FEVER INFECTION.

Dominion, Volume 1, Issue 167, 8 April 1908, Page 8

FEVER INFECTION.

0 ■ DISCHARGE OF A HOSPITAL PATIENT. STATEMENT BY DR. EWART. NEED FOR MORE ACCOMMODATION. Tho troublo about tho alleged premature discharge of a fever patient from tho Wellington Hospital was again before tho Trustees at their meeting yesterday, when tho Medical Officer's point of view came up for review. The following rcpotr by Dr. Ewart was read:— "Tho Chairman, Trustees. "Sir,—rFroin newspaper reports ,1, notico that at your last meeting a discussion took place with reference to two return cases'of scarlet fever, which were said by Dr. Purdy to havo been caused by a patient having been discharged from tho hospital whilst still in an infectious. condition. Dr. Purdy's report . to tho Hutt Borough Council reads as follows; —' That one of Mr. Chapman's children that was away visiting at a friend's house in-Wellington con-' tracted scarlet fever, and was sent' to tho hospital. After six weeks it was sent home, still having a discharge from tho nostrils. There is. no- doubt tho other ,two cases in Mr. Chapman's house wore infected from this source.' I wroto Dr. Purdy, asking for particulars, and in reply received the attacked letter. It . will bo seen that the doctor did not seo tho child until nearly threo weeks after her dischargo froni the hospital. His report on tho child's condition must therefore have been based entirely upon hearsay. I don't doubt that' at .tyo time of his seeing tho patient thero was somo ■ ' nasal discharge, but lie has altogether , / failed to provo that this was'present on . February 20. . ' "As tho Trustees aro aware, I was . not in AYellington at tho time of tho child's discharge, but from inquiries I liavo made, there can bo no doubt that tho medical officers used every reasonable precaution. Usually patients aro. discharged at the end of six weeks, but in this case, for special reasons, the . child was detained for another week and then discharged, and this'only after a consultation between Drs. Gilray and Patrick. At this timo both doctors emphatically declare that, there was no nasal dischargo. Tho case afterwards proved to be infectious, henoe tho return cases', ' but everyone who has ' had exf periehco of fever' hospitals knows that ,' a percentage of such cases is, inevitable oven in the best hospitals. . "Millard,,Turner, ind Niven have dovoted special attention to return cases of scarlet. fever. Millard says that tho .' ■ infcctivo influence of such oases may last for six weeks. Turner, recognising the impossibility of preventing them in hospital cases, recommends that all patients should bo treated in separate rooms.. Niven has proved that in hospital wards tho mucous membranes of convalescents aro often infected, from other, acuto cases tho wards, and that,this infection frequently leads to chronic soro throats, car and mo'uth discharges. On leaving, the hospital-these cases may give riso to return cases.' Ho recommends that eonvalesccnts should not bo mixed with, acute cases'. It is impossible to say when a case ceases to bo infectious. All. , that can bo d-ano is to' carry out tbo rules of quarantine. Niven has also shownthat a.ten'weeks' residence in,a hospital . had no effect in preventing return cases. "In: 1893 tho Metropolitan Asylums Board of London commenced a series of investigations on return cases, -made by . Simpson', and ■! carefully conducted for six months. ■ During -that ■ timo : there were ninety return or 1.3 per cent, of tho total number discharged. ■ " Lauder, who does not believe that ' peeling from jbho skin is a cause of in-. , fection, had, in 1902,.. 208 cases under i - • his,caro, : wit-h .wen return'cases, after- .' an average stay of forty-eight days: in England. In 1903 ho had 353 eases, with an average stayiof only thirty-four days,-.-witli only seven 'return cases. This, I think, tends to show that a lengthy stay :. in hospital does not ; prevent return cases. * " Seeing that return cases occur in tho best-equipped and most ! up-to-d.itd hospitals, is it to bo. wondered at that • wo havo them here, whero curt wards aro ill every way quite unfitted for the purpose'for which they aro used? During tho last few years I havo again and again reported to tho Trustees that'our V fever..wards were, a menace to tho rest of tlio hospital, as well as to the com- , munitv at largo. You will also remember, that only a few years ago the honorary modical and surgical staff asked you to closo the wards. " At'present every patient who leaves tlio hospital is a possible .source of danger. Not only aro our wards too small for Wellington's requirements, but ,' in no way aro they fitted for the treat- ■ m-ent of fever eases.- They aro too near ■ to tho.general hospital, they are insanitary, there is no possibility of separating. . convalescents from acute cases, and there ms practically no accommodation for, tho housing of-nurses. Is it surprising that, , under the .prosent conditions a large proportion of tho nurses doing' duty in tho fever wards become infected with, soro throats, nasal discharges, and scarlet fever? Their bedroom is practically in the. fever ward, being only ■ separated from the patients by .'a wooden partition. . "In-conclusion, I .wish to say that I do not consider that Dr. Gilray was in any way to blame. Return cases aro inevitable, and, ho seems to havo taken every precaution; oven going so far as to, liolfl a consultation ovOr tho caso beforo discharging it.—l am, etc., i. . . ' , "J. EWART, < " Medical Superintendent. • " P.S. —Millard defines return cases of scarlet fever as those.- caused by th.o carrying homo of infection by patients. returning from hospital." - . OF THE. TRUSTEES. . The Chairman said the "matter of providing better accommodation for fever cases had been. considered by the House Committee, and the Government had been, approached in the matter." The Premier had promised to meet the Trustees and visit tho proposed site with- them when ho returned' from tho South. Mr. A. C. Poarco said the matter was one of tho greatest urgency. An epidemic might .break out at any time, and there was no •adequate accommodation to copo with it. In regard to tho special caso under notice, Dr. Purdy had stated'that the child was discharged ' before it was properly cured, but Dr. Ewart considered that his assistants, had taken overy precaution,, and ho. was quite prepared to take Dr. Ewart's view of the case. 1 The Chairman said Dr. Purdy apparently not see the child until eighteen days after her discharge. . He moved; "That the action of the committee be confirmed, and tho reports sent to tho Premier, tho Minister for Public Health, tho Chief Health Officer, and tho Hon. Dr. Findlay." Mr. F. G. Bolton, speaking in support of tho motion, said lie brought tho matter up at tho last meeting, not to reflect in any way upon tho staff, but to show the necessity of care being taken. Ho^ accepted tho officers' explanation, but it apnea red from Dr. Purdy's report that tho child had infected both its mother and another child. His'information was that tho child went homo the same day it left # the hospital. He would point out that thero was no great scarcity of accommodation in tho fevor ward at the timo. Ho agreed that there was no reflection to bo cast upon tho-staff. Tho rosolution was carried.

The Now Zealand Association held a progressive whist tournament on February 19 it tho club rooms, Westminster Palaco Hotel, ibout 50 members and friends attending". Handsome prizes were given for th*o highest scores. Miss Norton and Miss D. Norton ivon tho first and Becond ladies' prizes, and tho prize for tn'on was won by Mr. B, Spillerj of Christchurch.