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Scarlet Fever.
The remarkable thing in connection with this disease is not only the great increase in number,
but also the invariable mildness of the attacks which occurred during the period of greatest prevalence.
A regrettable circumstance, however, has to be noted, that in spite of the mildness, the
infectiousness of the patient seemed to persist during convalescence for an unusually long period
and in a larger number of cases than it is usual to expect. It is to be assumed that the increased
incidence of the disease is to be attributed to a particularly active infection, and possibly that very
fact accounts to some extent for the undue persistence of the infectiousness in the patient. In my
opinion, however, a much more potent factor was the circumstance that in order to accommodate
all the cases overcrowding of the wards constantly prevailed. The floor space per patient being
approximately 50 per cent. of what is generally considered adequate. As the result of a fairly long
experience, I have no hesitation in saying that if the floor or cubic space, of Scarlet Fever patients
especially, is diminished below the recognised standard, that will at once aggravate the infectiousness
of your patient. A large proportion of patients, once this happens, do not convalesce so readily,
their throats, nose and ear conditions do not heal, purulent discharges from all these sites become
frequent and persistent, they interchange their infections, and generally the patients remain in a
quite unsuitable state for discharge to their homes.
It is not my intention to try to prove that persistence of infectiousness is solely attributable
to overcrowding; there are other factors at work, but I am anxious the Council should realise that
when you diminish the floor space or cubic space per patient below the standard, that you defeat
the very end for which the hospital exists. By so doing, instead of rendering the infection in the
patient harmless, you foster and intensify it. There is ample proof that free ventilation and adequate
space per patient renders Scarlet Fever infection quickly inert, just as there is proof that the reverse
aggravates it. It is false economy to provide insufficient accommodation for your infectious patients
To refrain from building may effect a saving in that particular direction but it invariably means,
and experience teaches it here, that extra expenditure is incurred by reason of the fact that your,
patients remain longer under treatment.
Diphtheria.
The 605 cases of this disease is the highest yet reached. Diphtheria seemingly is as prevalent
as ever, and clinical experience shows that there is no diminution in its virulence. Were it not for the
beneficial effect of anti-toxin treatment there can be no doubt that it would be the most fatal of all
the infectious ailments now existent in this country.
Throughout the year the type of attack for the most part was severe, and there is the added
fact that, even in cases which came early under treatment, the diseases seem to have progressed with
unusual rapidity. Many cases of great malignity were admitted, and several exceeded anything in
that respect I have ever seen before.
Attention might be drawn to the unusual number of cases of nasal diphtheria admitted. Many
of these cases had no throat affection, but a condition entirely limited to the nasal passages. These
pure nasal cases are never fatal. They are, however, intensely infectious. There is great danger
of the condition spreading to others and of the condition continuing long after the patients return
home in spite of that fact that a negative bacterial examination was obtained at the time of leaving
the hospital. This is the explanation, at any rate in part, in my opinion of the rather large number
of return cases of diphtheria that occurred during the year, though here, also, the crowded state of
the wards may have played its part. In any case it has been the experience that return cases of
diphtheria are extremely rare, but there is no doubt that for the last two years, since when patients
suffering from this disease have had to be treated under crowded conditions, that return cases have
greatly increased.
Considerable discussion is at present being carried on in the medical journals with regard to
the advisability of discharging diphtheria convalescents who are still harbouring the specific germ.
The invariable custom here is to discharge the patient only when the bacteriological examination
has proved that he or she is free from infection. It is an interesting fact, however, that experience
here shows that no harm accrues in the case of a patient discharged after a faucial or throat attack,
and who possibly, in spite of a negative bacteriological examination, harbours the specific organism
on his return home, but that a second or return case frequently results on the return home of the
patient recovered from a nasal attack in whom apparently the infection had similarly persisted.
I would again draw your attention to the fact that all bacteriological examinations connected
with diphtheria and other infectious diseases are still being made in London, and that delay is caused
thereby. This, in many instances of diphtheria, I believe, has militated against the chances of
recovery of the patient.
Other Infectious Diseases.
The total admitted under this heading was 63, and these include:—
8 cases of Enteric Fever.
2 „ Whooping Cough.
9 ,, Measles.
16 „ Infantile Diarrhoea.
8 ,, Erysipelas.