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53
removing him to hospital. This point arises particularly when the nature of
the disease is not diagnosed until the third week has been reached. In such
cases the distance to the hospital is commonly supposed to be an important
element in the risk of haemorrhage or of perforation of the intestine involved
in removal. Dr. Brownlee has tabulated the number of cases of enteric fever
occurring in patients aged 10 years and upwards who have been removed from
each mile zone to Belvedere Fever Hospital since the introduction of
pneumatic-tyred ambulances, and the corresponding fatality. The numbers
in each of the first four zones varied from 441 to 921, a sufficient number to
eliminate mistakes due to accidental causes of variation. In patients admitted
from a distance under one mile, the fatality was 21.7 per cent., in patients
admitted from a distance of one to two miles it was 20.3 per cent., from a
distance of two to three miles 21.3 per cent., and from a distance of three to
four miles it was 21.1 per cent. In other words, the distance from which the
patients were removed made no difference, so far as the prospects of recovery
were concerned. This is a valuable result, and it ought to remove prejudices
against the removal of enteric patients who cannot be safely and efficiently
nursed at home. Dr. Brownlee has also investigated the influence of date of
removal on the prospects of the patient. His conclusion is that, "though the
death-rate among the cases removed to hospital in the third week exceeds that
of those removed in the first and second, yet that result is just as likely to be
due to the want of attention received during the earlier stage of the fever,
where there is often great lack of skill and knowledge of nursing." And it
may be added that, as there is great danger of other members of the family
becoming infected where there is any lack of skill or knowledge in nursing an
enteric fever patient, removal to hospital is strongly indicated.

There were also 332 cubicles fumigated and cleansed, and one omnibus.