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35
Scarlet Fever.
The 262 cases notified during the year represents a rate of
5.24 per thousand living, compared with a figure of 2.16 in
1927 for England and Wales. The prevalence was therefore
2.4 of that of the Country. For children under 15 these figures
were 13.9 and 8.64, representing a prevalence of 1.6 times that
obtaining in the Country for children of these ages.
Of the primary cases 151 occurred in the L.C.C. houses and
36 in other houses. The incidence in proportion to the children
occupying the two classes of houses was therefore slightly
less in the estate houses.
In the earlier part of the year almost all cases were removed
to the Isolation Hospital, the only ones remaining at home
being those whose home circumstances were particularly favourable.
With the Autumn increase however, cases had to be
selected for admission. The grounds on which selection was
made were:
1. Severity of the illness and complications
2. Home nursing unsatisfactory, for example:—Mother ill
or father out of work.
3. Homes where the father would have to be excluded from
work were the patient to remain at home. A number of
the inhabitants on the Estate are engaged on Bus, Tram
or Railway service.
4. Homes where there are large numbers of susceptible
persons.
As the pressure on the Hospital beds became more acute,
the standards of selection became more stringent, cases being
selected more on clinical grounds. Where other occupants
would have been excluded from work, they had to make arrangements
for sleeping elsewhere, while the risk of spread amongst
the other susceptible occupants had to be run.
Isolation Hospitals were provided originally in the hope that
the removal of the infectious patient would limit the spread of
infection. In this it has failed almost completely, the reason
being, in most cases, that the infection was conveyed to another
before the diagnosis of the primary case was made. Once
recognised as a case of disease however, the child was generally
removed to hospital or confined to its bed at home. In the
latter case apart from home infection, the disease is unlikely
to spread as the vast majority of cases cease to be infectious
long before the usual period of isolation practised.