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158
1907
hospital where no visitors are allowed, and where there is no communication
whatever with the patient's home. In reply to this view it is urged that other
agencies are brought into play in the hospital. Patients are collected together
in wards containing perhaps as many as twenty beds, so that although they are
isolated each from his own home, they are in the hospital not isolated but
aggregated. This aggregation, it is alleged, increases infectivity, and the
patient leaves the hospital in a condition capable of spreading infection."
And then he goes on to state that in the areas he has charge of the question
has not arisen because coincidently with the increased provision and use of hospitals Scarlet
Fever has diminished not merely in fatalilty but in prevalence, and by means of two
charts he shows that whereas in 1093 the attack rate was nearly 8 per 1,000 of the
population, in 1895 it was only slightly over 1.5 per 1,ooo, and that the death rate
which in 1893 was 0.35 per 1,000 was just under 0.05 per 1,000. These figures
indicate that effective hospital isolation can be afforded for the protection of the
public; and notwithstanding the idea conveyed by the Holborn Borough Council,
I think it will he seen that it has also been afforded in Islington, and, indeed, in
London.
In my Annual Report for 1904 this matter was discussed, and as it is entirely
germane to the question before you, I venture to quote from it now:—
"Much has been said and written lately with respect to the isolation of
Scarlet Fever in hospitals, and it has been stated by some observers that it
has had no appreciable effect in the prevention of the disease. This is a
startling statement, and one with which the writer cannot agree; and, indeed,
it would require some very strong facts to convince him that the removal of
over a thousand cases of infection, for the most part from tenement houses,
occupied by numerous children, nearly all susceptible to the disease, has had
no effect on the public weal of this borough. When we are considering this
question we must recollect that coincident with the notification of infectious
diseases, which gave such an impetus to hospital isolation, came the very
stringent application of the Education Act, in consequence of which children
were whipped up to school by the attendance officer in a manner that, while
it has filled the schools, has not been to the best interests of public health,
and we should put to ourselves this query: What would have happened if
there had been no isolation ? The answer, of course, can only be based on
surmise. Schools have ever been a source of infection to scholars, more
especially since large eatablishments, where sometimes between one and two
thousand children are gathered together, have become general, and frequently
cases of Scarlet Fever have been traced to scholars who either had returned
to school too early after home treatment, or who, through the ignorance of
their parents, in slight cases, had returned while in an infectious state.
"But there is also another light in which to look on this question, which
is that isolation in hospital prevents an enormous dislocation of school work,
as well as of business, especially of businesses where food stuffs or drinks are
sold, and where clothing is made.
"It is a sine qua non in all school codes that children shall not attend school
from houses in which there is a case of Scarlet Fever, and consequently
whenever a case is notified to a Medical Officer of Health one of his first acts
is to inquire the names of the schools attended by the children living on the
premises, so that he may forward the information to the school teacher. He
has no option but to do this, for the London Public Health Act, section 55 (4),
provides that the Medical Officer of Health shall within twelve hours after the
receipt of a certificate send information to the head teacher of the school
attended by the patient (if a child) or by any child who is an inmate of the
same house as the patient.