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hospital they are fit to work, and are detained solely for the welfare
of the unprotected public." They also allude to the case of "persons
who, though not having small-pox, are through errors of diagnosis,
admitted to hospital and exposed to infection." Happily these cases
are few, as no case is admitted without the sanction of a Medical
Superintendent, and all doubtful cases are at once revaccinated. But
in cases of both classes referred to, there will be little doubt as to the
reasonableness of the suggestion that "the Managers should have
discretionary" powers to give pecuniary compensation.'
Clinical Instruction.—As an illustration of the necessity tor
medical students becoming practically acquainted with the diagnosis
of fevers, the Committee refer to cases of " mistaken diagnosis;"
no fewer than 188 patients in the course of the year having
been found, after admission, not to be suffering from the diseases
mentioned in the medical certificates upon which they were
removed to hospital.* It may, not unreasonably, be asked, why,
then, were the patients admitted ? No case is admitted without
previous examination by the Medical Superintendent, or one of the
assistant medical officers. The cases of " mistaken diagnosis " must
be even more numerous than stated as, when the mistake is recognised,
the patient is returned to his own home. Many of the 188
patients, therefore, who were mistakenly sent, and mistakenly admitted,
to hospitals, may have been, " doubtful " cases ; the doubt as to the
nature of the illness requiring time for clearing up the diagnosis. Upon
any other supposition the statement made would involve as much
reflection upon the medical staff as upon the medical practitioners
who certified for the removal of the patients.
The Committee observe that
" The percentage of errors in the diagnosis of patients, sent to the Managers'
hospitals, has increased during the past five years from 2.4 to 6.2, and in
* The percentage of cases of mistaken diagnosis, was, as regards scarlet fever
cases, 2.3; diphtheria cases, 10'3 ; enteric fever cases, 23.6; and typhus cases,
55"5 per cent. Of 124 cases certified as scarlet fever, 45 had measles, 9 had
febricula, 10 pneumonia, and 16 tonsillitis. Of 135 cases certified as diphtheria, 50
had tonsillitis, 6 broncho-pneumonia, and 16 pharyngitis and tonsillitis. Of 178
cases certified as enteric fever, 26 had febricula and simple continued fever, 10
broncho-pneumonia, and 44 pneumonia. Of 10 cases certified as typhus, 3 had
pleurisy.