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155
1907
about nine weeks returned home. She seemed quite well; skin in good condition
; no discharge of mucous from the ears, nose or throat. She had been
at home, however, for only four days when one from the nose commenced, with
the result that in a few days her sister was infected. More frequently, however,
cases have arisen shortly after the arrival home of the patients from
hospital, although they have been apparently entirely free from disease on their
discharge.
"But surely it is no reason because these cases now and again occur that
hospital isolation should not be practised, but that on the contrary the patients
should be allowed to remain at home, for the most part, living in tenement
houses, confined (as they might be but unfortunately are not) to a single room
for weeks, with their fathers and mothers constantly with them, and with their
brothers and sisters and their friends running in and out to them. Is this what
should be allowed ? It certainly could not be prevented—is such a state of
affairs conducive to the best interests of the public health ? Is such a practice
or isolation in hospital the more likely to prevent the spread of the disease ?
Common sense, despite all reasonings to the contrary, will dictate the answers
at once and unambiguously."
I have not seen any reason since then to alter this opinion.
ii. The receipt of the Holborn letter has, however, caused me to examine
the records of this borough more closely than before, and I find, as indeed, I
expected, that Islington has derived very substantial advantages from the isolation
in hospital of its Scarlet Fever patients; and so that these advantages may be
definitely appreciated, I have taken quinquennial periods for comparison, because
when taken year by year, owing to the fact that in one year there may be a decline,
and in another an increase, the true significance of the returns is obscured. These
are the years 1891-1895, 1890-1900, and 1901-1905, which I will call respectively
the "first," "second" and "third" periods. I may also state that I fixed on 1891
because in that year the notification of infectious disease was first properly
enforced, and also because in that year the Public Health (London) Act was passed.
My investigation showed that in the first period there were 8,502 cases of Scarlet
Fever notified, and these cases fell to 7,512 in the second period, or a decrease of 990
cases; and that the 7,512 cases in turn fell to 5,867 in the third period, or a decrease
of 1,645, while the decrease between the first period and the third period amounted
to the substantial number of 2,635. And meanwhile the attack rate, i.e. the number
of cases per 1,000 of the population, showed a corresponding decline, being for each
period respectively 5.20, 4.46 and 3.46 per 1,000 inhabitants.
But this is not all, for I found that between the first and second periods the
number of deaths fell from 332 to 201, and from 201 to 166 in third period. Thus
between the first and second periods there was a decrease of 131 deaths; between
the second and third periods a decrease of 35 deaths, and between the first and third
periods 166 deaths, or 50 per cent. This is surely most satisfactory. I also found
that the admissions to the Metropolitan Asylums Board Hospitals from Islington
in these periods were in the first period 3,534 cases; in the second period 4,660, or
an increase of 1,126 cases, and in the third period 4,612 cases, or an actual decrease
of 48 cases on the return for the second period, but an increase of 1,078 cases on
that of the first period.
With respect to the percentages of the notified cases which were admitted to
hospitals, I found that 42 per cent. of them were admitted in the first period, 62 per
cent. in the second period and 79 per cent. in the third period. It must be noted,
however, that the 79 per cent. in the third period represented 48 fewer admissions
than the 62 per cent. did in the second period.
M