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hospital is very different, in that it is now accepted as being an institution
to which are admitted patients suffering from conditions needing hospital
treatment, but who because of their infectiousness cannot be admitted
to a general hospital. The isolation hospital, therefore, admits a far wider
range of case than formerly. As many of these are sporadic, patients
have to be admitted to small, even individual, wards. The design of
hospital construction has, therefore, been altered so that to-day's hospital
contains a very high proportion of its accommodation in small units.
Of the three diseases which were first admitted, typhoid fever is no
longer common, even during the autumn when the seasonal rise used to
occur. Diphtheria, it is hoped, will be controlled and kept to low figures
by immunisation. Scarlet fever at times is very prevalent, but of recent
years its type has been mild. Public opinion, though, seems to consider
that such patients should be admitted to hospital. Apart from the
wastefulness of such a practice, there is the real disadvantage in that,
when admitted to the general ward, the child is exposed to an infection by
a more severe type of organism than that which gave him his attack.
While less accommodation is required for this disease, though, the range
of case admitted is widened, and during the epidemic periods of influenza,
measles or whooping cough, many suffering from complications of these
conditions might with advantage be admitted.
Exclusion.
Because a contact of any sufferer from an infectious disease might be
a carrier either contact or incubationary, it was customary to insist on the
exclusion of contacts on quite a large scale. The stringency of this
practice has been gradually relaxed, until to-day many authorities exclude
only those whose occupations bring them into contact with those of
susceptible ages, or render them possible instruments of widespread outbreaks
through their handling of milk, or some other medium—though
even here the restriction is imposed only in the case of the more severe of
the infectious diseases. For many years the procedure in regard to the
exclusion of school child patients, suffering from infectious diseases and
of school contacts, has been governed by the recommendations contained
in the Memorandum on the Closure of and Exclusion from School, issued
jointly by the Ministry of Health and the then Board of Education. An
addendum, issued in 1942, recommended a modification of the procedure,
the general effect of which was that a patient who had suffered from
scarlet fever or diphtheria could be re-admitted to school one week after
being freed, instead of two weeks as formerly ; while contacts of patients
suffering from these diseases and treated at home could be admitted after
seven days' exclusion from the date of isolation, instead of waiting until
after the patient had been freed from infection.