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Diphtheria incidence in any urban locality might be about 50 per
cent of that of scarlet fever. In this district the rate for the last ten
years has been markedly low, even before the immunisation of children
had protected any appreciable number, and in not any of these years
have as many as 100 cases been notified, while the true incidence has
been about one-half the notification rate. For this reason then, in this
district the accommodation provided for diphtheria patients does not
need to be on the same basis as was at one time common practice, i.e.,
about one-half of that of scarlet fever.
In regard to other infections, arrangements have been made for
those patients who need hospital treatment because of some infectious
condition to be accepted at the hospitals of other local authorities.
Apart from groupings of cases suffering from complications of measles,
whooping cough or influenza, when these ailments are prevalent, most of
these patients are sporadic cases of such conditions as erysipelas, cerebrospinal
fever, enteric fever, puerperal infection, etc., most of whom would
require to be admitted to cubicle wards. The greatest number of such
cases for whom admission to outside isolation hospitals has been arranged
in any one year was 80. In most years it has been possible to find the
accommodation, only rarely it proving necessary for patients, whom it
was desirable to be treated in hospital, because of lack of accommodation,
to be nursed at home. In general then, the position for the past ten
years has been that the needs of the district have been met by most of
the cases of scarlet fever and diphtheria being accepted in the local
hospitals, and cases of other infections being admitted outside. It is not
suggested that the conditions are ideal. Quite apart from the fact that
what accommodation is available locally is provided in two detached
institutions which are run as one unit is that both hospitals are admitting
more than the desirable numbers of patients to the wards. On the basis
of 144 square feet per patient the Honeypot Lane Hospital accommodation
is 17 and South Harrow 25, whereas the limiting figures for these
institutions are 26 and 46. Nevertheless the needs of the district have
over these years been met by some 60 beds for scarlet fever patients and
some 12 for diphtheria, together with the admitting of cases of other
infections to outside hospitals.
At one time it was accepted as a rough guide that an urban area
would require isolation hospital accommodation on the basis of one bed
per thousand population. Changing factors have modified this. Although
scarlet fever and, to a less extent, diphtheria, provided most of
the patients admitted to an isolation hospital, most hospitals have, to an
increasing extent, accepted cases of other infections. In all, these would
not amount to a very high proportion of admissions, but has necessitated
the provision of some accommodation in small wards and cubicles. The
main factor curtailing admissions though, is the mildness of scarlet fever
today, as has been the case now for some years. This results in a larger
proportion of patients being treated at home, and also shortens the stay
of those admitted. More recently still the use of scarlet fever serum and
of the chemical drugs enables patients to be discharged earlier than was
the previous practice.
When consideration was given to the question of the size of the new