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31
It will be noticed that whilst Scarlet Fever remains at a little
over five weeks, Diphtheria and Enteric Fever are much reduced.
The reason is given in the following paragraph :—
Errors of Diagnosis.
Out of the 114 cases of Scarlet Fever admitted, 36
were severe, 64 mild, and in 14 cases, or 12 per cent.,
the diagnosis was incorrect; five of these developed the disease
shortly after admission; one Chicken Pox, three Measles, and
one Diphtheria.
Six cases were admitted within 14 days from the same house
to which a convalescent had been sent, being 4.28 per cent, of
the discharges. The usual percentage is about 5 of all discharges.
In the case of Diphtheria the error of diagnosis is
much larger. Out of 32 cases the disease was severe in 14, and
on three occasions tracheotomy was required; of the other 18 the
condition was mild in 9, and the remainder suffered from other
diseases being 28 per cent, of the admissions. Of the four cases
of Enteric Fever, in one only was the diagnosis correct. The corresponding
figures given in the Metropolitan Asylums Board's
report are for Scarlet Fever 12 per cent, error, Diphtheria 16 per
cent, error, and Enteric Fever 50 per cent, error. In so far as the
Practitioner sees the case first and has observed it in its initial
stages, and this applies especially to the case of Scarlet Fever, it
would be highly unwise for your Medical Officer to refuse to admit
doubtful cases. On the other hand, it is obviously unfair to place
such patients in a general ward. The only practical solution of
the difficulty is to isolate all such children. More than this, to
obviate the risk of introducing Measles or other diseases to
children already debilitated from an attack of Scarlet Fever, it
would be most desirable to isolate all admissions for seven days
before allowing them to mix in the general ward. In the detailed
plans that were submitted, the above points were borne in mind
and provided for.