View report page

The primary cause of death in one of the erysipelas cases was cancer of the rectum with secondary
deposits in the liver. The case of acute nephritis and uraemia occurred in a diphtheria carrier and
was admitted to the Municipal Hospital on account of the latter condition.
Measles.
82 cases of measles were admitted to hospital during the course of the year. Three deaths
occurred, giving a mortality rate of 3.6 per cent. In addition 14 cases occurred in the acute diphtheria
ward due to a child being admitted to the ward incubating measles as well as suffering from diphtheria.
It is impossible to avoid this and similar occurrences unless every patient was treated in a cubicle
which is an impracticable suggestion.
Although it is not desirable to adopt any method which would entirely prevent measles, for
this would lead to a gradual development of a non-immune population which would be a very suitable
material for the disease to attack with serious results should it be reintroduced, yet there are particular
instances in which it is most desirable to avoid an outbreak of measles. In hospital where they
are closely aggregated, almost 100 per cent. of susceptible children develop the disease if exposed
to it. Prompt isolation of the infecting case is almost always useless, and the infected children who
may be seriously ill with some other disease are liable to have a severe or even fatal attack. It is
therefore highly desirable to prevent an outbreak from occurring in a hospital ward, and a means
to immunize the exposed patients is essential.
Four methods have been recommended during the last few years, and some reports on their
efficacy are now available. The first three are in the nature of antitoxins or sera of animal origin
and derived from micro organisms, which the discoverers claimed to be the cause of measles (Tunnicliffs
serum, Ferry and Fisher's serum and Degkwitz's serum). All have been tried in this hospital
with disappointing results and this appears to be the general experience. These sera being derived
from animals are liable to produce serum reactions and this phenomenon was specially marked in
cases treated with Degkwitz's serum. The fourth method is the employment of human serum derived
from convalescent cases of measles, and in three recent investigations has protected 95.7 per cent.
(Gunn), 98.3 per cent. (Nabarro & Signy) and 100 per cent. (Sutherland) of the exposed children
respectively. The best results are obtained when the serum is given within 5-6 days of exposure,
but even if given within 9 days, although the attack is not preventable, it modifies its intensity. Serum
taken 3-4 months after convalescence will modify the disease, while whole blood from adults who have
had measles in infancy has a similar effect.
There are certain difficulties in obtaining human convalescent serum, but these are not insurmountable.
In the first place it is desirable for the blood to be taken from an adult. Cases of
measles occurring in adults are not nearly so common as similar cases in children. We had, however,
6 adults (over 18 years of age) out of the total of 82 cases of measles treated in this hospital during the
year. Secondly, the adult must be otherwise healthy.
It is suggested that the Council should consider this question, in order that arrangements
could be made for a supply of human convalescence serum to be available for treatment of suitable
cases.