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4. The total number of return cases of scarlet fever was 90,
giving a percentage of 1.3 of the total number discharged. In
endeavouring to arrive at a definite conclusion as to the necessary
length of detention in scarlet fever, there are two points on which
elucidation is required. The degree of infectivity attaching to —
(a) The desquamation of the skin.
(b) Any mucous discharge occurring during convalescence.
In respect of the infectivity of the later desquamation of the skin
in scarlet fever, it is to be observed in Dr. Simpson's investigation,
that in only 2.7 per cent, was there any reason to suspect desquamation
of the skin as the cause of secondary infection. The
relatively high degree of infectivity of the mucous discharges as
compared with the later desquamation of the skin in scarlet fever,
as shown in the report, is one which is obtaining an increasing
support among those of the profession who have had much to do
with infectious diseases. It would suggest that possibly too much
importance has been hitherto attached to the infectivity of the
skin during the later weeks of scarlatinal convalescence. The
Committee have communicated with the authorities of many
hospitals in other large cities in this country, in America, in
Germany, and have ascertained that the period of detention
insisted on is of somewhat shorter duration than is practised in
those of the Metropolitan Asylums Board. Unfortunately, no
corresponding record of the incidence of the return cases is
available for comparison with that recently obtained for the
Metropolitan Asylums Board
In respect to the infectivity of the mucous discharges, the
question raised by the Managers of the Metropolitan Asylums
Board is of the highest importance, for on its solution depends the
practice which it would be advisable to adopt. If it can be proved
that the discharge after a time constitutes simply the vehicle, as
suggested by Dr. Simpson, and is not in its nature infective, as is
usually believed, it is obvious that the practice of removing the
patient from an infective environment for a short period before
return to his home is one which should be adopted. But on this
point the Committee are unable to express a decided opinion, with
the evidence at present available.