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at least five in number, and that cases which are admitted with
infection due to one strain can very easily contract a secondary
infection from a different and possibly more virulent strain
then present in the ward.
"For those reasons it would appear very desirable to
advise home treatment in the case of children suffering from
scarlet fever when the disease is mild or even moderate, and
when the home conditions are satisfactory and permit of suitable
attention and isolation. I need not stress the point that
there are many homes in Southgate which ideally fulfil these
conditions.
"Cases of severe infection and cases in which the home
conditions are not suitable by reason of inadequate isolation,
financial stringency, occupation of breadwinner or other
member of the family, and any further circumstances demanding
special consideration will, of course, be gladly admitted
to the Isolation Hospital on request.
"Free Supply of Anti-Scarlatinal Serum.
"As the serum treatment of scarlet fever appears to hold
out the prospect of best results, especially in severe or
moderately severe cases (although all patients appear to benefit
from such treatment), concentrated anti-scarlatinal serum
will be supplied, free of charge, to any practitioner for the
treatment of cases isolated at home. This serum can be
administered intramuscularly, intraperitoneally or intravenously
as required. Needless to say, the usual contraindications
against the exhibition of serum hold good."
The number of cases sent to hospital began to show a decrease
after this letter had been circulated, and it is now obvious that only
those patients for whom hospitalisation is definitely required are
being sent to hospital. This is very satisfactory and allows us to
reserve additional accommodation at the Isolation Hospital for
other diseases which call more urgently for such treatment.
Following the institution of the three weeks' treatment at the
Isolation Hospital, in conjunction with the administration of serum
to all cases irrespective of severity (see page 74), every case leavihg
the Isolation Hospital is now instructed to attend at the Town Hall
approximately 14 days after discharge, when their physical condition
and urine are examined for the presence of any abnormalities.
In addition to this examination, the patients are visited in
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