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79
In previous Annual Reports I have given the detailed results
of investigation into the incidence of complications in the Scarlet
Fever Wards of Leyton Isolation Hospital, and the results of such
an investigation by Dr. Henderson are shown on page 98.
Comparison of Hospital and Home Isolation.
The practice of different Authorities varies within the widest
possible limits with regard to the hospitalisation of notified cases
of scarlet fever. In some large cities and health resorts the rate of
hospitalisation is as high as from 98 to 100 per cent., whereas in
many rural areas and smaller towns home isolation is the rule.
In most areas, however, the extent of hospitalisation varies between
these extremes.
In Leyton, during the six years 1932-37 (excluding cases
occurring in institutions), 65.13 per cent. of patients have been
removed to hospital, and 34.87 per cent. have been treated at
home.
Is there any relative increase in the risk to patients or contacts
when one or other of these methods is practised ?
During the six-year period 1932-37 the case fatality rate in
Leyton was 0.72 per cent. for hospital cases and 0.22 per cent.
for home-treated cases. Of course, the great increase in the
fatality rate is to be expected in view of the circumstances taken
into consideration in the selection of cases for admission to hospital.
In Leyton Isolation Hospital, during the three years 1934-37,
the complication incidence rate has varied between 27 per cent. and
51 per cent. (See page 79).
I have no knowledge of any published results showing the
incidence of complications among scarlet fever patients treated
at home, and there are obvious difficulties in the collection of reliable
evidence where the personal factors of so many different medical
attendants are concerned. Since 1st January, 1936, I have been
investigating the incidence of complications among these home
treated cases. The following figures show the incidence of complications
among scarlet fever patients nursed at home during these
two years and the nature of such complications.