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proper nursing are all absent or deficient, to one of the
admirably equipped Hospitals of the Asylums Board, is of very
great advantage. In many houses too, it is difficult or impossible
to secure isolation, and removal to Hospital obviates
the spread of infection in the home. But when we come to
answer the question 'does Hospital isolation diminish the
prevalence of Scarlet Fever ?' an affirmative answer cannot be
readily given, though I think that it was formerly anticipated
that this would be the natural and speedy result of suitable
provision of Hospital accommodation, and of isolation becoming
general. Over 60 per cent. of the notified cases of Scarlet
Fever in Plumstead have enjoyed the advantage of Hospital
isolation every year for 10 years past, and the proportion has
steadily increased, until during the past three years over 85
per cent. of the cases in the Borough have been isolated. Yet
although the last four years show a marked diminution of cases
compared with the preceding eight years, they are still more
than in 1891, when only 20 per cent. were isolated in Hospital,
and there is no sign of the disappearance of the disease. The
death rate on the other hand has shown a marked and persistent
decline, and this may I think be reasonably attributed to
the existence and use of the Hospitals in the more serious
cases, and in those coming from the poorer homes.
At a rough estimate I should say that about half the Woolwich
cases are benefited by removal to Hospital, but that the
other half might be satisfactorily isolated at home with benefit
to themselves and without risk to others.
Each patient costs about £17 (i.e., 42/6 a week) for maintenance
in hospital (p.p. 37 and 207 Asylums Board Annual
Report, 1902), so that if my surmise is correct that hospital
isolation is useless for one half the patients, a sum of £2,856