V'ovenabcr 2. 1912. AUSTRALIAN MEDICAL JOURNAL. 755 THE LACK OF HOSPITAL ACCOMMODA- The cases of Measles and whooping-cough were TION FOR CERTAIN INFECTIOUS treated at the Children's Hospital as out-patients, DISEASES. if, during the course of treatment they- devel- oped broncho-pneumonia, -etc., an e ffort. usually CI I.AI:1,ES \ . AI.A('l<.AY. A1.1). unsuccessful, was made to obtain their admission to the_Melbourne Iospital. The usual procedure was ICI-inical Assistant to \Medical Out-Patients, AI el- for the child to be seen once in the early stages of bourneHospital; late _Medical Superintendent the disease, and the mother then instructed to re- A I elbourne Iospital ; la to Aiedical Superin- turn at frequent intervals to report progress and to tendent InfectiousDiseases Hospital.) obtain Medicine. These methods of treatment were most unsatis- 'fins paper is mainly a record of personal hospi- factory. and I vas duitc convinced at that time tal residential experience during the last six years, that a definite proportion of young children's lives with special reference to the difficulties encountered were lost owing to the absence of special hospital in dealing with cases of infectious disease. and with accommodation. 'l'he attitude of the controlling suggestions for improvement in hospital accommo- authorities of the Children's Hospital was, and, I dation. understand. still is, not to admit children to the My attention was first directed to this subject in institution suffering in ally degree from measles or 1906, when, as resident medical officer at the Mel- whooping-cough. There can be no question that bourne Hospital, I was surprised at the number of this attitude is a perfectly correct one in view of the young children suffering from whooping-cough and grave clanger involved to other children in the broncho-pneumonia who were admitted to the medi- institution. For at least the last six years, cal wards from the out-patient department of the however, there has been, a fairly large iso- Children's Hospital. I was impressed by the diffi- lation ward at the Children's Hospital which culty experienced in treating very young children in has been used for the isolation and treat- the wards of an adult hospital and by the unfortun- ment of cases of infectious disease which ate termination in many instances. It will be re- have broken. out in the medical or surgical cognised that the medical treatment and nursing wards. An extension of this principle might have of sick children, especially those suffering from been adopted so that some of the extremely severe acute infectious diseases, are, to a large extent, spec- cases attending the O.P. department could have ial branches of their respective professions, and, as been admitted. If it is practicable to isolate the such, not obtainable in a large usually crowded cases occurring in the hospital, it is surely- practic- general hospital. able to also isolate and treat the severe, compli- In the latter half of the year 1907 I was resident cated cases occurring- outside, in this way following medical officer at the Children's Hospital, perform- the example of Great Ormond-street with its spec- ing out-patient duties ; during that period, there ial whooping-cough ward. was a severe outbreak of measles in the North- During- the measles outbreak, in 1907, Dr. S. Pat- ern suburbs of Melbourne, and at the same time terson, with whom I was working- in the out-patient there were a considerable number of cases of department, computed that we saw over 400- sepa- whooping-cough. rate cases of measles, and we had the unfortunate I realised then the converse of the position and extremely unsatisfactory experience of seeing I had been in 'during- the previous year, several cases develop broncho-pneumonia and die. as, owing to the large number of children which hospital treatment and environment would who developed broncho-pneumonia during the in all probability have saved. course of their infectious disease, I was 'l'he present methods of treatment are practically continually placed in the position, of a sup- the same as those of five years ago. with the ex- pliant to the Melbourne Hospital, asking for ac- ception that the measles patients, after being sepa- commodation for these patients. This was often rated as far as possible, wait their turn, more or very difficult to obtain, and, when obtained, often less sheltered in the open air. The same difficul- too late to save life. The difficulty experienced in ties are being experienced by the resident medical treating cases of measles and whooping-cough at officers, and the extremely unsatisfactory methods this time was not confined to those requiring ad- of treatment deplored as nluclt as ever. mission to a hospital, the treatment of the out- Measles and whooping--cough are not usually patients was also most unsatisfactory. Children considered to be very serious diseases. vet their suffering from infectious diseases were segregated mortality rate, as evidenced by- statistics, is sur- as far as possible, and placed in a small consulting- prisingly large both for the State of Victoria and room, which they usually quickly filled and over- for the Commonwealth, while in nearly all Euro- flowed wherever possible. Here might be seen pean countries it is many times larger. In order cases of measles, whooping-cough, chicken-pox, that a satisfactory standard of comparison may be scarlet fever and diphtheria. 'Children suffering obtained, it is advisable to contrast the death-rate from the two latter diseases were usually trans- from these two diseases with that from scarlet ferred to the Infectious Diseases Hospital at Fair- fever and diphtheria. field as soon as diagnosed; but occasionally diffi- It must also be remembered that, as most of the culty would-be experienced if the patient came from deaths occur from broncho-pneumonia, it is very one of the non-contributing municipalities. possible that many certificat çs of death for regis- November 2, 1912. 756 AUSTRALIAN MEDICAL JOURNAL. tration are simply signed up as broncho-pneu- The relative death-rates for measles and scarlet nlonia the predisposing cause, measles or whoop- fever are well shown in the excellent graph in the ing-cough having occurred some weeks or months Commonwealth Year Look. previously. To show the age incidence of a disease such as The following statistics, either obtained personally whooping-cough the following figures are very in- or from the official Commonwealth Year Book, for structive. During the year 1910 the total deaths the years 1901-11, are supplied by the kindness of from whooping-cough in the Commonwealth were Mr. Knibbs, the Commonwealth Statistician, to 476, of that number 305, or 65 %, occurred in chil- whom I am greatly indebted:— dren under one year of age. For this one year in For the last five years-19o7-11 inclusive—the Australia, for which the figures are available, average yearlÿ death-rate from measles and whoop- whooping-cough takes almost equal fourth place ing-cough combined has been 13o in the State of among the scourges of infant life. -Victoria, and nearly 600 iii the Commonwealth. In A very interesting statistical record is the one Victoria, the total number of deaths from the worked out by Mr. Knibbs showing the monthly combined diseases during this period was 655. variations in the frequency of deaths from these in- DEATH-RATES FROM fectious diseases. Typhoid is thus shown to be NUMBER OF DEATHS AM) most frequent in the summer and autumn, whoop- MEASLES AND WHOOPING-COUGH, 1907-1911. ing-cough in the winter and spring, measles in the Victoria. spring, and diphtheria in the autumn and winter:— VARIATION IN DEATHS FROM VARIOUS Measles. Whooping Cough. MONTHLY CAUSES, ADJUSTED FOR EQUALISED MONTHS AND Year. Rate per CONSTANT POPULATION. Rate per 1000 No. No. 1000 population. population. Deaths per Month' per 10,000,000 of Population. 0.011 1907 39 0.0032 130 Diph- 0.006 1908 21 0.0017 76 theria 0.014 1909 4 0.0003 173 Scarlet and 0.006 Whooping 1910 27 0.0021 73 0.003 Month. Cough. Typhoid. 1Ïoasles. Fever. Croup. 1911 72 0.0054 40 January 85 200 21 7 50 9 57 492 February .. 98 217 9 Total .. 163 10 78 March .. .. 72 241 8 12 11 108 Commonwealth. April .. .. 74 216 12 17 122 May .. .. 99 140 0.259 133 1907 .. .. .. 147 0.036 1,070 June .. .. 92 118 10 16 0.059 123 1908 .. .. .. 125 0.030 249 July .. 124 56 12 11 257 0.060 22, 12 98 1909 .. .. .. 31 0.007 August . .. 139 48 0.109 13 96 .. .. .. 124 0.028 476 September . 130 47 36 1910 63 .. .. .. 206 0.046 291 0.065 October .. 105 36 36 11 1911 8 73 November . 99 80 46 11 72 Mr. Knibbs, in speaking of the graphic records of December . 95 133 27 the annual death-rates for the Commonwealth from the years 186o to 191o, makes the following The home conditions of many of the poor in the significant statement concerning the mortality northern suburbs of :Melbourne are quite unsuit- caused by measles :- able for the care of an acute case of illness, even if "On the whole, the graphs furnish clear evidence the mothers had the available time or the requisite of a satisfactory decline in the death-rate of the knowledge to adequately nurse the patient. Good- Commonwealth, a fall having taken place from all states that "uncomplicated cases of measles may 20.86 per 1000 of the population in 1860 to be allowed out of bed a week after the temperature 10.43 in 191o.