London's Pulse: Medical Officer of Health reports 1848-1972

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Southall-Norwood 1903

[Report of the Medical Officer of Health for Southall-Norwood]

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At the house in Liverpool, where she had been staying prior to
her visit to Southall, there had recently been a case of Scarlet Fever !
2.—A child returned home from the fever hospital after 10 weeks
treatment for Scarlet Fever, a few days afterwards, the two other children
in the house, were attacked with Scarlet Fever. The convalescent
case had not a trace of peeling, but there was considerable discharge
from the nose. This instance illustrates the value of hospital isolation
in protecting the other members of the family, and the infectious
nature of the nasal and other discharges which occur as sequence of
Scarlet Fever. The source of infection in "return cases" is being
carefully investigated by the Metropolitan Asylums Board, who have
appointed a Medical Inspector for the purpose, and the trend of the
evidence is that discharges from the nose and ears are the chief
factors concerned, and that the desquamating skin is not so infectious
(after a certain lapse of time) as it is usually thought to be.
3.—A child was " taken to the Doctor because of a large swelling
in the neck " ; he was found to be peeling on the hands and face. He
did not attend school: and was not a milk drinker, and the rest of
the family were frse from any evidence of Scarlatina. Enquiries
elicited the fact that a relative visited the house for a day, four days
before the patient was first noticed to be ill. The relative was an
employee at a Fever Hospital in the North of England.
4.—The only child of a family was attacked in October. He
did not attend school. His mother had been going backwards and
forwards to a house some half-a-mile away in which a case of Scarlet
Fever had been recently notified.
5.—In by far the larger number of cases evidence of infection
was not nearly so definite as in the instances cited. It was
only after the occurence of successive cases and a consideration
of the circumstances attending each group that it was possible
to say that there must have been some common centre of
infection, and the evidence goes to show that the attendance
at school of children in an infectious condition has been chiefly
responsible for the spread of the disease. This statement must not
be taken as a reflection on the School Managers. Measures are
taken by the School Board to prevent the introduction of infection
into schools by a system of certification and a periodical medical
examination of the scholars in all the schools. These cases of Scarlet
Fever in the peeling stage were found in the schools by the Medical
Officer to the School Board. From a preventative point of view,
however, Scarlet Fever in its slight and modified form assumes the
disguise of an ordinary Sore Throat, which is especially the cases in
adults and children who have previously suffered from the disease. To
recognise such cases as Scarlet Fever is a matter of great difficulty
and is practically impossible when there is no complaint of illness,
which is usually the case.