ISOLATION BLOCK.

Auckland Star, Volume LX, Issue 222, 19 September 1929, Page 15

ISOLATION BLOCK.

(Published by Arrangement.)

AT AUCKLAND HOSPITAL USES OF THE BUILDING. DISCUSSED BY BOARD. A review of the circumstances surr rounding the provision of an isolation block for the Auckland Ilospital shows that in February, of 1925, the deputyDirect or- General of Health sought a meeting between the Auckland Hospital Board, himself and his medical offi-! cers, on the question of the inadequate accommodation for infectious diseases in the Auckland Hospital grounds. Apart altogether from the necessary facilities for combating epidemics, there existed the serious liability of. crossinfection. The- board, through its medical superintendent, became alive to the danger '' existing' arid agreed with the Health Department to instruct the architects'to prepare": plans for a building to contain. 70 beds, the piers to bo strong enough to .hold two more storeys if necessary.- Mostly on account of financial considerations, the scheme did not definitely take shape until nearly three years later. .Meantime, various Conferences and interyiews took place between the board, its architects, and the honorary medical and surgical staff of the hospital. ' 7 * Tlie:,most representative meeting was xield phviJune- &9, 1020, when there were present, besides the. full meeting of the boa"4 the medical superintendent, the. pathologist, and 15 members of the honorary' staff. At this meeting it •was. unanimously agreed by the medical men present, that there existed an urgent need for building of an isolation block, ;where - all classes of infectious diseases . cotikT be handled without fear of contamination one with the other; At that time there were in the hospital cases of'diphtheria, scarlet fever, enteric fever, paratyphoid'fever, measles, ..German measles, .mumps, cerebro spinal meningitis, suspected - meningitis, puerperal .septicaemia and ophthalmia neonatorum. Sdm'e.of these developed after admissiojn,,to- the ordinary ward, although, originally diagnosed as something different 1 ; ''Many cases are on record where thei patient has been admitted suffering fropi-a complication of two or more infectious' complaints. A very recent instance is that of a child who was brought in Wffering from some unknown complaint,'; Which proved subsequently to be scarlet' fever, and before he could be removeds s, he had infected six other patients, li is for the purpose of adequately guarding against this contingency that theS' : isolation block is being erected. Every; case not definitely diagnosed will be .kept in a separate cubicle'until the nairird of the trouble is definitely ascertained. Where the patient may have three complaints he will be kept entirely - isolated from all other cases. ih'e- hew isolation block will provide seiWices\ : which are not available in the present.- wards, viz.: — (1)' -Single rooms with complete isola- !• tion for suspect cases under observa-. \. tion and awaiting diagnosis. (2)T'Single rooms and two or three bed wards for mixed infections arid for of low incidence. Access to these wards is gained without passing through any other wards or part's , of the building occupied by the paftehts. The. plan has been based on the principles'of isolation adopted at the Pasteur Hospital, Paris, and at such well-known American institutions as the Michael Keece" Hospital, Chicago, and St. Luke's Hospital, Jacksonville, Florida. Two ward blocks are provided on each floiny complete with -the utility rooms an<J-lavatories, and separated by a cen-,-tra.l service block, -which serves each of thdm..- ; ; This service block, is virtually isolated from the ward units by open air; spaces of eight feet wide. , y The. ward blocks are, virtually separate ward ufiits, yet under'one roof and-with;, the added advantage of a simpler" adm-jjiStration than is possible with' the wholly detached pavilion system. Generally speaking, complete isolation is provided for cases under observation, 80, ( that everything humanly possible is. befog;- done to minimise the chances of crdss-infection arising. Every provision is made with the most equipment for cleaning, disinfecting and sterilising various articles of/clothing and utensils in daily use. Particular precautions have been taken' invregard to the distribution of food to; and subsequent cleaning and. sterilising of all utensils. by Hospital Board. Opposition to the board's good work from;]certain quarters has been so mani-. fest. during the last month, attacks being mostly of a personal nature directed against the chairman, that members of the board agreed upon the follpvying resolution which was moved at the meeting on the 17th instant and carried without dissent: — '■( 1) The cliairinan has never . exceeded and expressed policy of the board in the matter, and • (2) That such policy has been carried to its present stage with the approval of the honorary medical staff in conference with' the board' and the - Department of Health, and, further, that the board - .expresses its entire confidence in Mr, Wallace as chairman, Mr. W. K. Howitt, th© mover of the motion, stated that the board had; always pursued a steady courae in its policy in providing an isolation block.. In 1925 Dr. Watt, assistant-director of health, stressed the importance of the hospital having one bed for every 1000 of the population . for . the treating ofinfectious diseases cases. We then decided at that meeting to go on with it. - The files and minutes of the board will show that we have pursued a steady course, and Dr. Valintine has always been a warm supporter of the scheme and the present site. Anything that has been done in connection with this isolation block has been done by the resolution of the board, and the chairman, as the mouthpiece of the board, has carried forward the policy. We are an independent lot of men. This board is made up of twelve units and the chairman carries out' the wishes of the board, The resolutions we propose. Ever since we have had. this matter before us, we have always been guided by the reports of the medical officers, Dr. Maguire, Dr. Gilmour and the honorary staff. I stand to-day absolutely independent, and with the facts before me I would be a traitor to the people I represent if I voted in any other way than I have voted. The reso-

lution stands for itself and it will commend itself to the board as a fair and reasonable statement of the caae. The chief thing we have in our minds is the interests .of the people we represent. A good deal has been said by people in the Grafton Road vicinity about the location of the site, although, for the, past 30 years there has been an isolation block .in the hospital nearer to the residents • than the proposed one. Never once has there been a case of infection of people outside from those wards. I am indignant that such unjust and unfair criticism should be levelled at the chairman of the board, when we as individual. members are equally responsible for everything the chairman has done. He is'only carrying out the resolutions of 'the board. Mr. Chalmers. expressed much pleasure in seconding that resolution. He personally took very strong exception to the remarks made in the newspapers about the chairman, who had always carried out the wishes of the board. •Mr. Potter said he did not know the question was going to come before the board, but as he had matter already compiled he would use it. He then made the following statement; — In approaching the problem of an infectious diseases, hospital to serve the Auckland hospital district, consideration must be given to the population and area. The population is estimated at 250,000, and the area exceeds 600 square miles, extending from Auckland to Mercer, on the south, to Helensville 011 the west and as far north as Warkworth. Motor transport is largely responsible for the spread of population in the hospital district. Up to the present time the base hospital, which was established 54 years ago on Hospital Hill, has rendered signal service, in providing accommodation primarily for the sick poor. In the year 1875 the leading local architect of the day, Mr. Hcrepath, commissioned by the hospital trustees, a body set up by the Provincial Government for that purpose, entered upon his' work and, with an eye to the then ,distant future, designed and supervised the erection of a hospital which- stands a monument to his foresight, and in design -and beauty . of position is a worthy realisation of his vision. The block was designed to accommodate all classes of patients —surgical, medical, and those suffering from different types of. infectious diseases.' At a later' period a small' infectious block was erected some distance from the main building, followed by two wooden wards known as 11 and 12. Generally speaking these buildings have met all requirements up to the present. There has been a decline in the more serious of infectious cases. For example, in 1901-2, with a population of 67,"2(1, there were 11S cases of typhoid, against only 15 in 192S with a population of 206,810. Site for Block Justified. Report from the medical superintendent for month ending June 30, 1929.—Scarlet fever 49, enteric fever 1, diphtheria 45. Although influenza is highly infectious .and responsible for more deaths than any of the infectious diseases mentioned above, it is not a notifiable complaint, and is largely treated in the home. The site selected is of sufficient, area to meet all requirements, and is; sufficient :justification for the board proceeding with the "erection of an block therein. ,-Ttebuilding plan -has" beeri -based on the principles of isolation -adopted at the Pasteur Hospital. In the United States of America it is common practice to place large isolation blocks on the same site as a general hospital, and in close relation to; the - pathological and X-ray departments". In'this and.other highly' technical iriaitersiwe. are guided by the opinions of opr experts. Whatever private and personal motives may govern individual doctors in t'heir attitude, they are under. no statutory responsibilities as are the members of the Hospital Board and their responsible advisers. ' An eminent authority. Dr. Gal ton, in his book on hospital construction, says "A hospital must b$ placed so that it will be conveniently available for reception of many diseases, enteric fever, 'pneumonia, scarlet fever, etc; . It is important .that the distance which the patient has to be carried is as short as possible."'' Another authority, Mr. C. B. jKer, in his manual of fever says:—"We must emphasise the predominant part I played by contact infections in many. ! diseases. But contact must be rela-tively-close. Nurses handling patients more freely than doctors frequently take infectious diseases, but out of 4000 students • attending the City Hospital only about., a dozen cases of infection occurred in 25 years." The situation of an isolation hospital is governed by financial, population, sentimental and 1 eographical reasons, The open site on Which the building is to be erected has definite claims for adoption. It is far. enough away from adjacent buildings to be unaffected by ■them. In an infectious disease sense .they are not close. The nature of the soil is very suitable and the fall of the land makes for good drainage. Therefore of the four reasons governing the situation, sentiment has not been a deciding factor in the past in any, existing infectious diseases hospital except in cases where houses have so far encroached upon the hospital environs that removal was desirable. A comparison between the location of the infections diseases block and important infectious hospitals in Europe a,nd America will give a better perspective of the problem. The present infectious diseases wards are 560 feet from Park Road and 160 feet from Grafton Road side. The new isolation block is 780 feet from Park Road and 360 feet from Grafton Road boundary. The infectious fever wards of London afford the following areas per patient:—East Hospital, Homerton, 98.5 square yards; North-West Hospital, Haverstock Hill, 128 square yards; Western Hospital, Fulhara, 100 square yards; South West Hospital, 117 square yards; South East Hospital, 115 square yards. The new three-storey block will provide accommodation for 61 patients, the five storeys, including sun balconies, will provide, accommodation for 128 patients'. The close.relationto the pathological and X-ray,-and the presence of so many of our leading practitioners are advantages that ; cannot be over-estimated. Infections Block Problem. The problem of providing one big infectious hospital for the whole of the hospital district would involve a big capital expenditure with a correspondingly heavy annual maintenance charge, without providing the many advantages that would result from the erection of an isolation block within a few hundred feet of the main hospital, with its pathological . and, X-ray departments', and the pmny medical services that would be available in...the centre of a big population. It is understood the future policy of the board will be to provide a hospital ■ for the northern boroughs, with isolation, accommodation on the site. The further development of the board's policy as outlined by tho chairman provides that a site will be selected in the southern area for

a hospital with the necessary isolation accommodation on 'lie eite. The provision outlined should meet ij.ll reasonable requirements in the hospital district. An authority has said that the whole tendency of modern thought is found in the idea that many diseases are of a preventable character. Typhoid fever is a disease' mostly contracted through polluted water, but preventable. The same authority says improved sanitary conditions have certainly tended to abolish cholera, and tuberculosis is year by year decreasing. The provision of a water scheme of sufficient magnitude in the hospital district would further reduce infectious cases. The drainage schemes completed and in progress will bring about a further decline in infectious cases. It would be futile to attempt to provide permanent accommodation for an epidemic of any magnitude similar to the 1918 outbreak. Emergency measures can always be adopted which proved successful during that period. Mr. Wood remarked that it was rather unfortunate to refer to it as the Wallacc Policy. Mr. Potter replied that it was not the chairman's policy. It was the whole board—not only being considered by the board but the Hospitals Department, honorary staff, and all in authority at the hospital. He had much pleasure in supporting the motion. It was simply a reflection on the chairman and on every member of the board. Mr. Rowe expressed himself quite in support of the motion, but could not support Mr. Potter in his statement. With regard to the confidence in the chairman, ho had every confidence in what the chairman had undertaken, and in everything he had done since he had been 011 tho board. Mr. Harbutt supported the motion. He thought it most unfair that the chairman had settled upon him all the opprobrium published in the newspapers with regard to the attitude of the board, which had acted upon information given by tho medical profession. It was most unfortunate if that had not, after all, been in accord with their considered opinion. Division of Opinion. Dr. Gunson, rising, stated that he personally would not like in any way to make any statement which could be regarded as a personal opinion against tho chairman. Referring to the second part of the motion, which refers to the fact that tho policy has been carried to its present stage with the approval of the honorary staff in conference with the board and the Department of Health, ho said; that if that be tho case, the position to-day is that there is ' a majority of medical opinion opposed .to placing the hospital on that site. Included in the medical "men opposing the site is an appreciable number of tho honorary staff. He was certain of that because they had personally spoken to. him about it. If the board pursues tho policy it has set its hand to it will do so knowing there is a considerable body of medical opinon opposed to it. It is a very, material point. The board cannot disregard the .fact that tli*re is a considerable body of medical opinion opposed to it. Mr. Dempsey thought tho controversy to bo a move on the part of some people to havo a modern setting of an ancient tragedy, the great Collosus striding the •world, > and petty men walking about .under 3ts legs and trying to find honourable graves.. All agreed that the chairman has sacrificed himself in the interests of public health and in the interests of the suffering public. There are men here who have given half their lives to public service, and would not sacrifice their opinions to please anybody. They 'are not afraid to give'their, opinions and would sacrifice their opinions;to7 please no man. We are still open to listen to reasonable criticism from capable men and women, but so far very little criticism carrying any weight has been offered. It is said that the medical men of are against us—we have here two criticisms by doctors, but where .are the others ? Even, if anyone has a reasonable opinion to offer at this late stage, the board will bo willing to hear it. The board cannot do anything without the help of the Health Department in Wellington, and the men who have the experience of the Health Department. A Conference Agreement. Mr. Savage said that we are apt, through the misuse of terms, to be somewhat confused by some of the critics. The real fact is that an isolation block is part and parcel of every hospital throughout the world, and if that statement is correct it is generally through the misuse of terms that we are getting into difficulty at the hands of our opponents. It was a pity that people wrote and spoke without knowledge of the facts. He said he knew jnen from the medical staff right to the Director-General of Health, who said that the block was in the right place. He, himself, was satisfied to go on with the policy that had been outlined, to place the isolation block in the hospital grounds, and that when the people wanted an infectious diseases hospital to meet the requirements of an epidemic like that in 1918, we will be able to put something before them then for that purpose. He went on to say that at present Parliament is not doing much, so- that the papers have a go at the Hospital Board. The chairman of the Auckland Hospital Board would hold his own with the rest of them. It was no use labouring any more in the matter of the site as he was convinced in that question, and he had pleasure in supporting the motion. Mrs. Kidd supported the need of an isolation block for an institution such as ours. Rev, Wood said the scheme had been approved, and the site decided upon, therefore it would go through. He said that when he first came to hear of this matter he thought that the board was very much to blame for using the term 1 infectious diseases hospital. He understood that there was a large and representative gathering of public men present at a. conference with the board, when the site was agreed upon, and asked that the names of the medical men present, who expressed approval of the scheme, bo made known. He noticed that the literary writer of the "Herald" stated that the chairman hadmisjed the board about the site after the conference with the honorary staff. That the chairman had misled his board and the public was not the truth. /Isolation Block Aspect. Dr. Gunson, in reply to Mr. Savage, affirmed that if the "building: were an isolation block he would not be opposed to it, nor would a single member of the profession. An isolation block is a block attached to a hospital for observation for a short period of cases that come in and are not definitely diagnosed. They are isolated for 24 or 48 hours until the cases become known. If they develop into infectious diseases cases, they are sent to the infectious hospital. But a block to. meet these isolation requirements for the Auckland Hospital would not require to contain more than 'twenty or thirty' beds. The pro-

posed block is specially designed to deal with infectious diseases cases, such as scarlet fever and diphtheria. That is the distinction between an isolation and an infectious diseases block. They needed an Isolation block in any case and when he was on the honorary staff he pressed for it. The honorary staff had repeatedly asked for an isolation block. There was not a member of the profession opposed to it. The profession was opposed to the site of the infectious diseases block, because of the serious proximity to the general hospital, especially with regard to the difficulty of administering . the block near to a hospital which had so greatly exceeded. This was a view of a great number of the profession. It was not necessary to be near the operating theatre for diphtheria cases. Mr. Savage asked: "You are then agreeable to the 20 or 30 beds ?" Dr. Gunson: It would be done in any case. It will be sooner or later, and we will ha've to go back with the infectious diseases block, and then the isolation block will be too large. Mr. Howitt said that Dr. Gunson had stated that it was necessary to have an isolation block, and in opposing its erection lie was simply confusing the issue. Dr. Valintine was just back from the Old Country with all the latest ideas, and if he was not right, where on earth were they ? Unanimous Resolution. This was not a hole and corner resolution. He had sprung a surprise on the board, and was glad to hear independent ideas in reply. He then put the motion, which, as before stated, was carried unanimously. In reply* to Dr. Gunson's remarks Mr. Potter read from a report of the "Herald" on May 2, 1928, as follows:—Dr. E. H. B. Milsom, who was the chairman of the honorary staff, said that his staff frequently brought to the notice of the board the necessity of a new infectious diseases block, as at present Dr. Cawkwell, who was in charjre, had •"> means

of isolating his patients, and the feeling was that he was carrying an unfair responsibility. He emphasised that the plans for the new block were eminently suitable, as far as the honorary staff were concerned, and the site chosen in the hospital grounds the best available. The block would be handy to the X-ray department and to the laboratories, which was necessary. . Dr. Cawkwell stated that the time had arrived when we should have proper isolation, and the sooner we got on with the new building the better. The "Herald," commenting editorially on the same day, dealt with the question of hospital finance, and made no protest whatever against the statements made by the board's medical advisers. The chairman (Mr. Wallace) expressed his pleasure at the resolution. He took the opportunity of informing the "Herald" that its attack was unscrupulous, and that mentally and physically he was never better in his life. He was strong enough to stand up against the attacks of the whole Press of New Zealand. He had given the past 20 years of his life to suffering humanity, and on every occasion on which he contested his seat he had been" returned by a large majority, showing that he had the public behind him. Mentioning the financial aspect, he said that in 1935 the loan of £250,000 would be entirely wiped off, leaving the board thus far free to consider other necessary extensions. He emphasised that the board was not creating an infectious diseases hospital —it had been there for 60 years. He had, with the Minister of Hospitals, inspected other sites with a view to establishing-an adequate infectious diseases block. To say that he, personally, had directed where the proposed block was to go was a falsehood and a stigma he would not be put under for any newspaper in the country. Everything that had been done was straightforward and above board, and had been approved by the Health Department.