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The percentage of " return cases " was 3.38 of the total cases notified. This question was
the subject of a short report to the Public Health Committee in September, owing to a
communication from Wcolwich Borough Council on a report of their Medical Officer, Dr. Davies.
The matter came before them a second time a little later, owing to the issue of Dr. A. G. R.
Cameron's elaborate report on the subject. This was referred to me, and the following is my
report on the subject:—
" Return Cases."
This subject has been before the Committee on several previous occasions and
has given rise to severe criticism of the Metropolitan Asylums Board by public bodies
and others interested in it. That the Board are anxious to put an end, if possible, to
these so-called return cases is evident from the investigation which they have caused to
be made. Professor Simpson was first appointed and his inquiry" extended from
October, to March, 1899. Dr. A. G. R. Cameron was appointed in 1901 to
continue prof. Simpson's work, and we received in September, 1905, his report the
publication of which was delayed.
" Th is cover s a period extending from July Ist, 1901, to July 31st, 1902, and his
investigations were completed at the end of July, 1903.
"The main object of the work was to ascertain the conditions under which 'return
cases' arise, and to discover whether their incidence bears any relation to their period
of detention in hospital.
" The report is a very long one and consists of 224 foolscap pages. The total
number of inquiries were about 900, 800 of which concerned 'return cases' of either
scarlet fever or diphtheria.
"Dr.Cameron defines a ' return case 'as one which is alleged to have contracted
infectious disease from another case discharged from hospital, and the case which
causes the infection as the 'infecting case.'
"The volume consists of the report proper and the appendix. The former contains
three parts, the first of which is devoted to scarlet fever, the second to diphtheria, and
the third to cases of mixed infection. The appendix gives further particulars of return
cases, and at the end 28 pages are devoted to observations and criticisms by the medical
superintendents of the various hospitals under the Board, on the body of the report
"The conclusions as regards scarlet fever are embodied in 34 paragraphs and for
diphtheria in 13. Unfortunately they are not very definite on the main issues, and
point to the necessity of still further investigation.
"It would appear from this that there is no very constant relationship between
length of stay in hospital and inactivity, and also that patients which have suffered
from complications, especially nasal discharge, are more likely to infect others.
"A number of recommendations and suggestions are made by Dr. Cameron and the
Medical Superintendents, and these I am informed are now under the consideration of
a special sub-committee. One of them has already been adopted, and is in the form of
a circular which is handed to the parents or guardians of every child discharged after
scarlet fever. It reads as follows:—
"It is recommended—
1. That for three weeks after leaving hospital the patient should not sleep in the
same bed (or, it possible, the same room) as children who have not had scarlet fever.
2. That during this period articles used by the patient (such as cup, plate, spoon,
handkerchiefs, towels, toys) should be kept distinct from those used by other children.
3. That the patient should not attend school for three weeks.
The above precautions are especially important in the case of those patients who suffer
from discharge from either nose or ears.
" I may add that I have sent out a somewhat similar circular to all discharged
patients during the greater part of the past year, but have stopped it now that the
Board have taken the matter up."
Enteric Fever.
42 cases of this disease were notified in 1905, being 24 in Bermondsey, 11 in Rotherhithe
Nine eases were returned as not suffering from enteric fever, making the
actual total 33. This is a considerable diminution on 1904 and 1903, when the numbers were
respectively 73 and 76 and is very satisfactory.
On enquiries by the District Inspectors as to the sources of infection, the following
information was received :—
In 14 cases of enteric fever the source of infection was attributed as follows: —
7 patients were in the habit of eating watercress.
„ „ mussels.
„ cockles and whelks.
1 patient ate refuse picked up in the street.
1 patient washed dirty tins over sink.
. ere has been a remarkable absence oi any of those localised outbreaks which occurred
in previous years in families or groups of houses. ■
There were 9 deaths, which makes a case mortality 21'4.
Continued Fever.
The cases notified under this head are usually anomalous ones of enteric but none
occurred in 1905.