Return cases of scarlet fever and diphtheria : reports and papers relative to the Board's inquiries / Metropolitan Asylums Board.
- Metropolitan Asylums Board (London, England)
- Date:
- 1901
Licence: In copyright
Credit: Return cases of scarlet fever and diphtheria : reports and papers relative to the Board's inquiries / Metropolitan Asylums Board. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![baths. Therefore how does lie know that these baths have not prevented the occurrence of a larger number of “ return cases” than have actual]v arisen? I am, however, quite ready to agree with him with respect to the statement made in the last portion of this paragraph, which relates to the effects of warm baths and exposure to the weather. From personal inquiries made ip a few cases, I believe that ill effects have occasionally followed, both with regard to the health of the patient himself and the renewal of infection. In the cases of a few weakly ^children, I have, as a matter of fact, carried out Dr. Simpson's suggestions, and have given the final bath the afternoon before the day of discharge, the patient after the bath being placed for the pight in an isolation ward. Most of the cases I have so treated have been sent straight back to general or children's hospitals; and so far no instance of scarlet fever or diphtheria having been imported into the wards of these hospitals by these patients has been brought to my notice. I am therefore quite prepared to advise that Dr. Simpson’s suggestion as to the transference of patients about to be discharged to less infective wards (see paragraph viii.) should be more extensively carried out. But the provision of these less infective wards means either the reduction in the number of beds for acute cases or the erection of new buildings. The above remarks on this paragraph refer chiefly to scarlet fever. With regard to diphtheria, I believe the warm bath immediately before discharge to be quite unnecessary. As a matter of fact, in consequence of the very inadequate accommodation for discharging patients at this hospital, this bath has (since the increase in the number of beds for diphtheria) been given the night before the patient’s discharge, and the patient has been discharged almost directly from the ward in which he has been during his stay in the hospital. He is not dressed in his clean clothes in the ward, but in a room (formerly used as a nurses’ sitting room) adjoining it. I gather from Dr. Simpson’s report that the number of “ return cases ” of diphtheria is trivial, so that the practice I have been compelled to adopt has had no ill effects. Paragraph (vii.).—On the whole I agree with what Dr. Simpson says in this paragraph ; but with him 1 think the figures are so small that the results of the comparisons shown in the tables on pp. 20 and 21 must be accepted with great caution. Dr. Simpson appears to have overlooked the fact that the cases detained for long periods are just those cases which are thought to be infectious because they are the subjects of some complication, especially a discharge from the nose or ear, on which account they have not been sent out of hospital at an earlier date. Dr. Simpson does not show that if they were to be discharged earlier they would give rise to fewer “return cases” than they do. It is, indeed, quite possible that they would give rise to more. I may add that both Dr. Neech, of Atherton (vide Lancet for 25th September, 1897), and Dr. Millard, of Birmingham (vide British Medical Journal for 3rd September, 1898), in valuable reports made by them on the subject of “ return cases,” came to the opposite conclusion with respect to the relation between duration of stay in hospital and occurrence of “return cases to that arrived at by Dr. Simpson. Paragraph (viii.).—Here again I think that Dr. Simpson's idea that the discharges act as carriers and not as causal agents of infection is not supported by](https://iiif.wellcomecollection.org/image/b22369697_0028.jp2/full/800%2C/0/default.jpg)
