer of Health, as to the milk, water supply, sanitary
arrangements, drainage, school or department attended by the patient
and rest of the family, state of the house, out-buildings, number in
house, and means of isolation, these reports being entered into an
Infectious Disease Register, where the results of subsequent weekly
visits to enforce isolation are also recorded. Notices were sent to the
school where children attended from infected homes, requiring exclusion
of these children from school until the house was cleansed and disinfected
to the satisfaction of the Medical Officer of Health after recovery
or removal of the patient. Where cases were removed to hospital, the
usual routine followed was fumigation, the removal of infected bedding
and clothing to the borough steam disinfector, and, where necessary,
the stripping and limewashing of the infected house or parts thereof on
the certificate of the Medical Officer of Health.
Scarlet Fever is a variable disease, some cases being of a most
malignant form, whilst others are of a mild form. Even in the latter
type complications may arise. Some attacks are so mild as to escape
recognition altogether, thereby acting as " carriers," and being the means
whereby this complaint is spread, which partly accounts for the difficulty
and often impossibility of tracing the source of infection. Contaminated
milk, food and water supply, overcrowding and insanitary conditions play
an important part in the spread of scarlet fever and zymotic disease
generally. It is by these mild missed cases or "carriers " that infection
is spread, especially in schools, although the work done by medical
inspection of school children has done much to reduce one great source