Scarlet fever was one of the first diseases to have an active preventive policy directed against it, and for some late nineteenth-century observers it came to represent a great triumph of preventive medicine. At the mid-century it accounted for some 10,000 deaths per annum in England and Wales. Its principal incidence was on small children between the ages of one and five; although adults not uncommonly caught it, it was relatively rare in infants. In the 1860s it was ‘the most dreaded, yet the least feared, of all familiar diseases’, and was considered to be more infectious and deadly than any other disease. It was widespread through all social classes, and was often fatal. The early efforts of London's medical officers in disinfecting and isolating cases where possible had little effect, but the opening of the Metropolitan Asylums Board isolation hospitals in the 1870s was accompanied by a decrease in mortality, more pronounced in London than elsewhere.
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