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53
home but were later admitted to hospital. In one instance removal
was requested because of the development of aural complications,
in three, owing to the lack of nursing facilities as the mother had
contracted the infection, and in two instances because of the
difficulty of caring for the patient.
Of the 316 cases treated in hospital, ten were removed either
from a hospital or residential school. In only two instances was
the reason given for the request for the removal the clinical condition
of the patient. Eight were admitted because nursing of the patient
at home would have entailed the abstention from work of some
member of the household. In 105 instances there was either
limitation of accommodation to such a degree that the patient
could not have a bedroom to himself or there were numbers of
susceptible children at home. Forty-five of those admitted to
hospital were adults. In twenty-one other cases there would have
been difficulty in the nursing of the patient, in some cases there being
no one to look after the patient or there being a young baby in the
home demanding the mother's attention; and in a few cases there
was extreme poverty. In ninety-one instances there appeared to be
no real reason for the removal of the patient to hospital in that the
illness was apparently not of a severe character, there was sufficient
accommodation in the home to permit of the patient having a room
to himself and there appeared to be no others in the house demanding
the whole attention of the mother. It is questionable in such
circumstances whether it is better for the patient to be removed
to hospital. Being placed in a general ward he is subjected to
infection by strains of organisms other than his original one. The
return case rate approximates that to which secondary infection
occurs in home-treated cases after the date on which removal could
have been effected. The prevailing type of illness is mild in
character, and the whole question of whether or not it is better
for a child in such circumstances to be removed to hospital really
devolves largely on the degree to which the child, if kept at home,
would be subjected to the same restriction in bed as he is in the
isolation hospital. Quite apart from the removal of infectious
patients, treatment of the sick in hospitals is becoming more
popular, largely, probably, because there is less disruption of home
life if the patient is removed than if he is treated at home. For
this reason many would appear to concur in the removal of their
children to hospital because the alternative is not put to them.
On the other hand, there is no wholesale demand on the part of the
public for the removal to hospital of uncomplicated cases of measles
and whooping cough, diseases which are more infectious and much
more damaging to younger child contacts than the scarlet fever
of to-day. Possibly if there were less insistence on the exclusion
of child contacts from school, parents would be more inclined as
a matter of course to treat cases at home. Apart from the fact that
exclusion of the contact results in a loss of school time, as a preventive
measure the practice is of questionable utility, possibly, on occasion