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88
5 cases of Ophthalmia Neonatorum.
6 ,, Pneumonia.
1 ,, Varicella.
8 „ Influenza.'
Most of the above diseases require to be isolated from the other patients and in special wards.
The lack of small ward accommodation made it a matter of great difficulty to provide adequate isolation,
especially during the winter months.
Coexistent Disease.
Under this heading a total of 54 cases were admitted :—
In 35 patients Scarlet Fever and Diphtheria coexisted at the tim,e of admission.
7 „ „ „ Chicken Pox „ „ „ ,,
7 „ ,, ,, Measles ,, ,, ,, „
4 „ Diphtheria and Chicken Pox ,, „ ,, ,,
1 „ „ „ German Measles ,, ,, ,, „
The number is a considerable increase on previous years, and is due to the fact that a more
systematic bacteriological examination of the throats and noses of Scarlet Fever patients during the
acute stages of the attack have been carried out Amongst the 35 coexistent Scarlet Fever and
Diphtheria patients, 19 had developed Diphtheria in an ordinary faucial or throat form, the balance
exhibiting the intensely infectious nasal type I have already referred to in an earlier part of this
report. I specially allude to these Coexistent Scarlet Fever and Nasal Diphtheria cases for the reason
that a large proportion of them have very clearly, I might add very unpleasantly, brought home to
me the very close relationship there is between Coexistent Scarlet Fever and Diphtheria, and Return
cases of the former disease. So much so, that I have now the greatest diffidence in discharging
those cases of Scarlet Fever in which I know this second infection to have existed. During the
eighteen years I have been in this hospital I have had a very intimate knowledge of every case of
Scarlet Fever that has passed in and out of the hospital, for all of them have been under my own
particular care in the wards. I have in consequence a very clear idea of the class of patient which
gives rise to a Return Case of Scarlet Fever on its return home and I have no hesitation in saying
that a very large number of these return cases of Scarlet Fever are set up by patients discharged
from hospital in whom Coexistence of Scarlet Fever and Nasal Diphtheria has existed. So repeatedly
has this occurred on the discharge home of these Co-existent cases during previous years that it only
required the convincing experience of last year to remove all vestige of doubt. It is in consequence
of this fact that I have drawn special attention to it. It has long been recognised that convalescent
cases of Scarlet Fever with mucous discharges from the nose are above all others the most likely to
give rise to return cases, but I do not think it has been noted that the infecting cases are mixed
infections or that the mucous discharges are in many instances of diphtheritic origin. The interesting
fact to note in connection with the whole question is that these cases of Scarlet Fever or Nasal
Diphtheria on their return home seldom give rise to Coexistent Scarlet Fever and Diphtheria return
cases, and still more seldom to pure Diphtheria cases; in the great majority of cases the return case
suffers from Scarlet Fever alone. In other words the Coexistence of the two infections intensifies
the power to infect of the Scarlet Fever element almost to the exclusion of the other.
Non-Infectious Cases.
Reference to Table No. 1 shows that 1,495 cases of this category were admitted. This is
an addition of 515 patients as compared with 1919, the increase actually taking place in the case
of children of school age and in maternity. There was also a slight increase amongst Gynaecological
cases and adults.
Children under 5 Years of Age.
I here is nothing to state under this heading, except that the number of cases as compared
with the previous year shows a decrease of 79.
Children of School Age.
Tables Nos. 59 and 60, which deal with the above, appear in the School Medical Officer's
Report and are specially dealt with by him. I would, however, draw special attention to the large
number of cases in which enlarged tonsils and adenoids were removed, also to the fact that although
one morning a week is given up entirely to operating on these particular patients the number on
the waiting list does not diminish and at present, approximates over two hundred. It is obviously
a very prevalent condition, and even if the hospital admitted nothing but infectious cases, I am of
opinion that the systematic removal of these enlarged tonsils and adenoids would be well advised.
J here is a close relationship between the conditions just mentioned and the onset of infectious ailments,
and it is well recognised that not only are these cases more prone to catch infection than others, but
also that they suffer from that infection more severely, and above all harbour it for a protracted
period of time. It is these tonsil and adenoid cases which carry infection home in a large proportion
of cases, and it is these cases that are so difficult to prepare and get ready for discharge and remain
so long in hospital.