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89
NON-DIPHTHERIA CASES ADMITTED TO HOSPITAL.
One onerous duty imposed on those administrating isolation
hospitals is the treatment of cases sent in with a diagnosis
of diphtheria when such a diagnosis is in doubt.
To emphasize this point the case is taken of the subject
from whom a positive swab has been obtained before admission
but who, on arrival at the hospital, has no clinical symptom of
any kind. Presumably the patient had some clinical sign
prior to admission otherwise swab-taking would seem superfluous.
Not only from the economic and the social standpoints,
but also from the point of view of the safety of the individual,
the appropriate period of detention in hospital becomes an
involved consideration.
If the negativity of symptoms at the time of and subsequent
to admission to hospital indicates a policy of shortening
of detention to comply with social and economic needs, the
possibility of the case having been one of true diphtheria from
which clinical and bacteriological evidence had disappeared
has got to be faced, and shortening of detention period might
result in some of the alarming sequelæ of diphtheria developing
with even the possibility of fatal results, after a patient's
return home.
Moreover, there is the further complicating factor,
referred to elsewhere, that the longer the detention in hospital
the greater is the hazard of acquiring types of organism not
associated with the cause of admission.
These observations are made because the difficulties and
anxieties encountered in hospital administration are not fully
realised by those who do not experience them.
MIDDLE-EAR DISEASE IN DIPHTHERIA.
One complication of diphtheria, one that has received
something less of attention in literature than it merits, is
middle-ear disease.