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scarlet fever.
The outbreak was due to the case of C. D., who was admitted for "atrophy and catarrh"
on Jan. 11 to the general ward, whence he was removed to a small ward for isolation an hour
later. Characteristic desquamation was observed on the 14th, on which date he was
transferred to the Asylums Board's Hospital. C. D. was bathed on admission by C.O., one
of the nurses of the ward. No new patients were admitted to the ward after the diagnosis of
C. D.'s illness, but the ward could not be disinfected as the remaining patients could not be
accommodated in other parts of the building. The intervals which elapsed between what
may be called the first, second, third and fourth outbreaks were longer than might have been
expected. Thus no case occurred between Jan. 13 and 20, between Jan. 21 and Feb. 1, or
between Feb. 1 and Feb. 8. There were some cases of measles under treatment in the ward,
a fact which made the diagnosis of some of the cases somewhat difficult.
There was an exceptional prevalence of the disease during August and September,
51 cases being reported in 5 weeks (32nd-37th weeks). The following notes were put together
at the time:—
32nd-37th weeks.
32nd-34th weeks.
35th-37th weeks.
Notified: 1904 51 cases 9 cases 42 cases
1903 62 „ 26 „ 36 „
1902 26 „ 11 „ 15 „
1901 51 „ 16 „ 35 „

The cases, with the exception of four, occurred within a comparatively small area lying
to the north of the line Fernhead Road, Carlton Terrace and Kensal Road. A complete
tabulation of the facts relating to each case was prepared, but is too lengthy for publication.
There was nothing to suggest any connection with the milk supply or with school attendance.
The most striking feature was the delay in notification (and consequent isolation) which took
place in connection with 8 of the primary cases. Intervals of 5, G, 7, 9 (2 cases), 14 (2 cases)
and 17 days were noted between the onset of the sickness and the notification of the case.
One case with a delay of 7 days gave rise to 5 others, and one with 17 days' delay to 4 others.
In the latter instance the other children from the house continued to attend school for over a
week after the onset of the primary illness.
Reviewing all the facts noted, the conclusion arrived at was that the exceptional
prevalence was due to the delay in isolating the earlier cases.
Of the 305 cases notified, 324 (including 7 erroneously diagnosed) were sent to hospital
for isolation—equal to 88.7 per cent. of the total, or 2.0 less than the percentage for 1903.
From Oueen's Park Ward 99 per cent. of the cases went to hospital, and from Westbourne
Ward, 98. The smallest proportion removed to hospital (25 per cent.) was from Lancaster
Gate (East) Ward. (Sec Table 18.)