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75
of May. It was found that this outbreak of cross infection coincided with the spell on duty in
this particular unit of a certain member of the staff, and on her removal to a less exacting form
of work these unsatisfactory occurrences ceased. During the year chickenpox cases complicated
with another intercurrent infectious disease, for which an open ward was available were
transferred to the appropriate ward on the 10th day of chickenpox in 3 cases, on the 11th in
1 case, on the 12th day in 1 case, on the 13th day in 2 cases, and on the 14th day in 3 cases,
without causing secondary infection.
During the year, 290 cases passed through the " bed isolation" unit, their classification
beine as follows :—
Scarlet fever 29
Scarlet fever and diphtheria 9
Scarlet fever and measles 3
Scarlet fever and rubella 1
Scarlet fever and whooping-cough 2
Scarlet fever and chickenpox 1
Diphtheria 25
Diphtheria and measles 1
Diphtheria and whooping-cough 3
Diphtheria and rubella 1
Diphtheria and mumps 1
Diphtheria, measles and mumps 1
Measles 14
Measles and chickenpox 4
Measles and whooping-cough 1
Rubella 31
Whooping-cough 7
Chickenpox 4
Mumps 1
Mumps and rubella. 1
Erythema infectiosum 2
Non-infectious diseases 148
Total 290
Cross infection occurred in 12 cases (i.e., 4'I per cent.): 2 cases contracted diphtheria, 1 case
scarlet fever, 1 case chickenpox, and 8 cases measles. The chickenpox and measles cases arose
as a result of the admission of cases in the incubation period of these diseases, and the group of
measles cases has derived from one case. A note is also made of the fact that 19 cases of rubella
in the first 3 days of disease, 7 cases of whooping-cough within the first 14 days of disease, and 4
of mumps within the first 7 days of disease were successfully nursed throughout their illnesses in
this unit without cross infection.
The possibility of contracting infectious diseases additional to those for which
the patients are admitted still bulks largely in the minds of the public as one of the
serious disadvantages of the fever hospitals, and it is one of the greatest difficulties
that has to be faced in the administration of such a hospital. Figures showing the
cross infection rate for the Council's fever hospitals generally are not available,
but it is probable that from 96 to 97 per cent, of patients mostly at susceptible age
periods pass through the wards of those hospitals without receiving additional
infection, and those responsible for the management of fever hospitals are entitled
to ask that a reasonable view should be taken of this matter. It is unfair to assume
that every case of secondary infection is the result of ignorance or carelessness on
the part of some member of the staff, since all but a negligible proportion of secondary
infections are the result of introduction of infection (1) by a patient suffering from
one disease and incubating another such as chickenpox or measles, and (2) by
carriers of droplet infection such as the causal organisms of scarlet fever and
diphtheria. To secure a proper perspective in this matter the state of affairs existing
in fever hospitals should not be compared with some hypothetical community
in which the transmission of infectious disease never occurs, but with that obtaining
in any institution or community in which provision is made mainly for children,
e.g., in the general medical or surgical wards of a children's hospital. The twc
factors referred to above are bound to operate with similar effect in such hospitals
and indeed in all communities in which children are congregated.
Cross
infection.
Unfortunately, figures are not readily available from non-infectious institutions
but it is the firm conviction of all who have practical experience of infectious medicine
that comparative figures would reveal very little difference.
Apart from other important difficulties caused by cross infection, the wastage
of bed accommodation resulting from quarantine periods imposed after ward outbreaks
of secondary infections is a serious loss from the economic standpoint. An
attempt has been made to estimate this wastage at the North-Western hospital
during the two years 1933-34, inclusive. The figures given below were obtained
by taking the number of unoccupied beds in any given ward in quarantine on each
day of the quarantine period, and the sum of these during the period of closure
entailed by the quarantine represents the minimum number of bed days lost as a
result of the quarantine. This of course understates the actual loss of bed days
as many cases are retained in hospital until the quarantine has expired, who nor-