A FEVER DAGGER

New Zealand Times, Volume XXX, Issue 6489, 8 April 1908, Page 7

A FEVER DAGGER

RETURN CASES. REPORT ON RECENT ALLEGATIONS,

The allegation that scarlet fever was spread through the premature discharge of a natlent from the Wellington fever hospital was satisfactorily disposed of yesterday by a lengthy report irom tho medical superintendent (Dr Ewan) to the Hospital Trustees, who desired the press to publish it in full. It is as follows:

“HEARSAY' EVIDENCE/' “Tho Chairman Trustees.—Sir.—From newspaper reports 1 notice that at your last meeting a discussion took place with reference to two return cases ol scarlet lover, wnich acre said by Dr Furdy to nave been caused by a patient having been discuargea from tho hospital wiinst sciii in an luteciums conuiUun. Dr Furdy's report to the i±utt Borough Council reads as follows; —‘.that one of Mr Chapman's children time was away vlsitln" at a friend's house in Wellington contracted scarlet fever, and was *eut to the hospital. Alter six weeks it was sent home, sail having a discharge from tho nostrils. There is uo doubt the other two cases in Mr Chapman's tiouse were infected from this source/ I wrote Dr Burdy asking for particulars, and in reply received the attached letter. It will be seen that the doctor did not see the child until nearly three .icuks after her discharge from the hospital. His report on the child's condition must therefore have been based entirely upon hearsay. I don't doubt that at the time of his seeing the patient there was some nasal discharge, but he has altogether failed to prove that this was present on February 20th. “As the Trustees are aware, I was not in Wellington at the time of the child's discharge, but from inquiries I have made . there can bo no doubt that the medical officers used every reasonable precaution. Usually patients are 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 time both doctors eraMically declare that there was m nasal discharge. Tho case afterwards proved to be infectious, hence the return cases, but everyone who has had experience of fever hospitals know* that a percentage of such cases is inevitable even in the best hospitals. RETURN CASES.

“Millard, Turner and Niven have devoted special attention to return cases of scarlet fever. Millard buys that the infective inlluence of such cases may last for six weeks. Turner, recognising tho impossibility of preventing them in hospital cases, recommendsrthat all patients should bo treated in separate roome. Niven has proved that in hospital wards the mucous membranes of convalescents are often infected from other acute cases in the wards, and that this infection frequently leads to chronic sore throats, ear and mouth discharges. On leaving the hospital these cases may give rise to return cases. Ho recommends that convalescents should not be mixed with acute cases. It is impossible to sny when a case censes to be infectious. All that can be done is to carry out the rules of quarantine. Niven has also shown that a ten weeks' residence in a hospital had no effect in preventing return oases.

"In- 1898 the Metropolitan Asylums Board of London commenced a series of investigations on return cases, made by Simpson, and carefully conducted for six months. During that time there were 90 return cases of scarlet fever, or 1.3 ner cent, of the total number discharged. "Lauder. who does not believe that npelinT from the skin Is a cause of infection, had in 1902 208 cases under Ills care, with seven return cases, after an average stay of 4S days in hospital. In 1903 he had 353 cases, an average stav of onlv 34- dnvs. with only seven returns case. This. 1 think, tends to show that a lengthy stav in hospital does not prevent return cases. UNSUITABLE WARDS.

"Seeing that return cases occur in the best equipped and most ur-to-dato hosnitals, is it to be wondered at that we have them here, where our wards are in every way quite unfitted for the purpose for which thev are used ? During the last few rears I have again and again reported to the Trustees that our fever, wards were a menace to the rest of the hospital, as well as to the community at large. You will also remember that onlv a few years ago the honorary medical and surgical staff asked you to close the wards. "At present every nntient who leaves the hospital is a possible source of danger. Not only are our wards too small for Wellington's requirements, but in no wav are they fitted for the treatment of fever cases. Thev are too near to the general hospital, thev are insanitary, there is no possibility of separating convalescents from acute cases, and there is nracticallv no accommodation for the housing of nurses. Is it surprising that under the present conditions a large proportion of the nurses doing duty in the fever wards become infected with sore throats, nasal discharges and scarlet fever? Their bedroom is practically in the fever ward, being only separated from the patients bw a wooden partition. "In. conclusion, I wish to say that I do not consider that Dr Gilr.iT was m anr wav to blame. Return cases are inevitable. and be seems to have taken every precaution, even going so far •as to hold a consultation over Ih© case before discharging it.—l am, etc., "J. EWART, ‘■'Medical Superintendent. "P.S.—Millard defines return cases of scarlet fever as those caused by the carrying home of infection by patients returning from hospital.” DE PURDY'S EBPOET.

Writing to Dr Ewart on March 27th, Dr Purdy stated that ho saw Mrs Chapman for' the first time on March 2nd and reported the case as one of scarlet fever Dr Hector had seen one of the children before. Mrs Chapman was very ill indeed for six days. He pot a nurse to look after her the day of his first visit, and saw her twice a day tor a week. He did not attend the child. Ho was asked by the Town Clerk to report to the Council on several infectious cases, includin': Mrs Chapman and child. He then learned from Mrs Chapman that one of the children had been in the Hospital with scarlet fever, and had come home with a discharge from its nostrils. He then saw the child, and it still had a slight discharge from the nostrils, although this was over a week after its return. Ho was not sure when the child returned, but thought it was on February 25th or 27th. There could be no question that this child infected the other cases.

TRUSTEES’ VIEWS. The chairman (Hon. C. M, Luke) said the whole thing came back to the Trustees responsibility for providing further accommodation for fever patients. He bad received a private oomunioation from the Premier, who stated that upon his return he would make arrangements to meet the Trustees and visit the proposed fever hospital site. Mr A. C. Pearce remarked that the Trustees had to wait and sit still. When it became known that the nurses’ bedrooms were practically open to the fever ward, and that they were open to any disease in that ward, it would be realised that the position was most serious. They could not" sufficiently impress upon the Premier and the Hon. Dr Findlay the urgency of the position. He was pre--arod to take Dr Ewart’s statement that -efficient precautions were taken before the patient’s discharge, but it was rather hard that after a child left the Hospital three weeks, and fever broke out, a report went in from Dr Pnrdy before he ascertained more about, the case.

The chairman: "It was assumed he had seen the child a week after its discharge.

.Nereis It was eighteen days/' Ho moved: — That the action of the committee be confirmed, and that the reports be sent to tho Prime Minister, tho Minister of Public Health, and the Hon. Dr Findlay.

Mr F. G. BoKon agreed with the resolution, and said he was ouitc propared to accept the statements. He had brought tho matter un not upon personal grounds, but with the object of preventing spread of infection if_ this could be done. There was no scarcity of accommodation in the fever hospital at the time. , . . The motion was adopted.