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44
7.—Hospital Accommodation.—It may have been observed that
during the last few weeks there has been a considerable decline in
the prevalence of infectious disease, as indicated by the reduction in
the number of notified cases, the result being that the Asylums
Board have been able to take in all applicants for admission to their
hospitals. Attention may be called to the disproportionate provision
of accommodation for scarlet fever and diphtheria, upwards of 3,800
beds being set apart for the first-named disease and only about 700
for the latter. And yet diphtheria is by far the more serious of the two
diseases, seeing that the case-mortality in hospitals in 1896, (about
21 per cent.) was five times as great as that of scarlet fever (4.05
per cent.). It would be wise to provide accommodation for
diphtheria to the full extent necessary, even by the exclusion of a
considerable number of scarlet fever patients. It would indeed be
an imperative duty to do so if it were possible to select the more
severe cases of scarlet fever for admittance, when it is not
possible to admit all applicants; but in practice the rule is "first
come, first served." Several reasons could be adduced in support
of the course recommended, the most important one having been
already indicated; viz., the relatively greater danger of diphtheria,
whose victims should therefore be placed in the circumstances most
favourable for recovery; that is, in hospital, where the per-centage
of recoveries is greater than in the cases treated at home; whilst, on
the other hand, the case-mortality in the home treated cases of scarlet
fever is considerably lower than in the hospital cases. A very large
proportion of the cases of scarlet fever a re of the mildest description;
but for complete recovery many weeks' stay in hospital is necessary.
I would gladly see all such cases isolated, if there were room; but
assuredly I would not admit them to the exclusion of diphtheria,
however mild the cases of the latter disease might seem to be. I
note with satisfaction that this question is receiving the attention
of the Managers, who have instructed the Ambulance Committee to
"report to the General Purposes Committee (i.e., the Board sitting
in Committee) from time to time, whenever, in the opinion of the
Ambulance Committee, the incidence of infectious disease in the
Metropolis may necessitate the re-allocation and re-appropriation
of beds in the several fever hospitals of the Board." The General
Purposes Committee, moreover, have been empowered, until further
orders, to take such action in the matter as they may deem
necessary under the circumstances. The action taken will, no
doubt, lead to a large increase in the number of beds appropriated
to the treatment of diphtheria, a course from which the
most happy results may be anticipated.
I am able, by the courtesy of the Clerk to the Asylums
Board, to lay before your Vestry the subjoined interesting statement
showing the existing and the prospective accommodation in the
hospitals for fever, &c., and small-pox respectively.