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108
Since 1948, the Medical Officer of Health has not been any more closely
associated with infectious cases than the medical practitioners, who now
obtain the second opinion from the medical superintendent of the isolation
hospital. To obtain a consultant's opinion in doubtful cases of smallpox
or typhus fever, advantage is taken of the arrangements made by the
Ministry of Health.
Isolation
Whether the isolation of a patient suffering from a communicable
disease is necessary depends on the usual mode of spread of the complaint.
The stringency of the isolation is partly dependent on the severity of the
disease; its value is largely determined by the infectiousness of the
patient before the nature of the disease is first recognised.
Isolation hospitals were established as places to which infectious
patients might be admitted with the object of preventing the spread of
infection to others. The diseases from which those who were accepted
were suffering were scarlet fever, diphtheria and enteric fever. In this
object, isolation hospitals failed largely because of the infectiousness of
the patient before the disease is diagnosed, so that secondary infection
would already have occurred. Nevertheless, isolation hospitals have
continued to be erected and have continued to be used, but to-day's
conception of their purpose is that they are institutions to which are
admitted patients suffering from conditions needing hospital treatment,
but who, because of their infectiousness, cannot be admitted to the
ordinary ward of a general hospital. At the same time the range of
usefulness of the hospital has been widened, and most of those suffering
from communicable conditions who need to be treated in hospital are
now admitted to the isolation hospitals. Not all those suffering from
the communicable diseases, then, have to be admitted to hospital. It is
not usual to admit those suffering from the commoner non-notifiable
children's complaints, such as mumps, chickenpox and german measles.
It would not be practicable, nor is it necessary, to admit all those suffering
from measles and whooping cough, though it is most desirable that those
suffering from these complaints who are very young or are badly housed,
or are suffering from the more serious of the complications, should be
admitted. Diphtheria and enteric fever are two diseases which need
skilled nursing, and all sufferers should be treated in hospital. Although
infection is considered to have only rarely been spread by actual cases
of poliomyelitis and cerebro-spinal fever, sufferers from these diseases
are treated more often in isolation than in general hospitals. Particularly
during an epidemic of influenza, those suffering from the complications
of this complaint are if possible admitted to hospital. With the very
mild clinical type prevailing to-day, it is unnecessary for many of those
suffering from scarlet fever to be admitted to hospital. Although the
proportion of those suffering from scarlet fever who are admitted to
hospital is to-day less than it was before 1948, there are to-day many beds
which could be better used if parents and medical practitioners would
realise that not only is it unnecessary for many of the children to be
removed to hospital, but that there are actual disadvantages in this being
done, because, having to be admitted to a general ward, as so many ot