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11
(a) Cases admitted wrongly diagnosed.
As reference to earlier paragraphs of this report on diphtheria
and scarlet fever will show, a wrong diagnosis is by no means as
uncommon an occurrence as might be expected. During the year
cases have been admitted as diphtheria, to be subsequently
diagnosed as pneumonia, measles, chickenpox, etc., and as scarlet
fever, to be subsequently diagnosed as diphtheria, measles, rubella,
etc. These cases were, of course, admitted to the wards corresponding
to their provisional diagnosis and might quite well have given
rise to the spread of infection therein. In order to obviate this risk
as far as possible, all cases are carefully examined immediately
on admission by the medical attendant, or in his absence by the
Matron, or her deputy, and where there is any reason to suspect
that the case may be a danger to other patients it is isolated in a
side ward until a final diagnosis can be made. When some doubt
exists as to the nature of the patient's condition, the examination
is made in the ambulance before admission. When a resident
medical officer is appointed at the hospital, as is anticipated in
the near future, he will be able to make an examination of every
case immediately on admission.
(b) Doable Infection.
Cases of double infection include (i) patients admitted in the
early or in the acute stages of a second disease in addition
to that of the provisional diagnosis, (ii) patients admitted in the
convalescent stage of a second disease, the acute signs and symptoms
of which may not have been recognised, and (iii) patients admitted
in the incubation stage of a second disease, and so showing no
signs or symptoms thereof.
Cases (i) and (ii) are usually detected on admission and are
dealt with by separate isolation. Cases in group (iii)
present much greater difficulty and are the source of most of the
cross infection which occurs. A history of exposure to a second
disease occasionally helps. The control of spread of infection from
this source however depends to a great extent upon our knowledge
of the disease involved. Cross infection with diphtheria or scarlet
fever can now be kept completely under control. By means of
skin tests (the Schick test for diphtheria and the Dick test for
scarlet fever) the susceptibility of each patient admitted is