Cases of mistaken diagnosis

A N A L Y T I C A L NOTES. of patients. Their relatives have also told me that their sanitary environment at home was faulty. 4. Light is shed on how the disease is spread by even the little we •are able to find out at the hospital. For instance, a boy went from here to join his brothers and sisters at the seaside ; he was intimately associated with them there, and they were all quite well till a week after their return home. Scarlet fever then broke out in that family. -Again, two patients went from here to a convalescent establishment, as they were unable to return to their lodgings direct. Not being able to take their goods with them when admitted here, these things had been forwarded to a friend. The lady wrote to me from the convalescent home : " T h e friend to whom I sent on trunk has taken scarlet fever, and they protest my things have conveyed it. It is most unfortunate, but as they were all disinfected by the sanitary people, I cannot see how it can be." Clearly in neither of these instances, quoted as examples, was infection caused by the discharged patient. The time has arrived when an attempt to exterminate scarlet fever in London might be made. The managers are the only authority capable of doing this work. Aided by notifications and partial isolation, they alone can bring it to a practically successful issue. A beginning might be made by starting with some such investigation as has been here suggested for these instances of scarlet fever occurring at home after the discharge of a patient from hospital. CASES OF MISTAKEN DIAGNOSIS.* In the course of ~894 no fewer than 864 patients, or a percentage on the total admissions of 5"2, were, after admission at the fever hospitals of the ~letropolitan Asylums Board, found not to be suffering from the diseases mentioned in the medical certificates upon which they were removed to hospital. The largest number of cases of mistaken diagnosis admitted at any one hospital was, as in previous years, at the Eastern Hospital, where 258 , or 9"8 per cent., were received. Of the patients admitted to the hospital ships, 24 wer~ not suffering from small-pox at the time of admission. Of this number : Four were mothers admitted with their infants ; Nine were infants admitted with their mothers ; One had no symptom of disease at the time of admission, but was sent to hospital as convalescing from small-pox ; and Ten suffered from other diseases, a list of which is given in the report of the medical superintendent on p. i it. t " F r o m the A n n u a l R e p o r t of the M e t r o p o l i t a n A s y l u m s Board. f O f these there were R 6 t h e l n 2, Varicella 2, Measles ID A c h e I, I m p e t i g o I~ E r y t h e m a I, S y p h i l i d e I, Exfoliative D e r m a t i t i s I, no s y m p t o m of disease on admlssion L

339

From these figures it appears that the actual number of mistakes in diagnosis amongst the patients admitted to hospital was 1% or only o'8 per cent. If, however, we consider the total number of cases certified as small-pox, and removed to the wharves and medically examined there, we find that out of 1,263 cases 155 , or 1 2 " 2 per cent., were in the opinion of the managers' medical officers not suffering from small-pox, and were returned to their homes, with the exception of four, who were transferred to fever hospitals. It would be interesting to hear the other side of these cases. Did any of these patients, after being returned home prove to have the diseases originally notified ? Do mistakes in diagnosis occur only on the parts of private medical practitioners ? There is a general concensus of opinion in large towns that isolation accommodation for doubtful cases forms an indispensable ~part of the administrative machinery of fever and small-pox hospitals; but this is almost entirely wanting in the metropolis.

A N A L Y T I C A L NOTES. D R S . B O K O R N Y AND D U C L A U X have carried out some further investigations as to the important part that green plants, and more especially aquatic bacteria, ptay in the purification of water containing organic matter. Dr. Bokorny exposed volatile fatty acids, amido-acids, skatol, urea, etc., in suit. able solutions to the action of algae. The results showed that all these, even urea, were assimulated and used as nutriment by the atg~e. The condition of the Seine at Paris and above that city is very impure, while lower down Duclaux found the water practically pure. H e attributes this to two agencies. The physical action of mineral matter in suspension, which is carried into it largely by the ground waters, and which, owing to their density, fall to the bottom and carry down other matter. This purification, however, he says, is quite subsidiary to the vital influence of the microbe.

P. Mohr finds the amount of sulphur in different keratins varies considerably. The results of his analyses are as follows : - Sulphur Source of keratin, W o m a n ' s hair, d a r k Monde ...... Girl's ,, brown ...... Boy's ,, red blonde . . . . . . . . . R a b b i t ' s ,, . . . . . . . . . . . . Calf's ,, . . . . . . . . . . . . Horse °, . . . . . . . . . . . . Pi~"s . . . . . . . . . . . . . . S h e e p ' s wool . . . . . . . . . . . . Goose feathers ......... Pig's hoof . . . . . . . . . . . . . . . Calf's ,, . . . . . . . . . . . . Ox ~, white . . . . . . . . . . . ,~ ~, black . . . . . . . . . . .

per cent. 4"95 5"34 4"98 4"o! 4"35

3"56 3"59 3'68 2"59 to 3 ' I 6 2"69 3'57 3'49 3"45