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39
Return Cases of Scarlet Fever and Diphtheria.
Twenty cases of Scarlet Fever occurred at periods varying
from 4 to 39 days after the return of a previous Scarlet Fever
patient from hospital. Two cases of Diphtheria occurred under
similar circumstances. In 4 of the Scarlet Fever cases,
however, there were other possible sources of infection, and
although in the remaining 16 cases no other source of infection
could be traced, it is probable that in some of them the return
of the first case before the infection of the second was merely
a coincidence. In some instances, however, there appeared to
be a causal relationship between the two cases. It is not
surprising that this should be so. It is impossible thoroughly
to disinfect a human being as one disinfects a blanket, and in
the present imperfect state of our knowledge of the sources
of infection in Scarlet Fever, the absolute prevention of
"return cases" appears hardly practicable. For some time
past the London Medical Officers of Health have endeavoured
to induce the Metropolitan Asylums Board to furnish them
with the dates on which it was proposed to discharge from
hospital recovered cases of Scarlet Fever and Diphtheria, and
since early in 1903 this has been done. It is now one of
Miss Dawson's duties to visit the homes to which recovered
patients are to return, and to advise the mothers to take certain
precautions; for instance, not to allow the child to sleep with
other children soon after his return. She also ascertains to
what school it is proposed to send the patient, and a letter is
then addressed to the Head Teacher requesting that the child
be excluded from school for a fortnight after his return home.
This procedure appears to have been beneficial.
The number of days occurring between the date on which
the first patient was discharged, and the date on which the
disease appeared in the second patient varied from 4 to 39.
The following table shows the number of cases infected
after each of the varying periods.