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44
It must be patent to all that a certain number of mistakes in the
diagnosis of Infectious Disease must be unavoidable, and any reflection
cast upon the Medical Profession for such mistakes is to be deprecated,
as calculated to impede the Sanitary Authorities in effecting that prompt
and complete isolation which it is their aim to attain.
That individuals sent to Hospitals with their diseases wrongly
diagnosed may come to harm in consequence is possible, but very improbable,
and no such effect has hitherto been apparent, but a doubtful
case kept in the crowded homes of the poor for days or even weeks until
the diagnosis is absolutely certain, is capable of doing incalculable
mischief by infecting other persons.
The certifying practitioner is often placed at considerable disadvantage
in making his diagnosis; he has to act upon his judgement, and it
is most desirable in the interest of the whole community that he should
act with all promptitude and despatch.
Some idea of the difficulty of making universal correctness may be
gleaned from a statement made by the Medical Superintendent of the
South Eastern Hospital at the time that Hospital was about to be
reconstructed.
He states as follows: "During the year 1903, 1,286 patients were
admitted with a certificate of Scarlet Fever or Diphtheria. Of 735 cases
certified as Scarlet Fever, 538 cases were diagnosed (only one incorrectly)
Scarlet Fever in the receiving room; whilst the diagnosis in the
receiving room was 'doubtful' in 197 instances. Of these 197 cases,
158 were 'ultimately' diagnosed Scarlet Fever, and 39 were 'ultimately'
diagnosed other diseases. Of 551 cases certified Diphtheria, 317 were
diagnosed (only two incorrectly) Diphtheria in the receiving room,
whilst the diagnosis in the receiving room was 'doubtful' in 234 cases.
Of these 234 cases, 154 were 'ultimately' diagnosed Diphtheria and 80
were 'ultimately' diagnosed other diseases."
It will thus be seen that certifying practitioners were wrong in
their diagnosis in but 54 per cent. of the cases of Scarlet Fever and 14·9
per cent. of the cases of Diphtheria.
As will be seen from the subjoined table, the number of cases sent
back in Hampstead is small, but I am of opinion that it might be further