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The removals to hospital were not quite so numerous proportionately
as they were in 1914, but there is no doubt that they
now take place from homes where a few years ago one would never
have anticipated such an occurrence; in fact, now the very poor are
not those who show most anxiety for the segregation. This may be
due to an exaggerated fear of infection, or the hope of better
treatment, but it is possible that a desire to save trouble and
expense may have a more important influence.
At times it was impossible to remove persons to the isolation
hospital whose home circumstances warranted the presumption
of the spread of infection, and as a consequence of this delay, the
Metropolitan Asylums Board resumed the practice of asking
for lists of persons from the various sanitary districts at the
end of September, 1914. The form asks for various particulars as
to the number of applications made, the inhabitants of the house,
&c. A list was accordingly forwarded each day, and a note was
made on it, calling attention to any urgent necessity for removal. As
a rule this was duly attended to, but in a few instances we found that
from some cause, possibly pertinacity on the part of the parents of the
child, cases had been removed which were not to be found on the lists.
The mortality from this disease was over double that of last
year, so that the case mortality has risen roughly from under 1 to
1.5 per cent. This is, of course, a great reduction from the rate
which formerly prevailed, but the increase last year rather suggests
it is the infecting organism that varies in virulence, and that decrease
in the mortality is not so much due to a greater resisting power of
the individual.
Coincident with scarlet fever, there is shown an increase of
diphtheria, there being 461 notifications, compared with 394 last
year. The increase was shown in all the districts, except Dulwich,
with a very marked rise in South Camberwell. The notifications
showed an irregular occurrence, and there was no regular sequence
which might indicate the implication of a school. But the disease
itself seemed to be of a more fatal type, for had the same ease mortality
prevailed as last year there should have been about 900
notifications. The increase in the deaths between the ages 2 to 5
and 5 to 15 was very marked.
The deaths from measles were almost identical with the previous
year, but the children, over one year, seem to have suffered rather
more severely.
During the prevalence of scarlet fever, it was found necessary
by the Metropolitan Asylums Board in June, 1914, temporarily to
discontinue the admission of measles. This policy was rather in
startling contrast to the views of those who, in advocating more
administrative measures against this disease, are never weary of
pointing out how much more fatal is this disease than scarlet fever.
One would have rather thought that the admission of measles
would have gone on and more stringent rules put in force so as to
limit the removals of the latter disease.