A Social Study of Hospital Treatment
Authors: M. Brown, F. C. Carling
Journal: BMJ (1945)

negative in all the fluids.Sera of these cases gave negative results on agglutination with the leptospira of Weil's disease.The patients were evacuated to base hospitals, where three of them made a complete recovery within two months.The other two cases developed sequelae, as described below.Case IV C.S.M. J., aged 32, was seen by Major A. D. Leigh, R.A.M.C., neurologist, in Dec., 1943, three months after the onset.The follow- ing notes are extracted from his report.The patient complained of weakness and numbness in the legs.There was no jaundice and the liver was not palpable.The pupils and cranial nerves were normal.There was slight weakness of both hand-grips, with exaggerated reflexes in both limbs.Blunting to cotton-wool and pinprick was present on both hands.Power in both lower limbs was diminished, more particularly in the right leg.Muscle tone was 'increased in both legs and the gait was mildly spastic.The deep reflexes were much exaggerated, except the right ankle-jerk, which was diminished.The planter responses were flexor.There was diminished sensation on the outer side of both thighs and over the dorsum of the feet, with absolute loss on the toes.The cerebrospinal fluid was normal.The patient was invalided to the U.K. Case V On Sept. 2, 1943, Capt.R., aged 33, complained of sore throat.On the 9th he had a rigor, which recurred despite quinine.On Sept. 14 he was admitted to an M.D.S., where his urine was noted to be dark in colour.The next day he complained of pains in the calves and thighs, and these were followed by loss of power from the hips downwards.On Sept. 17 there was a complete flaccid paraplegia, with anaesthesia below the groins.The patient com- plained of pain in the right arm, and on examination weakness of abduction was noted.There was no complaint of headache.On Sept. 19 he was admitted to a C.C.S.; he vomited several times that day.The next day he complained of headache, pain in the back, and blurring of vision with the onset of fever.There was difficulty in emptying the bladder.Jaundice was now present and the liver was enlarged and tender.The C.S.F.showed no increase in cells and the protein content was normal.The white cells numbered 9,000 per c.mm. Improvement was noted during the next few days, and on Oct. 2, on arrival at a field hospital, a consider- able return of power and sensation had taken place in the left lower limb and, to a less degree, in the right.By the end of October no weakness of the right arm could be detected.The abdominal reflexes were normal.There was weakness of flexion of the right knee and 2 Chronic empyema 1 Chronic nephritis 1 case Thyrotoxico is; fibroids .9 Rheumatic fever .1 Meningitis .1. ... Undiagnosed cases .3cases Delay in supply of special services: radiotherapy, surgical specialists, etc.: Leukaemia and reticuloses .4cases Pulmonary Tb. case Carcinoma of lung .1,Renal stone.1 Essential hypertension.1 Delayed admission to another hospital: Psychoneuroses . . 2 cases T uberculous effusion ..I case Diabetes; cataract .1Estimated waste of bed-days: 680* Patients with diseases of the blood were not considered in the second analysis because they were usually studied for research pur- poses and were kept in hospital for observation longer than their condition demanded.