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Ambulance Service.—The Managers express regret for being unable to report the
acquisition of legal power to utilise their ambulance service for the conveyance of persons
requiring removal, other than those suffering from infectious disease—their application to
the Local Government Board to obtain for them the desired power, having been made as far
back as November, 1903. " The experience of another year (they say) offers further proof
of the pressing need felt in London for an efficient public ambulance service for cases not
provided for by the Public Health (London) Act, 1891."
Cases of Mistaken Diagnosis.—The Statistical Committee report that "no fewer than
1,993 patients, or a percentage on the total admissions of 10-7, were, after admission at the
fever hospitals, found not to be suffering from the diseases mentioned in the medical
certificates upon which they were removed to hospital . . . The percentage on the
total scarlet fever cases was 6-7; diphtheria cases, 161; and enteric fever cases, 25.9."
The percentages of cases of mistaken diagnosis do not differ materially from those recorded
in previous years, and the subject would scarcely call for notice, but for the broad statement made
by one of the Managers, that the cases in question ought never to have been sent to the Board's
hospitals. This statement involves a reflection on the medical profession which is alike undeserved,
and calculated to deter practitioners from sending patients to hospital until the diagnosis is quite
certain, thus leading to detention of sufferers in the crowded homes of the poor, at the imminent risk
of spread of disease. The doctor has to act upon his judgment; and in my opinion he does well
for the interests of the public in acting quickly. There appears to be no evidence of injury to the
individuals whose illnesses were wrongly diagnosed, and if doubt as to the nature of an illness
should exist in the hospital receiving room, the patient would be placed in an isolation ward.
The certifying practitioner has but a few minutes, it may be, in which to make his diagnosis; the
hospital doctor days, or even weeks.
The best evidence of the difficulty of ensuring universal correctness, is supplied by an
interesting "Note" by the Medical Superintendent of the South-Eastern Hospital, "on the number
of cases admitted in whom the diagnosis was doubtful in the receiving room." During the
year 1903, he states, 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.
This interesting statement arose out of an inquiry to ascertain the probable requirements for
isolation of "doubtful" cases at the South-Eastern Hospital, then about to be reconstructed;
and the conclusion come to by the Medical Superintendent was, that " in order to isolate every case
which appears doubtful in the admission room, if the above figures are taken as a guide, we shall
require to isolate 27 per cent. of the cases certified to have scarlet fever, and 42 per cent. of those
certified to have diphtheria." As already stated, the "errors" in diagnosis by certifying practitioners,
in respect of scarlet fever, amounted to no more than 6.7 per cent., and in respect of diphtheria,
to no more than 161 per cent.
This question of mistaken diagnosis was brought to the attention of the Borough Councils
by the Holborn Borough Council in a letter in which they called attention to an alleged expenditure,
amounting, according to their estimate, to about £60,000, which, they said, had been occasioned
by the admission during the last five years into the Asylums Board's Hospitals, of some
10,000 cases of mistaken diagnosis. A conference between the Board and the several Metropolitan
Borough Councils to consider the subject was suggested. The letter adverted to was
referred by the Managers to the Hospitals Committee, who in their report, after dealing with the
question of the extra cost to which the Board had been put by the admission of such cases—which
they estimated at £3,200 per annum, in the last five years, as against the estimate of £12,000 per
annum made by the Holborn Borough Council—remarked that—
"It is undeniable that in the early stages of many cases of infectious disorder, there
could be no absolute certainty of diagnosis, and that to detain at home every patient until
such certainty is attained, must frequently result in the spread of infection, the prevention
of which is the primary object of the Board's hospitals. It must therefore be always