WIL 063 WILLESDEN Urban District Council. HOSPITAL REPORT FOR THE YEAR 1897, BY D, S. SKINNER, M.D., Member of the Royal College of Surgeons, Eng.; Licentiate of the Royal College of Physicians, London; Fellow of the Society of Medical Officers of Health; Medical Officer of Health for Willesden. London: Martin & Son, Printers, 211, High Road, Kilburn, and Marylebone. 1898. HOSPITAL REPORT, 1897. To the Chairman and Members of the Willesden Urban District Council. Hospital Visiting Committee:— Dr. J. S. Crone, Chairman. M. Coombes, W. B. Luke, F. S. Priest, Dr. Stocker. Gentlemen, I beg to present my Report for the year 1897. There were 62 patients remaining in hospital at the commencement of the year, and 487 were admitted during the year, so that there have been 549 patients under treatment, and an average of 60 every day. 4 TABLE No 1. Cases under treatment:— Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Other Diseases. TOTAL. Remaining on December 31, 1896 55 6 - - 1 62 Admitted 329 137 16 1 4 487 Total 384 143 16 1 5 549 Discharged 326 87 14 1 5 433 Died 9 34 2 — — 45 Total 49 22 — — — 71 TABLE No. 2. Wards and other places from which cases were admitted:— wards. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Other Diseases. TOTAL. 1. North West 35 9 3 1 — 48 2. South West 16 11 4 — — 31 3. „ Central 52 30 3 — — 85 4. „ Kilburn 104 34 2 — — 140 5. Mid „ 61 34 — — — 95 6. North „ 13 12 1 — — 26 7. „ Eastern 39 2 3 — — 44 Other Districts 5 2 — — — 7 Staff 4 3 — — 4 11 Total 329 137 16 1 4 487 There have been 117 more cases this year than last. 5 TABLE No. 3. Deaths distributed to the various Wards from which they came:— WARDS. Scarlet Fever. Diphtheria. Typhoid Fever. TOTAL. 1. North East I 1 — 2 2. South „ I 3 — 4 3. „ Central — 8 — 8 4. „ Kilburn 5 8 — 13 5. Mid „ 1 10 — 11 6. North „ — 2 — 2 7. „ Eastern 1 1 2 4 Other Districts — 1 — 1 Total 9 34 2 45 Males. Females. Scarlet Fever 5 4 Diphtheria 15 19 Typhoid 2 22 23 There were 45 deaths during the year, giving a rate of all admitted of 9.2 per cent.; but of all the cases under treatment of 8.1. The following figures give the rates per cent. of cases admitted for the different diseases in 1896 1897 Scarlet Fever 4.0 2.7 Diphtheria 22.6 21.8 Typhoid Fever 60.0 12.5 All causes 8.1 9.2 6 It will be seen that the death-rate of scarlet fever was lower; of diphtheria, although the number of deaths was much more, the rate was not so very much higher on accouut of the much greater number of cases admitted, 137 instead of 53 the year before. The death rate of typhoid fever was very much less than the year before, but the number of cases was too small to be of much value. Of the cases admitted 218 were males, and 269 females. The ages at which they were admitted were— Under 1 year 5 From 1 to 5 years 146 „ 5 to 10 „ 192 „ 10 to 16 „ 79 ,,16 and upwards 65 487 The youngest admitted without the mother was 3 weeks, another of 5 weeks was sent in at the same time, both from a home connected with Queen Charlotte's Lying-in Hospital; they were suffering from scarlet fever. The charge for maintenance which the Council resolved on trying for twelve months, from February 1st, 1896, not having proved very encouraging, it was resolved not to renew the charge, so that during the 7 present year it has not been enforced; the charge for patients from outside the district remains the same, three guineas a week. In my report for last year I drew attention to the needs of increased accommodation, and said, from the experience of the two previous years we might expect there would be 390 requiring admission during 1897. My estimate proved to be far too little, the actual admissions being nearly one hundred more. It is not to be wondered at, therefore, that there was a breakdown in the autumn, and extra temporary accommodation had to be provided. If the patients were restricted to one disease there would be far less difficulty in arranging for their accommodation, but with three diseases imperatively requiring admission, the accommodation may soon be overstrained. Separate buildings have to be kept for each disease, and it would be quite possible for the accommodation to be too little, for instance, for diphtheria, while the scarlet fever wards were half empty, it being of course out of the question to place the diphtheria patients in the scarlet fever wards; or the scarlet fever wards may be overflowing while the others are comparatively empty. There is another point also which occasioned a great deal of difficulty owing to the number of patients under treatment. There is one permanent block designed expressly for the purpose of isolating doubtful cases; this building I had been compelled to use permanently for diphtheria and typhoid fever cases, and consequently was unable to isolate doubtful cases 8 of scarlet fever, It happened, therefore, that some cases were admitted to the scarlet fever wards and a few days afterwards were taken with the illness in very severe form. It is frequently impossible to be certain of the diagnosis, and once in the ward the patient has had to remain. What I wish to point out is the necessity of keeping the isolation block for isolation purposes, and that at present I am unable to do. Soon after the vacation I was obliged to report to the Committee the great difficulty that had arisen in regard to both scarlet fever and diphtheria, and on a special report from the Committee, it was at once decided by the Council to furnish the house of Stonebridge Farm, at that time unoccupied, for the reception of diphtheria, and to build another temporary iron building for scarlet fever. The necessary alterations and the furnishing of the Farm were completed in a week, and the first patient was admitted on November 3rd. The preparing of the ground and erecting of the iron building took nearly a month. With this increase of room there were 98 cases under treatment at one time, 72 of them being scarlet fever. After my report, the Surveyor was requested to prepare preliminary plans for the permanent enlargement of the Hospital, and the subject was under consideration at the end of the year. Although there has been a larger number of cases admitted, the great increase has been due to diphtheria. The proportion of casts to the population has increased, but not so much as might be 9 expected. In 1895 and in 1896 out of every 1,000 of the population, 4.3 each year wore admitted to the Hospital; in 1897 the proportion was 5.0. Of scarlet fever only, 1ho proportion in 1896 was 3.3, and this year 3.5. No doubt the proportion would have been higher if I could have admitted all the cases. It was not long, after the increased accommodation enabled me to admit those requiring it, before the disease began to decline in the district. The Hospital has been full during each quarter, in the first 99 cases were admitted „ second 85 „ „ „ third 124 „ „ „ fourth 179 „ „ it will be thus seen that directly there was the usual autumnal increase the accommodation hopelessly failed, and the provision of sufficient number of beds for this is what is really required. It is not contemplated that Stonebridge Farm will be anything but a temporary occupation, and as soon as circumstances will permit (it is hoped early in the ensuing year), the premises will be able to be vacated.* It will be necessary to use one of the permanent hospital blocks for diphtheria, at present used by scarlet fever patients, and to transfer the latter to the new iron building. This block for diphtheria will be able to accommodate 16 beds (all it was sanctioned for by the Local Government Board), but other provision will also ba necessary, as thirty cases of diphtheria have been under treatment at *It has since been done. 10 one time. It has been said that I am asking for a very heavy expenditure of money, and no doubt it is so, but it would not have been so much if the original proposal of four blocks for patients had been carried out. The population of the parish is increasing at the rate at the present time of about 6,000 a year, and it will be apparent that before any new buildings are completed the population will be 100,000. It has been proposed to erect a building with two floors capable of holding 32 beds, a block in present use will hold 16 and two iron buildings 12 in each, there would be therefore a total of 72 beds for scarlet fever patients. I have already had that number in the Hospital at one time, and have hoped that even with the annual increase of population it may prove sufficient for a while, but it would be shutting one's eyes to a very obvious fact if I were to say that I considered it would prove sufficient for long. With regard to diphtheria I have shown that there have been already 30 cases under treatment at one time, and there is accommodation for 16, leaving, as is absolutely necessary, the isolation block for isolation purposes and for typhoid fever cases. I consequently must press upon the notice of the Council the unfortunate circumstance of one block in the original plan not having been built, and to emphasise the fact of its being urgently wanted now for diphtheria patients. The experience in England for the last few years has shown that diphtheria has become much more prevalent in towns than was formerly the case, and 11 our own experience during the year has been that collecting a large number of children together in one school is calculated to give rise to sudden outbreaks of the disease; therefore to have the facility for removing such cases at once is most important. In caring for sufferers from this disease I have been much impressed with the great necessity of plentiful air space for each case and due means of ventilation. A moderately mild case may become a malignant one under the influence of improper surroundings. The air of a ward that has a very bad case of diphtheria, smelling most offensively, may become infected. Sir Richard Thorne, Medical Officer of the Local Government Board, has said—"How common it is to find the bacillus diphtheria on the faucial mucous surfaces of nurses and other attendants in diphtheria wards." Of course, a nurse must of necessity be brought into close contact with such a patient when attending to the throat, may have particles of the membrane coughed into her face; but the atmosphere must also become infected and the currents of air convey the germs, hence the necessity of sufficient space between the patients. ANTITOXIN SERUM. There will be seen among the expenses a sum of £12 11s. 6d. for Antitoxin Serum. I have made great use of this means of treatment, being convinced of the value of it, especially when able to be used early in the disease. 12 I feel confident that the death rate would have been higher but for this application. It is an expensive item, as every dose, on an average, costs nearly half-a-crown. TRACHÆOTOMY. Trachæotomy was performed in nine cases, but in one the child was moribund on admission, and though the operation was performed at once the child was dead before it could be completed. Four cases recovered. ERYSIPELAS. Only one case was admitted, at the urgent request of the Doctor in attendance. It is not a disease that is supposed to be admitted. EXPENSES. 1896. 1897. £ s. d. £ s d. Land, Interest, &c. 109 2 11 .. 107 14 7 Buildings, ,, 1039 10 6 .. 1266 14 10 Furniture 118 12 1 118 14 0 1267 5 6 1493 3 5 Medical Officer.. 175 0 0 .. 200 0 0 Staff 734 0 0 .. 722 0 0 Provisions 1380 3 3 .. 1510 0 6 Furniture & Property,including House Linen 210 18 8 .. 150 4 1 Clothing 135 18 10 .. 110 18 8 Necessaries, Household 235 8 2 .. 100 16 11 13  1896. 1897. £ s. d. £ s. d. Repairs 40 16 4 .. 54 7 0 Coals 213 12 6 .. 244 11 10 Gas 126 5 11 .. 120 3 5 Drugs 27 0 7 Drugs 31 2 10 Antitoxin 12 11 6 Druggist Sundries 94 6 3 Printing and Stationery 16 10 9 .. 34 13 11 Disinfectants .. .. 6 6 10 Plants .. .. 5 0 0 3295 15 0 3397 3 9 Wages: Gardener, Carpenter, &c. 62 19 10 .. 91 14 11½ Water 11 9 10 .. 23 8 10 Gas Main 107 17 4 .. 85 3 8 Rates 106 15 7 .. 111 11 7 Insurance 21 7 3 .. 9 9 5 Sundries ,, 17 5 0 .. 24 16 2 Repairs, altering Ventilators, &c. 50 15 0 .. 21 15 0 Rent of Land 19 8 4 .. 9 15 0 397 18 2 377 14 ½ £4960 18 8 £5268 1 9½ Disinfecting— Forage,Shoeing,&c. 32 16 8 40 6 3 Coachman & helper 34 4 0 33 10 0 Horse hire .. 11 10 0 Engineer 28 12 0 23 12 0 Coals and Wood 18 9 5 19 4 0 114 2 1 138 2 3 Stabling— Forage 16 0 0 .. 16 0 0 Coachman 19 0 0 .. 19 0 0 35 0 0 35 0 0 14 RECEIPTS. The amount received from other Sanitary Authorities for patients taken at their request was— Acton, £137 14s. 0d.; Chiswick, £56 14s. 0d.; Hendon Rural, £27 9s. 0d.; Wembley, £21 12s. 0d.; Guardians, £3 13s. 7d. Total, £247 2s. 7d. This might have been very much increased if there had been accommodation, as 12 patients were obliged to be refused in the latter part of the year. I have placed the two years side by side for the sake of comparison. The salaries of the Staff have remained very nearly the same. The amount for provisions has increased by £130, but in 1897 there were 125 more patients to maintain than in the previous year. The other items have varied, some more and some rather less. Gas has been rather less, although the number of burners in the latter part of the year was increased. I think the incandescent burners have, to a certain extent, reduced the consumption. There has been an additional expenditure in preparing Stonebridge Farm for occupation and in erecting the new iron building, also in providing the furniture for the two places. Altogether the cost came 1o £807, for which application will be made to the Local Government Board to sanction a loan. The average weekly cost of each patient during the year for maintenance was 5s. 2d., and for the Staff 8s. 6½d. The expenditure for patients includes 15 brandy and wine; in cases of diphtheric paralysis, a good deal of wine is used in preparing jelly; it has frequently been found that a soft jelly can be swallowed by a child when liquids return through the nose, owing to paralysis of the soft palate; for this reason a large quantity of Brand's Essence of Meat has been used. The above remarks on page 11, with regard to the diphtheria bacillus being present in the atmosphere and actually found in the throats of the attendants is an indication of the gravity of their occupation and the importance of a good diet in helping to keep them in health. Although there have been serious cases of illness among the Staff at different times I am happy to be able to say there has been no death. Including the 62 remaining in hospital at the beginning of the year, the actual cost of the provisions divided amongst the 549 patients comes to £2 15s. each; in 1896 the cost for the same was £3 5s. Counting the number of beds during 1896 at 72, the cost per bed, including all expenses, was £70. It is difficult to make the same calculation for 1897, as for about seven weeks, when the new building and Farm were occupied, there were 100 beds. Owing to the very great urgency, the wards were fuller for a time than the space warranted, but I trust the necessity will not again arise to lead to such a condition. 16 Chicken pox broke out in the scarlet fever wards and assumed a most serious character ; one child admitted with diphtheria quickly developed measles, but fortunately was able to be isolated at once, so that the disease did not spread. HOSPITAL STAFF. This consisted for most of the year of medical superintendent, matron, steward, four charge nurses, one assistant (who had served two years as a probationer) and eight probationers. When the Farm was opened the Committee sanctioned a fifth charge nurse and a second assistant nurse, who had also been a probationer. There is one seamstress, who has been obliged to have assistance; 12 subordinate female staff, including laundry maids; coachman, engineer to attend to the steam apparatus, whose wife attends to the lodge; a lad to assist in the Laundry and disinfecting, another to assist in the house and generally. GENERAL MANAGEMENT. Articles brought in for use in the Hospital are received by the Matron, who marks the delivery ticket, if correct, and hands it to the Steward, who enters the items in the various books kept for the purpose. These books show the details of every article every week, what is used by the patients and what is used by the Staff. 17 The Matron gives out the necessary articles for the various wards and the house. The articles for clothing are given to the seamstress, who has to show so many articles made from so many yards of material received by her. These books are, of course, frequently examined by the Committee and the Clerk. I can speak with confidence of the great care and attention given by the Matron and Steward at all times. I desire to add that I have received from the Charge Nurses most valuable and willing assistance; Nurse Shrouder has been with me for over three years, and had charge of scarlet fever wards and of diphtheria; Nurse Morris has been here for over two years; has had charge of the diphtheria wards, and when the Farm was opened was placed in charge as Acting Matron in addition to her nursing duties. I have the honour to be, Gentlemen, Your obedient Servant, D. S. SKINNER, Medical Superintendent.