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the institution at the time of the beginning of the outbreak was 169 in the Boys' Department,
132 in the Girls' Department, 77 in the Infants' Department, and 40 in the resident staff. The
ages of the " boys " ranged from 7 to 14£, of the " girls " from 8 to 14£, and of the " infants "
(both sexes) from 5 to 8. The boys were living in four dormitories, the girls in four, and the
infants in four. In the normal life of the institution the children of the three departments are
more or less separate, there being separate sleeping, dining, lavatory and school accommodation,
and separate playgrounds are adhered to, but mixing may take place as the children pass in the
passages and grounds of the institution, and the two older groups, viz., bovs and girls, meet on
occasion at chapel services, choir practices, drill, &c. The children attend school and chapel
inside the institution and do not visit houses outside, but visitors from without are not excluded.
The first case was a " girl," who, after being kept under observation for about
36 hours in the Infirmary (an isolated hospital in the grounds), was removed to the Metropolitan
Asylums Board hospital on November 26th. At this time the institution was recovering
from a large outbreak of measles, and the measles convalescents were being kept together
and away from the others in a separate dormitory on the boys' side, one on the girls'
side, and one in the infants' department, which for convenience were called the boys', girls'
and infants' measles convalescent wards. The second case of scarlet fever sickened on December
6th in the boys' measles convalescent ward, and was removed on December 7th. Two more
cases were removed from the same ward on December 13th, and one on December 19th. On
December 20th an " infant " developed scarlet fever while in the measles ward of the Infirmary.
On December 22nd the disease appeared in the girls' measles convalescent ward, when three girls
sickened and were removed to hospital, and on December 23rd another girl was removed from
the same ward and a boy from the boys' measles convalescent ward. On December 24th cases
developed for the first time in the general girls' dormitories, and two girls were removed from
these on that day. Two more went from the girls' dormitories on December 29th, one on January
1st, and then more in rapid succession until, by January 21st, 42 cases in all had been removed
from the girls' dormitories, after which there were only a few more cases amongst the girls.
After December 23rd cases also fell rapidly in the boys' measles convalescent ward and the girls'
measles convalescent ward. In all there were 14 cases in the former and 13 in the latter until
January 19th, by which time the distinction between these wards and the boys' and girls' general
dormitories respectively was no longer maintained. There were only 3 cases in the infants'
measles convalescent ward ; they were removed on December 26th. 29th and 31st. The disease
appeared in the general infants' department on January 19th, when there was one case, and a
girl of 14 who was living with the " infants " was also removed on January 25th. There were
subsequently only four more cases amongst the " infants." The general boys' dormitories were
invaded on January 15th, when one of the boys sickened with scarlet fever ; another fell ill on
January 21st, after which the disease spread in these dormitories until, by March I4th, 31 cases
had been removed from them. After that date the cases in the boys' dormitories fell less rapidly,
there being none in May, but, bv July 26th, when the whole outbreak ceased, 11 more boys in
the general boys' dormitories had fallen ill and been removed. After January 21st (see above)
11 more cases from the general girls' dormitories were removed, the last being on May 19th.
The only other cases to be mentioned are a nurse in the measles ward of the Infirmary, who was
removed with scarlet fever on January 6th, and an " infant " in the same ward who developed
scarlet fever on January 17th ; two girls who developed the rash of the disease in another ward
of the Infirmary on January 28th and 30th, after they had each been there 10 days with influenzal
symptoms ; two women members of the staff on the girls' side, who became ill on February 1st,
and a housemaid, who sickened on March 26th.
The outbreak of scarlet fever was associated with the occurrence of 8 cases of diphtheria,
which were removed to hospital on April 8th (a girl who had recently returned after scarlet
fever), 9th, 17th (boys), 17th (girl), and 20th, May 9th and 16th (boys), and June 19th (infant).