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baths could be easily and economically provided. The First Aid
personnel co-operated whole-heartedly from the first and from
early in May 1942 a very useful service was provided for the
District at negligible cost except for that of the materials
used. The efficacy of the treatment and the fact that children
could return to school after their first treatment rapidly
popularised the Centre and more and more cases were detected among
residents, often with a history of months duration. The
issuing of the Scabies Order 1942 increased the powers of the
Medical Officer of Health to require the submission to
examination of contacts and their subsequent attendance for
treatment, if necessary, in the minority of cases who were non
co-operative. The number of cases from Schools diminished
rapidly and a special clinic which was established for the
treatment of such cases was discontinued. More cases were
sent by general practitioners who realised the value of the
treatment provided.
A routine gradually became established whereby cases
not sent by a doctor are seen by the Medical Officer of Health
who also visits and follows up all contacts who fail to attend
for preventive treatment. As it has been shown that the disease
can take 5 weeks to reveal itself it is important that all
contacts should have one preventive treatment, usually at the
time when the original case is having its second or third bath,
which baths are given at intervals of 6 or 8 days. Instructions
are given at the time of treatment on changing clothes, bedding,
etc., and its subsequent disinfection by the patient's family at
home. The discontinuance of steam disinfection since the use of
benzyl benzoate has saved much inconvenience, the bedding, etc.,
formerly being away from the family for 24 hours at least, and
much expense, as formerly it cost the Council 10/- for every
load conveyed for disinfection to the Wandle Valley Isolation
Hospital.
Cases and contacts are encouraged to attend for
inspection about 5 weeks after the completion of treatment, if
necessary further treatment being provided.
During the last 8 months of the year 237 persons were
treated at these baths (107 adults and 130 children) almost all
of whom showed some evidence of infection, A total of 695 baths
were given; 40 persons were still undergoing; treatment at the
end of the year or reappeared for further treatment in 1943. Of
the total of 237, the single course of 2 to 3 baths proved
sufficient in 175 cases. 3d of the remaining 62 (26%), return for
further treatment occurred within 6 weeks in 24 cases (8 families)
(10%) suggesting a relapse in some cases due to an incomplete
initial course, while 38 cases (14 families - 16%) returned after
6 weeks, suggesting reinfection. In almost all the latter it
was obvious that reinfection occurred owing to incomplete initial
treatment of the whole household which must be considered and
treated as a unit. For the early months of such a scheme in
which compulsion has not been used, these results are not
unsatisfactory. It is hoped that with more experience and
fuller co-operation of the patients better results will be
reported in future.
VERMIN.
Attention was given during the year to the small number
of families in which it has-been found by the school nurses that
head lice are more than casual residents. Again the family has
to be approached as a unit and encouraged by the use of special
combs which are supplied at cost price, if necessary repayable
by instalments, and "Lethane" etc. to institute regular habits
of cleansing. The results have not been quite so satisfactory
as in the case of Scabies treatment, chiefly owing, to the lack
of discomfort experienced by the infected persons, but constant
vigilance is being maintained.