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So far as the Council is concerned, we are of opinion that in the present state of
knowledge it would be premature for the Council to introduce any measure of active
immunisation among school children, even on a limited scale, until further experience
is gained. The Education Committee concur in this view. Close observation will
continue to be kept on the results of the new method of prevention where it has been
adopted, and we have given instructions for a further report to be submitted to us
on the subject in a year's time."
Scarlet fever.
During 1927, 6,498 cases of scarlet fever were reported as occurring among
children attending the Council's schools, and 235 schools were visited from time to time
by the Council's medical staff in connection with outbreaks of this disease ; these visits
were supplemented where necessary by the attendance of school nurses for the
purpose of "following-up." At these inspections over 45,000 children were
examined.
Scarlet fever has been very mild in type for some years past, with the result
that a large number of ambulant and unrecognised cases occur, thus increasing the
difficulty of control. Many of these cases are exceedingly difficult to diagnose, and
there is no doubt that many of the spurious rashes met with are actually attributable
to scarlet fever, whereas they pass under the names of other exanthems such as
rubella, morbilli, fourth disease, epidemic roseola, etc. Rubella especially occupies
a prominent place in the differential diagnosis of scarlet fever. Dr. G. E. Friend,
the medical officer of Christ's Hospital published in the Lancet of 11th February,
1928, a very interesting account of a number of outbreaks of various exanthemata,
in which he describes very fully the differing characteristics of each, and leads up to
the conclusion that there are, in addition to the classic type of scarlet fever, two
additional strains which he refers to as para-scarlet A and para-scarlet B. The
latter type, he states, is very benign, corresponding to the milder form of scarlatiniform
rubella (the epidemic roseola of Dukes), and only needs rest in bed during the
period of the rash, with mild treatment, whilst para-scarlet A may be either benigr
or severe ; it may even assume a fulminating or malignant form. Whilst he states
that scarlet fever and para-scarlet A may be taken together, the complications of
the 'para' forms differ markedly from those commonly associated with scarlet fever
Dr. Friend summarises the importance of distinguishing these diseases from one
another as twofold:—
"(1) Neither scarlet fever, the para forms, nor rubella protect against
each other, and a wider recognition of their separate nature will help to prevent
the admission of the 'para' forms into hospital with cases of scarlet fever.
"(2) Recognition will facilitate the early discharge of the para B and the
mild cases of para A from hospital. There are few, if any, medical officers who
would regard it as safe or expedient to liberate a case of scarlet fever, howeve
mild, under four weeks, while the majority of cases of para A and all of para B
can be discharged to ordinary life with perfect safety in two weeks. This is
important on the grounds of finance, public opinion and school management."
Further investigation into this suggestion of the differing types of scarlet fever
and their distinguishing characteristics from other exanthemata would thus appear
to be desirable from every point of view, and it remains to be demonstrated whether
the observations of medical officers of fever hospitals bear out the conclusion
arrived at by Dr. Friend.
The tendency of both scarlet fever and diphtheria to persist for a number of
years in certain localities has been observed for some time past, and the following
table is shown to illustrate this phenomenon. The statistics cover a period of five
years (1923-27).
It will be noted that both diseases favoured the poorer class and more densel
populated areas, namely the East End, especially Shoreditch and Bethnal Green
and the riverside districts on the South, notably Bermondsey, Southwark, Greenwich
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