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52
Former Outbreaks.—There has been a succession of outbreaks of infectious disease
at the Foundling Hospital. Dr. Sykes, the late Medical Officer of Health, reported on an outbreak
of enteric fever in 1891, involving 35 cases, and of scarlet fever in the same year, involving
42 cases (see Annual Report of M.O.H., 1891, page 17, and 1893, page 25). As a result of Dr.
Sykes' recommendation the present convenient Infirmary in the institution grounds was built
at that time.
Another outbreak of scarlet fever took place in 1905, of which an account by Dr. Sykes
will be found in the M.O.H.'s Annual Report for that year, page 68. There were 103 cases
(17 boys, 30 girls, 54 infants, and 2 staff), in addition to 46 who were removed to the fever hospital
and found not to be suffering from scarlet fever. The first case fell ill on August 26th, 1905,
and the last on January 5th, 1906. There were 27 cases who sickened in the six days of August,
37 in September, 10 in October, 21 in November, 4 in December, and 4 in January. In his report
Dr. Sykes wrote : " I can confidently assert that greater care could not have been taken in the
prompt removal of suspicious cases and the repeated and thorough disinfection and cleaning,
often on a large scale. The repeated examinations of the whole of the children in the institution
made by the medical officer was also as thorough as could be desired."
No further large outbreak is recorded until 1912 (see Annual Report, 1912, page 45), when
there was an epidemic of diphtheria, involving 70* cases, of which 53 were boys, 3 girls, and
14 children of 7 years and under. A large proportion of these cases were diagnosed on bacteriological
grounds only, without any exudation in the throat. At that time the drainage system
of the premises was examined and some minor alterations made, but no serious defect was found.
The diphtheria appeared again in the following year, 1913 (Annual Report, 1913, page 55), when
there was an outbreak of 36 cases, including 6 carriers, entirely confined to the girls' side. In
1914 there was a single case of diphtheria (girl), and in 1915 6 cases (4 girls, 1 boy and 1 staff).
There was another single case in 1918 (girl) and 1 in 1919 (staff). From January to August,
1920, there were 31 cases of diphtheria (17 girls, 13 boys and 1 staff), and 25 cases of scarlet fever
(17 boys and 8 girls), and from October, 1920, to January, 1921, 30 cases of scarlet fever (27
infants and 3 girls). There were 2 cases of diphtheria (infants) in November and December,
1920, and in 1921 12 cases of diphtheria (10 girls and 2 boys), and 3 of scarlet fever (2 girls and
1 infant) prior to the 1921-22 outbreak, the subject of this report. The last of these cases of
scarlet fever was removed on May 21st. There were 6 cases of diphtheria in October, 1922
(1 boy, 1 girl and 4 infants), and no further cases of these diseases have since been reported except
one case of scarlet fever (boy) in April, 1923.
Just before and during the early stages of the 1921-22 outbreak of scarlet fever there
was a considerable epidemic of measles in the institution, involving 127 cases (56 boys, 35 girls
and 36 infants), and from April to July, 1922, there was an outbreak of 168 cases of german
measles (80 boys, 64 girls and 24 infants).
The buildings of the institution are old and in a central part of London, and the repeated
outbreaks of infectious disease provide an additional reason for carrying into effect as soon as
possible the scheme for removing the children permanently to the country, which it is understood
has been determined upon by the Governors.
DIPHTHERIA.
725 patients were notified in 1922 as suffering from diphtheria or membranous croup.
Of these, 111 were afterwards found not to be suffering from the disease by Medical Superintendents
of the Metropolitan Asylums Board, and 2 by other medical practitioners.
The corrected number of diphtheria cases notified was therefore 612, equal to an
incidence rate of 2-9 per 1,000 population.
* The figure 54 given in the 1912 Report did not extend to the end of the epidemic.