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42
easily be prevented by the visitors themselves." It is satisfactory to
be informed that "the number of enquiries at the gate concerning
patients has fallen to a fraction of what it used to be, enquiry and
answer being now made largely by letter." Perhaps the most interesting
feature in connection with the work of the hospital, was an
outbreak of small-pox in the scarlet fever wards. There were 6
cases in three wards, between November 29 and December 17,
among convalescents. The patients had been resident in the
hospital from 28 to 46 days before an attack, "so the possibility
of their infection outside must be excluded." The cases
occurred in two groups, Nos. 1 to 4 invaded November 29
and December 5, and Nos. 5 and 6 invaded December 12 and 17.
"The second group," it is said, "cannot be altogether referred
to infection from the first group, since one of the (2) cases comprised
in it occurred in a different ward. On the other hand,
case 5 inhabited the same ward as case 2 and was attacked exactly
13 days after that case." "The facts on the whole are suggestive
of community of origin in each instance for members of the groups."
The possibility of infection having been carried in the clothing of
an assistant medical officer, who occasionally visited the fever wards,
is referred to, and means have been taken to prevent the recurrence
of such a possibility. "Failing this explanation of the outbreak one
has to consider the question of aerial transmission of infection."
The small-pox wards and fever wards are on opposite sides of the
site and distant from one another about 150 feet. At no time
when small-pox cases were occurring in the fever wards, were there
more than 20 patients in the small-pox wards. All the cases in
the fever wards were mild and they did well. It may be mentioned
that the occurrence of small-pox among the fever patients in the
Managers' Hospitals is very rare, although the distance separating
the two classes of cases is necessarily limited, the fever patients
being well within what would be called the "striking distance" of
the small-pox contagium, were the question of outbreaks beyond
the walls of a hospital, and in the "special area," under
consideration.