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district was specially affected. During the latter part of 1949
the Medical Superintendent of the Isolation Hospital to which cases
of infectious disease from the Borough are admitted, called a
conference to discuss the acute shortage of beds occasioned by staff
difficulties. It was then agreed that the admission of cases of
scarlet fever to hospital might have to be curtailed. In actual
fact, the recommended policy differed very little from that pursued
by the Southgate Borough Council for many years, i.e., that cases
of scarlet fever should not be admitted to hospital unless and until
the need for such admission had been definitely proved.
There was therefore no need to aiter our outlook or procedure,
although opportunity was taken to inform general practioners of
the acute shortage of available beds and to ask for their
co-operation. This has been willingly received.
The difficulty in controlling streptococcal infections generally
was very well exemplified during the year by a localised outbreak
of streptococcal infection at one of our schools (Garfield Road
Primary).
On May 17th, the Headmistress of Garfield Road Primary
School reported that 23 children and four members of the staff
were absent with “sore throats,” and that, over a period of several
weeks, a further 30 children and seven members of the staff had
been absent with the same complaint.
At or about the same time, four cases of scarlet fever were
notified from the school. The assistance of the Centra] Public
Health Laboratory Service was enlisted, and altogether 519 children
and members of the staff, including the Canteen staff, were
swabbed. Of these, 70 were proved to be carrying haemolytic
streptococci. Fifteen children who were heavily infected “carriers”
were excluded until after the Whitsun break. Nine of these
children were able to return to school early in June.
This outbreak is interesting for two reasons. It illustrates
the fact that streptococcal infection in a school tends to be polymorphic;
thus, the reaction may be (a) an infection of the throat
without any rash, (b) scarlet fever, or (c) the setting up of a
“carrier” condition, with or without original signs and symptoms.
The outbreak also shows the value of early liaison with the
Laboratory Service. The assistance afforded by the Public Health
Laboratory Service enabled us to trace “carriers” without delay,
and to segregate the heavily infected “carriers” until they were no
longer a danger to their fellows.
In this connection I have asked Head Teachers to inform me
as soon as possible whenever any conditions likely to have
epidemiological significance appear in a school. This enables us
to take the necessary action with the minimum of delay. As speed
is essential to success in such cases, the co-operation to which I
have referred is a most important factor. Although this is a
matter which more intimately concerns the School Health Service,
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