Bagthorpe Isolation Hospital

“Heathfield Hospital”


Annual Report for

 “1892 – 1893”


Report of the first full year’s service of the

Bagthorpe Isolation Hospital


By the Medical Officer of Health; Dr. Philip Boobbyer.


We have now for the first time an opportunity of reviewing a full year’s work of the institution. Notwithstanding the severe criticism to which it has been subjected, and the many grave and often absurd charges which have been made against it, the hospital has certainly gained in popularity during the year. The silent testimony of facts is certainly the most effective, and perhaps, altogether the best answer to the class of statements that were made on every hand while the new undertaking was yet on the stocks. One of the statements that have met with most singular refutation was to the effect that the hospital would never be anything more than an empty monument of its builder’s folly.


During the past year, without the use of coercion in a single instance, 1025 scarlet fever patients have been removed to the hospital, and the average daily number of inmates throughout the year has been about 150.


In confining my remarks to scarlet fever patients, I should perhaps explain that only nine patients suffering for other diseases were admitted during the year.


The cases removed to hospital constituted no less than 88% of the total number notified: this is the largest proportion of such removals hitherto recorded for any full year.


One hundred and sixty-nine, or 16% were removed on the first day of rash, or 86% within a week of this period.

 

Nottingham. Numbers of Scarlet Fever cases notified, and removed to Hospital in 1893, and other years respectively




The occasional development of secondary cases in the patient’s homes after their return from the hospital naturally attracts attention, and excites unfavourable comment upon the hospital. That a certain number of such cases should occur appears to be unavoidable, for their occurrence in a certain proportion in universal wherever hospital isolation is practised; they are even in some instances recorded after a detention in Hospital extending over many months. I myself have known them appear after a three months’ isolation. But deplorable and frequent as they are after hospital isolation, they are infrequently more numerous as a result of that practised at home. I may digress for a moment to explain, (a) that the scarlatinal virus is peculiarly prone to hang about the chronic discharges so frequently following an attack of the fever, (b) that in all probability a considerable number of scarlet fever patients suffer slight re-infections, resulting in what is called protracted desquamation, the scaling off of the outermost layer of the skin (thought by many to have no pathogenic significance), and (c) that the virus may be mechanically suspended in the person after its activity in the tissues has ceased. The existence of these sources of danger, the difficulty in many cases of detecting them, and the still greater difficulty, too often, of convincing the patient, or the patient’s friends. Of their existence, and of the necessity of guarding against them, explaining in great measure a very regrettable defect in the practical working of hospital isolation.


By the accompanying table, having reference to hospital and home isolation, it will be seen that so far as my returns enable us to judge the isolation in hospital has reduced the spread of infection, expressed by additional percentage of secondary cases, from 36 to 21, and the mortality from 8.6 to 3.0 of the cases. As, however, it is highly improbable that an aggregate morality of more than 8 ½ per cent should have occurred among the total home cases, and almost inconceivable that the death rate should have been as high as 10.8 in the secondary class of these cases, the inference follows that a considerable number of the latter have not been reported, and that the spread of infection, therefore, among the home cases is much greater than shown above. Ina former year it was proved to be at the least equal to 67%; it is probably even greater than this at the present time.


It is only fair to ourselves to say that a certain number of secondary cases have arisen through the discharge of patients contrary to our advice (when a private medical man was in attendance), and also through allowing patients immediately after their discharge to mix freely among, and perhaps to sleep with, susceptible persons. A warning card is sent out with each discharged patient urging the desirability on ground which I have already mentioned of maintaining a certain degree of isolation for at least a fortnight after the patient’s discharge.


Nottingham, 1892


Table showing the results of hospital and home isolation respectively, during the year 1892, both with respect to the development of secondary cases, and to mortality in each class of cases.







*First year of the practice of compulsory notification.



Total Cases in Isolation Hospital, 1892



No stronger evidence, in support of my statement that the institution is popular with the public, could be produced, than the fact that it is freely used by all classes of the community in their time of need.


The following table gives the approximate annual value and room capacity of private houses which our hospital patients during 1892 were admitted, or in which they would ordinarily live, with the actual number and percentage of cases coming from each; domestic servants and other like exceptional residents or visitors being classed as coming from their original homes. The table also shows similar particulars for cases not removed to hospital, which did not include any of the latter class.



NOTTINGHAM 1892


Scarlet Fever in Houses of various Classes


This is perhaps hardly the place to discuss medical details, but so much has recently been said by members of the medical profession and the public to the general effect, that owing to the concentration of cases certain complications are of much more common occurrence and of much more serious nature in hospital than at home, that I am constrained to say a few words on the subject. I here can be no doubt that the aggregation of a large number of acute or septic cases in a close atmosphere must have a prejudicial effect upon the cases themselves and all associated with them; but the fact is that this condition seldom obtains at Bagthorpe, for we make a rule of avoiding such aggregation, and the ventilation is for the most part thoroughly efficient. When the hospital has been full, we have made it a rule to draft out of the acute and into the convalescent wards at as early a date as possible all uncomplicated and rapidly recovering cases, choosing rather to crowd the latter than those of a more serious character. Cases, too, of a particularly noxious character have as far as possible, been separately nursed.


A better answer however than general statements are facts like the following:- Our death rate during the year was only 3% of the cases taken in, and this notwithstanding that a considerable number of malignant and anginal cases were admitted – and four of these were found to be moribund on admission.


The records of ordinary complications, with the percentage of patients suffering from each, were: -


   Otorrhoea (ear inflammation)                            9%

   Nephritis (kidney inflammation)                        3.5%

   Secondary Sore Throat                                    5%

   Rheumatism                                                     6%


The above mistaken impression – which it undoubtedly is – has probably been derived from the fact that a large hospital like that a Bagthorpe a considerable number of complicated cases are always to be seen, however low the sickness and death rates from the several causes may be; the sight of such cases very naturally giving rise to the idea that the proportion must be high, the observer forgetting the large number of patients with which we have to deal with.


The total expenditure of the hospital during the year ending on 31st March 1893, is given by the Borough Accountant as £4,558, showing an increase of £402 upon that of the previous year, during which, it must be remembered, the new hospital was only partially in use.


It is somewhat difficult to give accurately the annual cost per bed, owing to the variation in the number of beds occupied, but this may be approximately stated as £30. The average cost per patient, with a mean duration of stay in hospital of 7 ½ weeks, was £4 8s. 11d.


My own thanks and those of the town are due to Dr. J. D. Wynne for the efficient manner in which he has assisted me during the past year in the charge of the hospital. Dr. H. Meredith Richards, M.D., (London), a gentleman with a very distinguished record at University College, London, was appointed first resident officer of the hospital in November, 1892.



Nottingham. Notified Infectious Diseases: cases and deaths in age periods.


1890


1891


1892


Bagthorpe Isilation Hospital

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