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77
or compelling patients to enter hospital, but of persuading them
that removal to hospital is not a necessary measure of control.
As a result of the acknowledged benefits to be derived from hospital
treatment, members of the general public now regard any suggestion
of home isolation and treatment as a furtive attempt to deprive
them of a social service to which they have a legitimate right.
It is a matter for gratification that during recent years such
rapid progress has been made in the design, equipment and staffing
of so many fever hospitals, and that the Local Government Act of
1929 (Sec. 63) is likely to put an end to the parochial attitude which
has been responsible for the multitude of small isolation hospitals
throughout the country; for the small two-disease isolation hospital
is the relic of a past age, and has been aptly described as a "costly
shrine of an exploded superstition." Unfortunately there are still
many such small hospitals, and they raise problems and difficulties
in administration which are not appreciated in areas served by more
modern fever hospitals.
Incidence and Mortality.
Experience throughout the country has shown that there has
occurred during the last forty years a marked and progressive decline
in the severity of and mortality from scarlet fever, but no
marked reduction in incidence. The decline in severity and
mortality are undisputed facts, and very welcome; but the decline
began before removal to hospital became general as a method of
control, and it has continued in all parts of the country irrespective
of the extent and nature of the institutional accommodation and
treatment provided.
Period of Isolation.
A belief, apparently traditional, that scarlet fever desquamation
was per se infective, was responsible for prescribing for generations
the traditional minimum isolation period of six weeks; and it
required the upheaval of the Great War, with its unprecedented
demand for every available bed, to shake our belief in the necessity
for six weeks isolation. Now we know from experience that in
uncomplicated cases no useful purpose is served by prescribing a
detention period of more than four weeks, and that a much shorter
detention period can be adopted with safety. Indeed, it is now
generally recognised that it is not the patient released after four
weeks detention who gives rise to return cases so much as the