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empyema and acute arthritis. These conditions occurred in patients
who had been admitted from the North Middlesex or Prince of
Wales's Hospitals either for observation or suffering from some
infectious disease. In addition, several of the patients who
developed adenitis following scarlet fever required minor operative
treatment, while 4 tracheotomies were performed together with
several paracenteses and Wilde's incisions. One mastoid operation
was found necessary. The tracheotomies were, unfortunately,
unsuccessful in averting a fatal issue, but the remaining operative
treatment proved exceedingly beneficial in every case. Apart from
the actual operations, a considerable amount of work in the way of
dressings, artificial light treatment, irrigation, etc., was carried
out, with excellent results.
As before, Dr. Macdonald undertook the great bulk of the
surgical work required and never failed to respond immediately to
the calls made upon his services, either for operative or consultation
purposes. A throat and nose surgeon from London was obtained
to perform one of the tracheotomies, and several visits were made
by other West End consultants.
It is hoped in the present year to appoint Dr. Macdonald as
Consultative Surgeon to the Hospital at a fixed remuneration, thus
stabilising a position which has been rather nebulous, although in
practice very satisfactory, in the past.
Discharge Procedure.—The practice governing the discharge
of diphtheria patients has been amended, and now 3 instead of 2
negative swabs are necessary before any such patients leave the
hospital, unless by arrangement with the district from which they
were admitted. A "trial-period" disclosed the fact that several
patients gave a positive swab after two negatives and it was therefore
thought that the more rigorous standard would admit of less
error.
Patients with persistent diphtheria bacilli in the nose, throat
or ear are given special treatment in an endeavour to shorten the
period of carrying, and virulence tests are performed when required.
When possible, scarlet fever cases are discharged from the
Cubicle and Isolation Blocks, but in all cases the strictest care is
exercised to prevent infection being carried outside the hospital.
In this connection, a scheme whereby home contacts will be offered
a protective dose of anti-scarlatinal serum is being considered.
Period of Isolation in Hospital.—The average time of isolation
in hospital was as follows:—
Scarlet Fever—36.5 days (longest, 73 days; shortest, 11
days—desquamating on admission). Average
duration, 1932—37.4 days.
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