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29
DIPHTHERIA AND TYPHOID FEVER IN GENERAL HOSPITALS.
In enquiring into an outbreak of Typhoid Fever at the University College
Hospital, attention was directed to the fact that some of the London Hospitals,
which are not special Hospitals for the purpose of isolating and treating cases of
infectious disease, nevertheless received such cases. The Hospitals of the Metropolitan
Asylums Board, omitting Small-pox (which it treated in a separate and
distinct place from other infectious diseases), admit Scarlet Fever, Diphtheria,
Typhoid and Typhus Fever. Of the last-named fever, very few cases occur in
London, the first-named, primary Scarlet Fever, does not appear to be admitted to
General Hospitals. With Diphtheria and Enteric Fever the matter is different,
these two diseases are admitted at many of the Hospitals.
In reference to Diphtheria there appears to be a consensus of opinion, that cases
of this disease should not be admitted into the general wards of a general hospital,
but that, if admitted, they should be treated in a special ward isolated from others,
and that such provision may be made with advantage in general hospitals for
moribund cases requiring tracheotomy.
In reference to Typhoid Fever, on the contrary, there appears to be a considerable
amount of leading opinion that cases of this disease should be treated in
the general wards of a general hospital. No one has ventured to assert that it
would be disadvantageous and undesirable to treat cases of this disease in a special
ward in a general hospital, where all the special precautions necessary in nursing
Typhoid Fever could be carried out without oversight or failure. But, it may be
asserted that there is great risk in nursing typhoid cases in a general ward of a
general hospital, risk to other patients and risk to the nurses. Risk to other
patients, because scattered throughout medical literature will be found a number
of instances in which patients have contracted Typhoid Fever in hospital. Risk
to nurses, because in nursing general cases side by side with, and at the same time
as, typhoid cases they are very apt to overlook the special precautions requisite
for the latter, and a proportion of young adult nurses fall with the disease. If
Typhoid Fever be allowed to be nursed in a general ward the most careful precautions
must be taken, these precautions should be printed in the form of Regulations, of
which a copy should be in the hands of every nurse, and a copy should be hung
over the patient's bed. In these Regulations, not only should all the numerous
necessary details of cleanliness be prescribed, but it should be made a sine qua non,
that all vessels, linen, pans, pails, instruments, &c., used by the patient should be
kept separate and distinct, and be specially coloured or marked.
ISOLATION OF MEASLES BY EXCLUSION.
Whilst it is not possible, on the score of expense, to isolate by the seclusion of
cases of Measles in hospital, nevertheless it is possible by individual and family
effort to isolate by the exclusion of infected children from school and school playgrounds,
from other houses and places, and from other rooms than the infected
room in the house. With this object in view notices are sent in every known
case of Measles, and similar notices to all schools to the following effect:—