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43
With typhoid fever the difficulties are greater than with scarlet
fever, for several weeks may elapse before the diagnosis can be made,
and it is impossible for many families to stand the expense or supply
the necessary attention which a long illness demands. As a matter of
fact, with few exceptions, all the cases admitted as typhoid fever, which
eventually proved not to be so, were illnesses of a serious nature (nearly
25 per cent, of them proving fatal in the hospital), and they would
have had to be treated in some hospital or infirmary at the public
expense had they not been admitted to the Metropolitan Asylums
Board hospitals.
The suggestion that cases should be kept at home until the diagnosis
is indisputable would, if carried out, result in a much larger expenditure
of public money than is now incurred.
Another suggestion is that in doubtful cases the opinion of the
Medical Officer of Health should be taken. While there is no legal
obligation for the Medical Officer of Health to visit doubtful cases, and
the time at his disposal for so doing is very limited, it has always been
my practice to render such assistance as was in my power, but in many
instances it is impossible for any one to make an absolute statement at
the time and the question,resolves itself into one of expediency. I find
that in 1903 one of the medical officers of the Board stated that of
735 cases certified as scarlet fever, 538 were diagnosed as such in the
receiving room (one of these afterwards turning out to be a mistake)
and 197 were regarded as doubtful. Eventually 158 were found to
have been properly diagnosed by the outside medical man in the first
instance. Similarly with diphtheria.
Very little mischief appears to have been done to patients thus sent
in, but it would appear that what is wanted is the better provision of
rooms in which doubtful cases can be placed until the diagnosis is
made. The Metropolitan Asylums Board have recognised the need for
this in regard to smallpox; let them see to it more thoroughly for
other diseases.