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some three to four per cent. of Scarlet Fever convalescents upon
their return home from hospital are capable of conveying infection
to others. The infection was imported into the Borough in at least
two instances.
With this disease it is interesting to note that when the figures
for the period 1891-1900 are compared with those of 1908 it is seen
that the death-rate in the latter period has declined 40 per cent., and
the fatality rate by 35 per cent., while the attack-rate has only declined
6 per cent.
Anyone who approaches the subject in an impartial spirit cannot
but be impressed by the fact that fever hospitals are not such useful
agents in controlling the infection of Scarlet Fever as they were once
believed to be. It is certain that with respect to this disease the
isolation hospital must always exercise a useful part in the administrative
machinery of public health; but it is equally certain that where the
isolation of Scarlet Fever cases is made to prejudice the isolation of
Diphtheria and Enteric Fever a false step in the direction of preventive
medicine is taken, for Scarlet Fever has for many years furnished a
death rate of only about 0'1 as compared with rates of over 0.3 from
Measles and Whooping Cough. Indeed, Scarlet Fever is, for the most
part, of such a very mild type that there is a good case for exercising
greater selection with reference to the patients admitted, and confining
the admissions from this disease to those suffering from severe attacks
and those who cannot be nursed at home without danger to others. If
this selection were exercised in the Metropolis of London, the
community would be saved a very considerable expenditure of money
for which there is very little return. It is moreover to be hoped that,
as the experiment of treating cases of infectious disease in the open
air promises to produce such satisfactory results, the cost of construction
of fever hospitals will be somewhat reduced in the future.
In at least 18 cases the infection appeared to be secondary to the
infection in another member of the household and in several cases
the infection was introduced into one home by visits from occupants
of other infected homes.
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