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A great deal of pains was taken with a view to checking the outbreak. Dr. W. M.
Fairlie, the medical officer of the institution, was indefatigable in his attention and worked in
co-operation with the Medical Officer of Health, who visited on several occasions, and Dr. Bruce
Low, of the Ministry of Health, whose attention was called to the outbreak at an early stage,
also visited and advised. There was no reason to suspect the milk supply, which was distributed
largely in London without causing cases outside the institution.
Dr. Fairlie has kindly supplied me with the following notes on the precautions taken:—
Measures taken to limit spread of the infection.—As the outbreak of scarlet fever began during an epidemic
of measles, isolation of the children in groups as far as possible was in force, and this was continued. The
accommodation available and the administration of the institution did not permit of this being absolute. The
infants were satisfactorily isolated in two separate buildings, but the boys and girls were each in four large
wards in the same block (four wards in each of two wings), and could not'be further subdivided owing
to the lack of separate lavatory and dining accommodation, except in the case of one boy's ward, which had
separate lavatory, &c., and was used to isolate the measles convalescents among the boys. These groups,
viz., infants, four wards of girls, three wards of boys, and one ward of boys, were kept quite apart at all times
and the only possible contact arose from the coming and going from each group to a supply of food and stores
common to all, the staffing not being such as to permit of all stores being sent to each group. Contact was
minimised by supervising as far as possible the coming and going of the children (the older ones being used
only) to the points .common to them. The Chapel was closed prior to the outbreak and remained closed for
many months. Services were held separately for each group. School was not discontinued, but was separate
for each group. The periods were shortened, with more frequent intervals during which the children were
outside and the class-rooms well ventilated.
The children were frequently inspected. Those with discharges were isolated and treated, and any
suspicious children were removed for isolation and observation.
All children used a mild antiseptic gargle, viz., Pot. Permang. and Sod. C'hlor., throughout the epidemic.
Special attention was paid to ventilation of the dormitories. The children slept head to the top of the
bed and then head to the foot of the bed alternately all round the wards.
After the epidemic had existed a short time a general spring cleaning of the hospital was undertaken.
All wards were scrubbed out and the walls sprayed with 1 per cent. Izal solution, and these procedures were
repeated.
All the children's lockers were cleared out, and all papers, books of no value and rubbish were destroyed.
The use of the swimming bath was stopped, and later, when it was used (after the last case) the same water
was not used for children of different groups.
Disinfection of all clothing and bedding of the infected children was done as each case occurred, and
there was also destruction of old things likely to harbour infection. All toys and papers in contact with the
cases were destroyed as each case occurred.
The staff were inspected and supplied with gargle. The staff were instructed in the signs suspicious of
infection and every endeavour was made to separate as early as possible any who showed the slightest sign
suggesting infection.
The children were arranged in the wards so that those coming in contact at one part of the day remained
in contact at other parts, e.g., the children of one class in school slept in the same dormitory. It frequently
happened that infection was greatest in one section, and the children of this section were kept separate as
far as possible and kept more in the open air when the weather permitted.
Cases of scarlet, on returning from the M.A.B. hospitals, received careful attention. All with discharges
or who developed discharges were isolated and treated in the Infirmary till well after these had ceased. Those
without discharges were isolated in the Infirmary until 12 weeks had elapsed from the onset of the disease,
and at the same time no case had less than two weeks' isolation after returning to the Foundling. During this
period of isolation the throats were treated, being painted with an iodine paint. After the epidemic had ceased
still more care was taken of the returning cases. The period of isolation was extended to one month. The
main body of children went to camp at Bognor in July, and of the returning cases only those were sent to camp
who had had a month of isolation in the Foundling and were in time to get three weeks at the camp. The
others were drafted to the country before the main body returned to the Foundling in September, and after
that no child returned to the Hospital after scarlet unless it had had at least two months in the country after
discharge from M.A.B. Hospitals. The importance of this was shown by the fact that one case was sent to
camp in error after only two weeks' isolation in the Foundling after return from M.A.B. Hospital, and within
a week of its going to camp a case of scarlet occurred in the same tent. This was the only case that occurred
at camp.
Other general precautions.—Visits of the children to places outside were discontinued and visitors from
outside were not admitted; only those with business at the office were admitted inside the grounds.
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