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45
The Borough of Hendon have a relatively modern hospital near the
Harrow boundary and have ground on which the hospital could be
considerably extended. In 1944, then, it was decided that approach
should be made to the Borough of Hendon to discuss in general the
question of the provision of a hospital of size sufficient to receive patients
from both districts. At an early meeting it was agreed there were
advantages in having a still larger hospital for which there is room on
the site and which would serve the Borough of Wembley in addition to
Hendon and Harrow. This proposal was acceptable to all three parties,
and at the end of the year it seemed that the prospect of fulfilment was
quite bright.
Not all infectious patients are admitted as a matter of routine to an
isolation hospital—apart from the fact that it is not necessary, it would
not be practicable. When isolation hospitals were first established, the
three main infections admitted were scarlet fever, diphtheria and typhoid
fever, about half of the accommodation being required for sufferers from
scarlet fever. The type of illness of scarlet fever has undergone a marked
change, so that what was at one time a most severe complaint, to-day
is usually very mild. This waning in severity is reflected in the greater
willingness of parents and of the attendant physicians for the child
patients to remain at home. Diphtheria is warrantably classed as one
of the more serious diseases which needs such constant nursing as can
best be provided in hospital, so that in general all diphtheria patients
to-day are admitted to hospital. On the other hand there has been such
a marked decline in the prevalence of diphtheria that the accommodation
required for such patients is' much less now than formerly. The virtual
elimination of typhoid fever is, of course, one of the outstanding successes
in hygiene in this country, and to-day no special provision needs to be
made for such patients. Against these lessening demands, though, must
be set the increasing requirements for the nursing of other diseases, and
because these occur more sporadically than in outbreaks of any size,
cubicle accommodation is required to enable each patient to be housed
separately. To such cubicles should be admitted those patients needing
hospital treatment, but who because of an infectious state cannot be
admitted to the ward of a general hospital. Cases of gastro-enteritis
form one such group. In general, the patient suffering from measles,
whooping cough or influenza, does not need to be treated in hospital,
but the patient suffering from complications of one of these diseases does.
The test, then, as to the necessity for hospital admission is very different
from what it was. When first established, isolation hospitals were
institutions to which were admitted patients suffering from some acute
infectious illness with the object of removing an infective focus and so
limiting the spread of infection. In this they very largely failed. Today's
conception of the isolation hospital, though, is of an institution to
which are admitted patients suffering from something for which hospital
treatment is necessary, but who, because of their infective state, cannot
be admitted to a general hospital. This means, of course, that the
standard of treatment and the facilities for treatment at the isolation
hospital should be comparable to those obtaining in the general
hospital.