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1930
29
private house. There are many reasons for this phenomenon and
one of these is the preference shown for smaller houses. In London
many people prefer to live in service flats, but even in the suburbs
owing to the difficulty of obtaining domestic assistance, spare
rooms are becoming fewer and scarcer. When an illness happens
there are insufficient facilities for efficient nursing of the case.
Inquests and Coroner's Inquiries.
40 inquests were held and in 24 instances the Coroner issued
a certificate without an inquest after he had ordered a postmortem
examination.
Scarlet Fever. INFECTIOUS DISEASES.
207 cases of Scarlet Fever occurred in the district during
1930, and there was one death from the disease. The fatal case
was one in which the patient suffered from both Scarlet Fever
and Measles. During the early part of the year there was an
epidemic of Measles and some of the patients contracted both
diseases. Apart from instances of double infection, the disease
was of a mild character. It is possible that the mildne.ss of the
disease forms one of the greatest difficulties in the control of
Scarlet Fever epidemics, and it is doubtful if any of the means
at our disposal at the present time arc effe.ctive in preventing the
spread of an epidemic. Accepting the general opinion that most
cases of Scarlet Fever are contracted directly from another human
source, and that the infecting person may be quite unrecognisable
either as a mild case or as a clinically healthy carrier, it is easy
to see how the conditions of today favour the spread of Scarlet
Fever and make its control a very difficult matter. The aggregation
of people in towns and cities, the enormous increase in
transport facilities and the growing inclination to be carried in
vehicles rather than to walk, all these facts of modern life have
multiplied the opportunities for susceptibles coming into contact
with infectives; they have aiso made it almost impossible in
thickly populated districts to trace any case to its origin.
Among the newer suggestions for the control of Scarlet Fever
is the active immunisation by means of the Scarlet Fever Streptococcus
Toxin. Those who have had the widest experience of
the practical application of measures dealing with the Scarlet
Fever problem are almost universally of the opinion that the
routine active immunisation of susceptible individuals is not
advisable for not only do the attendant reactions prevent its
general acceptance, but the immunity lasts only about two years.
The position is different from that encountered in the case of
Diphtheria. Active immunisation of Scarlet Fever contacts after
Dick testing may be useful in isolated communities and in boarding
schools, but under present conditions it is not a feasible
method in towns and especially in the inner suburbs of London.