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36
The districts and towns selected have per 1,000 of their populations
considerably greater hospital accommodation for Scarlet Fever and
Diphtheria cases than Walthamstow; Leyton is much in the same
position as we are in this respect.
The reasons and causes for the amount of illness in these districts
equally apply to Walthamstow—well-to-do Kensington and Fulham and
London (as a whole) have a similar experience to ours.
It is obvious that, where primary known cases occurring in crowded
homes cannot be at once removed to hospital or isolated within the
home, spreading of the disease is more likely to occur, and this
probably accounts for the large Infectious Sickness rate at West Ham,
but according to the best known investigators, whilst the mortality-rate
for Scarlet Fever may be greater among the poor, the incidence of the
disease is no greater than among the well-to-do.
At the 1911 Census it was found that we had 1,265 overcrowded
tenements among our 26 399 habitations, that is, about 1 in 20, or in
other words 7'12 per cent. of the population were living two or more in
a room. The existing accommodation must be worse now, and it can
be readily realised that this factor, together with our limited Hospital
accommodation, militates strongly against the best efforts to control the
incidence of Scarlet Fever or Diphtheria.
I have shown that, taking the worst period September to December,
our experience is no worse than that of the best administered District;
that good or bad social conditions have little influence in its incidence or
its spreading, and, as is well-known, this disease has prevailed for the
past five months throughout London and Suburbs in an epidemic form;
it follows that this District must inevitably be likewise affected.
On page 27 of my Annual Report for 1919, will be found the General
Measures taken for the control of all Infectious Diseases. In addition
to these the following measures are taken by me. All school children
who are home contacts with Scarlet Fever or Diphtheria are seen by me
and no one is allowed to return to School until I am satisfied that he or
she is free from disease. In addition, every patient discharged from the
Sanatorium is seen by me to ensure that he or she is quite free from
Infection.
During the year a large number of cases presumed to be free from
Infection were found to be still suffering from Scarlet Fever or Diphtheria,
and were it not for the precautions mentioned our recognised favourable
standard in Public Health administration would be impossible.
A few typical examples of the difficulty in controlling, much less
eradicating Scarlet Fever in a populous District, may be of interest:—
S.G., taken ill on 21th May, was taken to a doctor, who said
(according to mother), the rash was due to ice cream poisoning.
Child was seen by Medical Officer of Health on 7th June, and
found to be suffering from Scarlet Fever.