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the very large extension of accommodation necessitated by the current epidemic of small-pox,
and which, it is to be supposed, will be available for fever, when the demand arises, should
small-pox be then, as it generally is, in abeyance.] As usual, the Committee furnish illuminative
maps spotted to show the distribution of the principal fevers throughout the Metropolis; scarlet
fever cases being spotted on four (quarterly) maps; diphtheria on two (half-yearly) maps; enteric
fever on one map; small-pox and typhus on one map; spots and crosses indicating cases of the
two diseases respectively. Certain tables exhibit the age and sex of notified cases. Of scarlet fever
and diphtheria, over two-thirds of the cases are children under ten years of age; scarlet fever
being most prevalent amongst children from five to ten years of age; diphtheria amongst those
under five years.
Ambulance Work—During 1900 21,524 (24,945)* fever, diphtheria and small-pox patients were
conveyed to the hospitals; 5,394 (7,973) convalescent patients were transferred to the Northern
and Gore Farm Hospitals; and 5,416 (7,904) recovered patients were brought back from these
hospitals to London. Some 327 (369) private persons were removed, on payment, to other places
than the Managers' hospitals; and 210 (247) enteric patients were removed from their homes to
the general hospitals under arrangements for their reception made by the Managers. Altogether
33,791 (42,119) removals were effected by the land ambulance service during 1900, and the
various vehicles made 24,808 (28,184) journeys, and ran 232,848 (260,367) miles. The steamboats
of the river ambulance service conveyed 1,635 (1,468) passengers to and from the hospital
ships at Long Reach, an insignificant number of whom, only 64 (11) were patients.
[The table at page 56 in the present report shows the accommodation at the several hospitals
at the early part of the present year, together with the additional accommodation in course of
being provided to meet the demand created by the epidemic of small-pox.]
Hospital Statistics.—The year 1900 commenced with 4,895 patients in the fever hospitals
then open; by May 5th the number under treatment had fallen to the minimum, 2,948
(April 20th, 1899, 3,208). The number rose to 3,220 by the end of May, and varied little from
that figure until the middle of August, thereafter falling until on the 1st September it was
reduced to 2,998. It then began to rise; the maximum for the year, 4,779, being attained on
November 27th (November 21st, 1899, 5,710), and it then declined until the end of the year, when
4,142 (4,895) patients remained under treatment. The distribution of patients amongst the
various hospitals on November 27th, is shown in a table (at p. 41), and other tables (i. to viii.),
and an accompanying chart, summarise the particulars relating to the several fever hospitals.
The total number of patients treated in 1900 was 2,920 fewer than in 1899, which was the
highest on record, and due to the exceptional prevalence of diphtheria and enteric fever. The
maximum monthly death-rate was: for scarlet fever in June; for diphtheria in January; and for
enteric fever in February, the same rate being also attained in October. The minimum rate was:
for scarlet fever in January; for diphtheria in April; and for enteric fever in May. Of
diphtheria, the admissions from Kensington (240) were considerably in excess of those for 181)9
(166).
Duration of stay in Hospital.—The average duration of residence of scarlet fever cases was
661 (69.1) days, including deaths; and-68.6 (70.4) days, if the fatal cases be excluded. At the
convalescent hospitals both averages were 80'0 (77'4) days, including residence in the London
hospitals. So that, on the whole, the total residence of cases completing their recovery at the country
hospitals was 11.4 days longer than that of cases at the London hospitals—a fact which possibly
may be accounted for by greater original severity of the cases sent to the convalescent hospitals.
The average length of residence of diphtheria patients at the London hospitals was 52.3 (5V2)
days, including deaths, and 58.9 (59.2) if the fatal cases be omitted. At the convalescent hospitals,
where there was no death, the average residence, including residence in the London
hospitals, was 76T (66.7) days, or 17.3 days longer than in the London hospitals. Great variations
in the duration of stay in different hospitals, of patients from both diseases, are shown to
have occurred in 1900, as in previous years. The average residence of enteric fever patients was
52.7 (50.7) days, including deaths, and 59T (58.6) days if the fatal cases be excluded.
The Committee state that the length of residence of patients in the hospitals is of the
utmost importance from an economical point of view. Not only would any shortening of the
period of residence effect a saving in the cost of maintenance; it would also enable the Managers
to treat a larger number of patients without increasing the number of beds, which is of very
much greater importance. The subject is receiving the careful consideration of the Hospitals
Committee.
Small-pox.—Only 66 (18) cases of small-pox were admitted during the year, of whom 3 (3)
died.
Mistaken Diagnosis: Fever—In the course of the year 1,706 (1,583) patients, or a percentage
on the total admissions of 7.8 (6.3) were, after admission at the fever hospitals, found not to be
suffering from the diseases notified in the medical certificates on which they were admitted. The
proportion of such cases at the Park Hospital was 10.7 per cent. on the total admissions; viz.,
on scarlet fever cases 5.5; diphtheria cases 8.3; and enteric fever cases 18.2. Amongst the 608
(542) cases wrongly certified as scarlet fever, there were 63 (53) of measles; 106 of rotheln; 129
(120) of tonsillitis; 104 (100) of erythema, and 60 (102) had no obvious disease. Amongst the 709
(693) cases wrongly certified as diphtheria were 40 (38) of measles; and 498 (491) of tonsillitis.
Amongst the 386 (322) cases wrongly certified as enteric fever, were 21 (25) of influenza; 89 (76) of
pneumonia; and 14 (15) of bronchitis. A considerably higher percentage of errors occurred with
respect to the cases sent to the Shelters for examination (having been certified as small-pox), prior
to removal of true cases to the ships.
Statistics since the Establishment of the Hospitals in 1870.—At page 53 is a table showing the
admissions and deaths of patients and mortality per cent. at the fever hospitals, together with
the annual mortality per 1,000 persons living of the population of the Metropolis, from scarlet,
typhus, and enteric fevers, and diphtheria, extracted from the Registrar-General's Annual
Summaries. The total admissions were:—Scarlet fever 161,646 ; diphtheria (since 1888) 48,529 ;
* Note that italic figures in brackets are the corresponding figures for 1899.