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Mistaken Diagnosis.— No fewer than 1,583 patients (1,488 in 1898), or 6.3 per cent.
(7.2 in 1898), were, after admission at the fever hospitals, found not to be suffering from
the diseases mentioned in the medical removal certificates. As usual, the proportion—
240 cases, or 10.2 per cent. of the total admissions—was greatest at the Eastern Hospital.
The percentage on the total scarlet fever cases was 3.9, diphtheria cases 7.4, and enteric
fever cases 17.3; the relative percentages in 1898 having been 4.7, 8.3, and 23.3 respectively.
Amongst the 542 cases wrongly certified as scarlet fever, there were 53 of measles, 120 of
tonsillitis, and 100 of erythema, whilst 102 had no obvious disease. Amongst the 693 cases
wrongly certified as diphtheria were 38 of measles and 491 of tonsillitis. Amongst the 322
cases wrongly certified as enteric fever were 25 of influenza, 76 of pneumonia, and 15 of
bronchitis. Of the 28 patients removed to the Wharves with certificates of small-pox the
mistaken diagnoses numbered 18, or 64.3 per cent.
Annual Admissions, 1870-1899 : Reduction in Mortality.—A return is given (page 36)
showing the annual admissions and deaths of patients at the Managers' fever hospitals, with
the mortality per cent., since the opening of the first hospital in 1870, together with excerpts
from the Registrar-General's annual summaries, showing the annual mortality per 1,000
persons living of the population of the metropolis from scarlet, typhus, and enteric fevers,
and diphtheria. The decreasing percentage of the mortality amongst scarlet fever patients
treated in the Managers' hospitals continues to be a noticeable feature. More noticeable,
however, is the decline in the percentage mortality amongst diphtheria patients from 40.74
in 1889 to 29.9 in 1894, to 22.85 in 1895 (when the antitoxic serum treatment was first
adopted), to 21.2 in 1896, to 17.69 in 1897, to 15.38 in 1898, and to 13.95 in 1899. The
rate of mortality of this disease to 1,000 persons living had for some years been steadily
advancing prior to 1893, in which year it had attained the high figure of 0.76. Since
that year there has been a considerable fall, coincident with the introduction and increasing
use of the antitoxic serum treatment, the rate in 1899 having been only 0.43 per 1,000
of the estimated population.
Staff.—No fewer than 4,765 persons were employed in 1899 at the fever hospitals,
including those employed at the Gore Farm Hospital, of whom 243, or 5.1 per cent., fell
ill with fever or diphtheria, and 3 died; while 1,280, or 26.8 per cent., suffered with other
forms of illness. None of the 88 persons employed on the hospital ships contracted smallpox.
The Committee, in their report for 1892, observed that " nurses and other members
of a hospital staff can be brought with almost absolute impunity into contact with small-pox
provided they are properly protected by vaccination." The evidence of each succeeding year
has but confirmed them in that opinion.
Kensington Cases.—The admissions of Kensington patients were 585, viz., scarlet fever, 381;
diphtheria, 166; enteric fever, 55; " other diseases," 33. The deaths, from all diseases combined,
were 53, or 5.64 per cent. on admissions.
Removal of the Sick to Hospital.—The removal of the sick to hospital, whether by land
or by water, is now effected in a satisfactory manner. The use of public vehicles by or for persons
suffering with infectious disease is unlawful. Occasionally we hear of the use of a cab, wittingly or
unwittingly, and in such cases the vehicle is usually lost sight of before discovery of the nature of
the illness, and so does not get disinfected. This is no doubt a danger to the public, but it is of
rare occurrence, as compared with the time before the passing of the Public Health (London) Act,
1891, the 70th section of which forbids the employment of public vehicles. No case of wilful breach
of the law came to my knowledge during the year.
Ambulance Arrangements.—Kensington patients are removed by the staff at the Western
Station, which adjoins the Western Hospital, at Seagrave-road, Fulham. In the early part of 1900
the Managers, on removing to their newly erected offices on the Victoria Embankment, at the corner
of Carmelite-street, E.C., arranged for the reception of applications for the removal of the sick to
hospital between the hours of 9 in the morning and 8 in the evening, on all days of the year, so
that it is now necessary to apply at the ambulance stations between 8 in the evening and 9 in the
morning only. It cannot be too widely known that the sick are admitted to hospital on the
application of any person whatsoever, the sole condition being the presentation of a certificate
signed by a registered medical practitioner, showing the nature of the disease, and the fitness of the
patient for removal. The application may be made personally, or by letter, or by telegram, or by
telephone. The telegraphic address is " Asylums Board London " : the telephone numbers are 1601
and 1602 " Holborn."
HOSPITAL ACCOMMODATION.
In the annual report for 1893 (pages 117—130 inclusive), I dealt with "The needs of the
Metropolis in respect of Hospital Accommodation for the Infectious Sick"; detailed the steps taken
by the Asylums Board to supply the then existing deficiencies, and referred to the difficulties
by which their efforts had been confronted and, to a certain extent, foiled. Those difficulties have
been now largely overcome; and the needs of the Metropolis have been met to an extent beyond
my estimate of them, made in the tenth monthly report for 1892, which, at the time, was thought to
be excessive, viz.; " at least 5,000 beds for scarlet fever, ' fever,' diphtheria, and isolation."
Fever Hospital Accommodation.—It is an accepted axiom that provision for the isolation
of infectious disease should be made at the rate of not less than one bed for each thousand of the
population. The subject, as regards the Metropolis, was dealt with by the Royal Commission in