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Scarlet fever
During the autumn and winter scarlet fever prevailed in epidemic form both in London and
throughout the country generally. From the Local Government Board statistics for the year it appears
that the case-rate for London (3*89) was in excess of the rate for the rest of England (2*96), excluding
Wales, but less than that of the county boroughs (4.26) in which urban conditions obtain. In the two
previous years, 1911 and 1912, it was found that the case-rate of scarlet fever in London was lowei
than that for the rest of England, as well as for the county boroughs. The number of school children
reported suffering from the disease was 7,969, while the number of sufferers of all ages was 17,552.
The number of schools which came under special observation on account of scarlet fever was
642, wThilst 121 schools were visited by school doctors from time to time during the year for special
investigation into the sources of infection and for examining the children with a view to detecting missed
or unrecognised cases.
The outbreak in England was preceded by an epidemic on the Continent, which commenced in
the towns on the borders of the Baltic and North Seas during 1912-1913. In December, 1912, the
epidemic wave had reached Amsterdam where considerable spread took place. One factor leading to
the wide dissemination of the disease was the mildness of its type.
The first indication of any abnormal prevalence in London was observed about the end of May,
1913. The disease was characterised here also by considerable mildness of type. The first sign of
unusual prevalence was observed at Cormont-road School, in Lambeth, where investigations were made
by two of the Council's medical officers, the investigation having originated because one of the assistant
teachers in the infants'department had contracted (29th May) a severe attack of scarlet fever. Upon
inquiry it was found that a child sickened with scarlet fever about the 9th May, and subsequently to
the illness of the assistant teacher, two other children, who were last in school on 20th May, were notified
as suffering from the disease. In both these latter cases the disease was so mild that they were not
recognised as scarlet fever until desquamation was observed. Further investigations led to the discovery
of a large number of children who showed obvious indication of having suffered from scarlet fever in
so mild a form that the majority had never exhibited any signs of serious illness nor had they been absent
from school. The majority occurred in the infants' department, but a certain number were detected
in the boys' department, while very few were discovered in the girls' department. In a small proportion
of cases only were the more serious complications found, such as nasal or aural discharge.
The medical officer of health of the metropolitan borough of Lambeth Was informed, and at
his request all the children showing signs of desquamation or other late indication of the disease were
officially notified under the Public Health (London) Act, 1891. The school was kept under close observation
and all absentees and exclusions were notified to the local medical officer of health. These precautions
may have had the effect of keeping the spread of the disease in check, but considerable difficulty
was experienced owing to the fact that the majority of the cases excluded from school by the teachers
on suspicion were not looked upon as serious by the parents and were therefore not segregated or
removed to hospital. Cormont-road School was kept under close and continued observation and the
head teachers were given specific advice with regard to the supervision of the children and were
requested to exclude and report all suspected cases to the school medical officer.