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39
convalescent hospitals, and of removals of recovered patients from these hospitals to London.
During the year 369 private persons were removed on payment to other places than the
Managers' hospitals : 144 persons were taken from the out-patient departments of general
hospitals to their homes, and 247 enteric fever patients were removed from their homes
to the general hospitals at which arrangements for their reception had been made by the
Managers. Altogether, 42,119 removals were effected by the land ambulance service, an
increase of 7,076 compared with the year 1898: the various vehicles made 28,184 journeys
(increase 5,064), and ran 260,367 miles (increase 45,690). The steamboats of the river
ambulance service conveyed 1,468 passengers to and from the hospital ships at Long Reach;
but of this number only 11 were patients taken to the ships, and 6 were recovered patients
brought back to London; the remaining 1,451 being visitors, staff, workmen, &c.
Hospital Accommodation: Fever and Diphtheria.—The new Grove Hospital at Tooting
and the new isolation blocks at the Eastern and Northern Hospitals were brought into use
during the year. The normal accommodation at the fever hospitals open at the end of the
year was for 5,183 patients; for small-pox patients the hospital ships provide 300 beds.*
Hospital Statistics: Fever.—On the last day of 1898 there were 4,377 patients in the
fever hospitals then open. By April 29th, 1899, the number under treatment had fallen
to the minimum, 3,208; the number then rose until November 21st, when the maximum for
the year, 5,710, was attained. The extra accommodation required by this number of
patients—it being in excess of the total normal accommodation in the fever hospitals (5,183)—
was obtained by placing additional beds in the wards of some of the hospitals, and by utilising
the Gore Farm Hospital. At the end of the year 4,895 cases remained under treatment.
During the year 29,469 patients were under treatment, including those who were in hospital
at the end of 1898. Scarlet fever admissions numbered 13,290 (increase, 1,165), and the
deaths were 353, or 2.65 per cent. (4.2 in 1898). Diphtheria admissions, 8,673 (increase,
2,107); deaths, 1,182, or 13.95 per cent., the lowest rate on record (15 37 in 1898). Enteric
fever admissions, 1,535 (increase, 666); deaths, 240, or 16 47 per cent.—the same rate,
practically, as in 1898. Of typhus there were 11 admissions, and no death. " Other diseases "
admissions numbered 1,583 (increase, 95), the deaths being 160, or 10.05 per cent. The
mortality on all admissions was 7.79 per cent., the lowest yet recorded. At the end of the
year 4,895 cases remained under treatment. The monthly admissions (all diseases) were
lowest in April (in February in 1898). In both years the highest number of admissions was
attained in October. In several districts the admissions were considerably in excess of those
of the previous year, the most notable instances being, as regards scarlet fever cases,
Greenwich 829 (399 in 1898), Woolwich 810 (640 in 1898), and Lewisham 401 (167 in 1898);
and, as regards diphtheria, Shoreditch 240 (148 in 1898), Mile End 202 (100 in 1898),
St. Saviour 1,012 (559 in 1898), St. Olave 542 (201 in 1898), Lambeth 690 (447 in 1898),
Camberwell 734 (326 in 1898), and Lewisham 402 (213 in 1898).
Diphtheria Mortality.-—The admissions, deaths, and mortality per cent. of patients,
divided according to age and sex, for the year, and in groups of years, &c., in respect of the
several diseases, are set out in a variety of tables, of which not the least interesting are those
(at page 27) containing particulars of diphtheria patients in the years 1888 to 1894; before
antitoxic serum was generally used, and in the years from 1895 (when the serum was first
generally used) to 1899. In the first period the admissions were 11,598, the deaths 3,516,
the mortality per cent. feeing 30.3. In the second period the admissions numbered 29,055,
the deaths 4,929, the mortality being at the rate of only 17 per cent. The difference in the
mortality rates during the two periods is particularly striking as regards young children.
Amongst cases in the first year of life the rate has fallen from 61.8 to 37.8, in the second
year from 63.1 to 35.5, in the third year from 55.1 to 26.5, in the fourth year from 48.3
to 23.0, and in the fifth year from 39.0 to 20.7. Amongst cases from 5 to 10 years of age
it has fallen from 28.1 to 15.0. The mortality per cent. of females in both periods was less
than that of males. The Medical Superintendent of the Northern Hospital draws special
attention (page 62) to the value of antitoxin in the treatment of post-scarlatinal diphtheria
cases. During the five years immediately preceding the introduction of the serum treatment
the mortality amongst these cases was 61.9 per cent., and during the succeeding five years
only 1.5 per cent.
Besidence in Hospital.—The average duration of stay in the different hospitals varies
considerably. Taking the cases at all the hospitals, the average time in scarlet fever is
about 70 days at the London hospitals, and a week longer at the convalescent hospitals,
this extended residence being due to the selection of cases in which recovery was expected to
be the most protracted owing to the severity of the disease, complications, &c. The average
length of residence of diphtheria patients at the London hospitals was 51.2 days, including
deaths, and 59.2 if the fatal cases be omitted. The variations in length of residence at
different hospitals ranged from 49.3 days at the North-Western Hospital, about ten days
below the average, to 70 days at the South-Eastern Hospital, or nearly 11 days above the
average. The average residence of enteric fever patients was 50.7 days, including deaths,
and 58.6 days if the fatal cases be excluded. The shortest residence of recovered cases was
47 days, or 11.6 days below the average, at the North-Western Hospital, and the longest, 74.5
days, or 15.9 days above the average at the Western Hospital. Of the cases of miscellaneous
diseases (cases of mistaken diagnosis) the average residence of each patient was 25.2 days,
including deaths, and 27.1 days if the fatal cases be excluded. The shortest residence was
at the Fountain Hospital, 181 days, or 9 days below the average, and the longest at the
Brook Hospital, 36.3 days, or 9.2 days above the average. The duration of residence, as
the Committee point out, is of the utmost importance from an economical point of view,
as not only would any shortening of the period of residence effect a saving in the cost of
maintenance, but it would also enable the Managers to treat a larger number of patients
without increasing the number of feeds, which is of much greater importance. The subject,
as the Committee say, is a very complex one, and is receiving careful consideration. [It
would be interesting to learn whether there is any marked relation between the duration of
the stay of patients at the different hospitals and the proportion of " return cases" connected
with the several institutions.]
* For detailsof the present amount of accommodation at the several hospitals, vide pages 41-2.