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95
SCARLET FEVER.
There were 323 cases during the year compared with 310 in 1935. The attack rate was
2.3 per cent., compared with 2.2 in the previous year. The age distribution and seasonal
incidence are shown in Tables 26 and 27 at the beginning of this section. 307 cases were
hospitalised and one death occurred.
MEASLES EPIDEMIC.
Circumstances for the investigation of outbreaks of measles are particularly favourable in
Fulham as the disease has been notifiable in the Borough since 1910. The disease was, at that
time, made compulsorily notifiable throughout the country, but, owing to the apparent inffectiveness
of notification in checking epidemics, the procedure was generally abandoned a few years later,
and notification is now at the discretion of the local authority. The difficulty of control arises
from the fact that the rash does not appear until the fourth day of the disease, whereas infectivity
is most marked before the rash appears and the diagnosis is made.
Epidemics occur in London with remarkable regularity every two years; thus in Fulham
the present epidemic gave rise to 2,804 cases up to July 10th this year. Compared with that,
only 41 cases occurred in the whole of 1935, but during the 1934 epidemic there were again
2,907 cases.
The London County Council have recently modified their system of control of measles
epidemics in order that cases should be diagnosed more promptly and any requisite treatment
provided; thus contacts are no longer excluded from school but, on the occurrence of cases in a
class, the class and then the school, is specially visited and the children regularly examined.
Measles in school children runs, on the whole a beneficent course, but in young children under
five is apt to be a dangerous disease, the most common complication being inflammation of the
lungs in one form or another. The disease is also apt to leave damaged structures behind it, the
eyes and ears, in particular, being liable to suffer. A prolonged condition of debility predisposing,
in undernourished children, to tuberculosis, is also not uncommon.
There are some 1,508 children under five attending London County Council and nonprovided
schools in the Borough of Fulham. It was, therefore, of some public health moment
to determine whether the London County Council's system of control, involving continued
attendance of these children at school during an epidemic, was likely to give rise to more chance
of infection than existed amongst children of three and four, who did not attend school, but whose
brothers and sisters did attend.
The opportunity furnished by the present epidemic was taken to determine whether school
attendance of children under five did in fact, lead to increased risks of infection. The outbreak
began towards the end of January and the notifications, by February 8th, had reached 12 or
13 daily. The peak of the epidemic was reached about March 28th—that is, about the 13th
week of the outbreak. Notifications, for two weeks in advance of this date and for a week
after, numbered about 50 daily. The outbreak ended towards the end of June after a duration
of, approximately, 28 weeks. Spasmodic cases continued to occur during July.