View report page

34
There were five fatal cases during the year. Of these, three were
Scarlet Fever and two Diphtheria.
This gives a mortality of Scarlet Fever of 2.0 per cent. of notified
cases. The rate for England and Wales being 3.4 per cent. of
notified cases. The rate of mortality of cases treated in the hospital
is 2.2 per cent., as compared with an average rate at all ages of
5.3 per cent. for the Hospitals of the Metropolitan Asylums Board.
The mortality rate of the cases of Diphtheria was 13.3 per cent.
as compared with 24.7 per cent. at all ages in the Hospitals of the
Metropolitan Asylums Board.
The majority of the cases of Diphtheria were of severe character;
one patient was moribund on admission, and the operation of
tracheotomy was performed in three cases, one of which proved fatal
from extension of the disease 36 hours after operation.
One patient developed post-diphtheritic paralysis, and one had
serious cardiac collapse during convalescence. There was no "return"
case of Diphtheria. This is due to the fact that it can be determined
with a high degree of certainty by means of Bacteriology when a
patient is free from infection. No case is discharged from the hospital
until three consecutive negative reports are obtained from swabs taken
from the nose and throat at intervals during the last 10 or 14 days'
stay of the patient in hospital.
Among the Scarlet Fever patients there were 4 who suffered from
Acute Nephritis; 6 from Bronchitis and Pneumonia; 4 from
Abscesses which required operation; 12 from Arthritis; 25 from
Otorrhcea (8 on admission) and 18 from Rhinorrhcea (3 on
admission).
During the summer months the average stay in Hospital of the
Scarlet Fever patients was considerably prolonged through an outbreak
of Measles and Chicken Pox. Both complaints were introduced into
the wards by patients incubating with the diseases on admission.
Three of the patients had Chicken Pox and 14 Measles. Many of
these latter cases were of a severe and anxious character, being
complicated by Bronchitis and Pneumonia.
There have been 5 probable "return" cases of Scarlet Fever
from three houses. In this disease there are no means of proving
that a patient is free from infection. The accepted rules for regarding
a patient as free from infection, are:—(1) Isolation for a period of
six weeks (this has been maintained in all cases of Scarlet Fever);
(2) Freedom from desquamation; (3) Absence of Rhinorrhœ,
Otorrhœ, or other infective sequeloe. I made careful investigation
into the supposed infecting cases (3 in number), having examined
them myself for discharge, and also at home after the occurence of a
second case. There is no doubt whatever, that the patients were
discharged from Hospital perfectly free from any desquamation;
without any discharge from ears, nose, or throat, and their stay in
Hospital conceded the average. When I saw them at home I found
that all patients had discharge from the nose.
It is well recognised that this condition may ensue as a result of