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47
covers the thirteen months between July, 1901, and
July, 1902, and contains much valuable information and
some most useful suggestions. The value of the report
is enhanced by the criticisms and recommendations of
the Asylums Board medical superintendents printed at
the end of the volume.
It is most difficult to fix the period at which a person
suffering from scarlet fever ceases to be infectious, for
(unlike diphtheria) the bacillus of this disease has never
been discovered. An apparently healthy person may
transmit infection yet a bacteriological examination
would afford no evidence of it.
Until recently the medical profession regarded an
inspection of the skin of a scarlet fever convalescent as
a certain means of deciding the question as to
infectivity. This inspection is still useful within certain
limits, but it has been proved that late desquamation
is by itself no evidence of infectiousness.
Dr. Cameron defines as an "infecting case"(or
quasi infecting case) any patient who on discharge from
hospital infects, or is alleged to infect, some other
person, and he restricts the term "return case" to the
person who is so infected.
Many of these so called return cases are merely
coincidences, that is to say the sufferer catches scarlet
fever from some source other than the so-called
"infecting" case. On the other hand a certain proportion
are true "return cases" and undoubtedly
contract their illness from the recently discharged
patient. Bethnal Green has been comparatively free
from cases of this kind.