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72
THE THIRTY.NINTH ANNUAL REPORT
FOR THE
Year ending 31st December, 1930,
ON THE
MUNICIPAL HOSPITAL
By ARTHUR G. TROUP, M.D., D.P.H.,
Medical Superintendent.
During 1930, 1,029 patients were admitted to Hospital as compared with 955 in 1929, 1,037
in 1928, 767 in 1927, 846 in 1926, and 601 in 1925.
Scarlet Fever.
During the past year 421 cases of this disease were admitted to Hospital as compared with
454 cases during 1929. Two deaths occurred, giving a mortality rate of 0-47 per cent. In one case
the primary cause of death was lobar pneumonia. The other death was due to the malignant or
toxic type of the disease. The latter patient, a woman aged 42 years, was admitted to Hospital
on the 5th day of the disease with a history of severe sore throat, vomiting and diarrhoea. The
temperature was 102-6° and the pulse 114. The erythematous rash was intense and of characteristic
distribution. It was accompanied by a petechial rash which was most marked on the flanks and
groins, and in this respect resembled the hemorrhagic rash of smallpox. The fauces were intensely
inflamed with a dry and stripped tongue and sordes on the teeth. There was no obvious nasal discharge
and the neck glands were only sightly enlarged. Mentally the patient was dull and inclined
to wander at times, but could answer questions intelligently when roused. Two days after admission,
desquamation was noticed on the neck and later there was profuse desquamation on the trunk. Scarlet
fever antitoxin was administered intravenously shortly after admission, and later two further doses
were given intramuscularly. There was a rapid fall of temperature after the first dose, but the general
condition of the patient did not show any appreciable improvement. The patient gradually passed
into the typhoid state with severe prostration, rapid and feeble pulse and terminal coma, death
taking place on the 11th day of the disease. A throat culture was reported as giving a profuse growth
of the streptococcus haemolyticus, which is now accepted as the causal organism of scarlet fever.
Malignant or toxic scarlet fever is fortunately rare now-adays, in this country; in fact this is
the first example of the type to occur in this hospital for many years.
Diphtheria.
420 cases were admitted or 73 more than the previous year. These cases may be classified
as follows :—Faucial 293, Nasal 66, Faucial and Nasal 32, Laryngeal 14, Aural 6, Bacteriological 9.
It was necessary to perform the operation of tracheotomy on 7 of the laryngeal cases, of which 4
recovered and 3 died. The total number of deaths from diphtheria was 14, giving a mortality rate of
3-40 per cent. The mortality rate for England and Wales for the year 1929 was 5-49 per cent. Four
of the diphtheria deaths occurred in patients suffering from the haemorrhagic type of the disease.
This form of diphtheria invariably proves fatal. In calculating the mortality rate, the bacteriological
cases have been excluded.
Two other cases admitted to hospital as suffering from diphtheria died, but as the cause of
death was not due to this disease, they have been excluded from the diphtheria deaths. The first
was a child who had received severe burns to the trunk and arms owing to an accident at her home,
and death was due to this cause. The second was a child who had a mild attack of nasal diphtheria.
Some time previously he had been operated on for double mastoiditis. The wounds had never
healed and he subsequently died from abscess of the brain.
Mixed Infections.
The following cases of mixed infections were admitted :—
Scarlet Fever and Chicken Pox 3
Scarlet Fever and Measles 1
Scarlet Fever and Diphtheria1
Diphtheria and Measles 1