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44
incidence for the immediately preceding years, being only a fraction
of the incidence rate for the country as a whole. This continued
low level of incidence, in the absence of a much higher degree of
artificial immunization of the community than is likely to be attained
except following the occurrence of an epidemic, must in time lower
the herd immunity of the inhabitants of the district to a degree
that it will then be ripe for an explosive outbreak. There are a
number of infectious notifiable diseases which, ordinarily, occur
only sporadically for whose treatment the proper place is the
isolation hospital, and cases of poliomyelitis, cerebro-spinal
meningitis, etc., erysipelas and typhoid fever should be admitted
to the cubicles of an isolation hospital rather than to the medical
wards of a general hospital. Cases of diarrhoea in infants should
preferably be similarly segregated rather than be admitted to
childrens' wards, while many patients suffering from such conditions
as acute tonsillitis are in urgent need of nursing which can be
obtained for many families only in hospital, but such cases should not
be admitted to general wards. Broadly, the function of the isolation
hospital should be the provision of accommodation for the reception
of patients requiring hospital treatment, but who because of the
infectious nature of their complaint cannot be admitted to general
hospitals.
The small isolation hospital with few or no separate small
isolation wards is run under great difficulties. Not only do these
arise on the admission of a case of which the diagnosis is doubtful,
but in times of epidemic prevalence of such diseases as measles
and chicken-pox, diseases with long incubation periods, many
patients are admitted with the main disease, such as scarlet fever or
diphtheria, only to find some days later that they were incubating
the other infection. To be able to deal with such circumstances,
accommodation over and above that which might appear to be
sufficient to accommodate patients in non-epidemic times is required.
PROVISION OF NEW ISOLATION HOSPITAL.
In July, 1936, an indication was given that the Council might
be able to obtain a certain site on which to erect an isolation hospital
which seemed eminently suited for the purpose. Owing to difficulties
in regard to covenants the Council is even yet not in possession of
the land.
CLINICAL ASPECTS.
Diphtheria.
Admissions—
Number admitted on a diagnosis of diphtheria 82
Number of cases clinically diphtheria 59
Number of carriers 9
In 14 cases the diagnosis of diphtheria was not confirmed, the
revised diagnosis in each case being acute tonsillitis.