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45
difficulties in diagnosis owing to the absence of some or all of the
symptoms usually associated with the disease. Some had slight Sore
Throat and no rash, others marked rashes and little temperature and
little else.
Some of these with few marked symptoms subsequently desquamated,
but during their first week's stay, owing to the presence of Diphtheria
bacilli in the throats, were a source of great anxiety, as the cubicle
accommodation was so inadequate.
From a medical and administrative point of view the existing paucity
of cubicles is a serious handicap, and exercises an adverse influence on
the Hospital's usefulness.
With another cubicle pavilion added a greater number of patients—
proportionately to beds— could be more satisfactorily dealt with and
their stay in Hospital curtailed.
With the exception of a case of Measles with Broncho-Pneumonia all
those admitted proved to be Scarlet Fever.
Nineteen of these patients had in addition definite Diphtheria, and
their stay in Hospital was proportionately prolonged.
This class of patient slowly recovers and needs great care and watchfulness
before discharge.
Some of the Otorrhœal and Heart cases were very slow in recovery
and were some months before fit to return to their homes.
I submit this in view of their prolonged stay.
The most serious complications encountered were Otorrhœa (14),
Heart trouble (6), Rheumatism (2), Nephritis (4), Glandular and Mastoid
disease (4).
There was considerable overcrowding towards the end of the year
which perhaps, though inevitable, was not conducive to the best results.
Under the circumstances the "Return Cases" were not numerous
and the total numbered seven. A considerable amount of odium and
dissatisfaction is attached to these, but until a definite standard is
obtained by which one can absolutely judge of the absence of infectivity
before discharge, one can only exercise caution and be guided by
experience.
Length of stay in Hospital nor completion of desquamation has any
influence in the prevention of "Return Cases," and the association of
these with patients who suffered from a mixed infection is verv curious.
The following particulars show the months in which they occurred,
duration of illness, the interval between discharge and secondary case,
and the number of susceptible children in the houses:—