Report on means of isolation in Victoria / by Dr. Gresswell.

  • Board of Public Health, Victoria.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Report on means of isolation in Victoria / by Dr. Gresswell. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    It will, of course, be understood tliat the risks of contracting infection are not alike in all cases. The infection of scarlet fever may be contracted from air-borne virus ; that of typlioid fever is generally tlie result of contamination of the water- or food-supply by discharges from some typhoid patient ; and the contraction of the infection of erysipelas or of puerperal fever probably needs a cut, a rent, or an abraded surface, the media of infection in the latter case being generally the hands, the clothing, or the appliances of the attendants. If regard he had to these several considerations concerning the difficulties of I'endering home-isolation and home-disinfection complete^ it must be concluded that the marked abstention from indoor hospital treatment^ or more accurately from hospital- isolation^ has not been without its influence in keeping up the prevalence of communi- cable diseases in the metropolis ; rather it must be admitted that it has had very largely to do with maintaining those prevalences. C.—Reason for Abstention from Hospital on the part of the Infectious Sick of the Metropolis. What was the reason for this marked abstention from hospital on the part of the infectious sick that died, and of the tens of thousands of others that recovered ? The answer is simple—there was no other course open to them. At none of the metropolitan hospitals are persons admitted when affected with diseases that are communicable by so-called personal infection. Though this practice has not at all times been rigidly observed, it is a fact that for some years past no case, for instance, of scarlet fever, diphtheria,* measles, erj^sipelas, whooping-cough, or puerperal fever, has been received into any metropolitan hospital, except the Melbourne, and into that only as a matter of real urgency ; and while, as regards persons suffering from typhoid fever, admission is given at the hospitals so far as the accommodation permits, that accommodation must be looked upon as limited, if regard be had to the great number of cases that occur, to the small numljer of deaths from typhoid fever in hospitals compared with the number outside, or to the fact that many patients in the typhoid season have been refused admission. Concerning the refusals reference may again be made to my Melbourne report. As there stated, of those, who applied—most of them in person—at the Melbourne Hospital during the twent}'-two weeks ended 21st May, ] 890, while suffering from recognised typhoid fever, or from fever which no doubt in many cases Avas typhoid, 263 could not be admitted ; and of the persons who, while similarly suffering, applied with orders for admission at the Alfred Hospital during the first half of the same year, 58 could not be admitted. It is said that within the latter period 100 or more Avere refused admission at the Homoeopathic, and a considerable number also at the Children's, Hospital. It would not be possible to determine the total number of persons to whom admission was refused ; for many were driven round from one hospital to another, and not a few of these may have been early admitted. It is, nevertheless, true that large numbers were not able to gain admission early ; and that many made repeated application before they succeeded. This, it appears, was a matter of necessity, for at the time referred to as large a proportion as 50 or 60 per cent, of the medical beds at the several hospitals was devoted to typhoid patients. It is, moreover, to be borne in mind that knowledge of the difficulty in the way of gaining admission to hospital no doubt deterred patients from making application who would otherwise have gladly availed themselves of the isolation and treatment provided in an hospital. Jt has been frequently stated that during more recent years the hospital- accommodation for typhoid fever has been ample. But this cannot be accepted as correct, for each year there have l)een hundreds of persons affected with typhoid fever who, though in urgent need of hospital-treatment, have passed through their illnesses at home. In Footscray alone, as shown by Dr. Shirres, there were 86 persons affected with this disease in the first four months of the year 1891 ; and, though but few of these could possibly have received treatment in their homes with- out the health of other persons being endangered, only two, so far as could be ascertained, were treated in hospital. A similar experience, moreover, has been met with each year since. Jt cannot, therefore, be admitted that, even for typhoid fever, the accommodation provided is sufficient. * During the first half of the year 1890, as many as 72 tliplitheritic patients were achuitted to hospital. It may, however, be noted that as many as 46 of these were admitted to tlie Children's Hospital, and that the admission of such patients into the latter hospital has now for about seven years been wholly forbidden.