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In house (11) both cases were returned from hospital as not suffering from scarlet fever, and
were probably cases of German measles. The first child had previously suffered from scarlet fever,
and both of them had also had measles.
In house (12) the secondary case was probably contracted from the first case before removal
to hospital.
"RETURN" CASES.
The only secondary cases in the above list that could have been "return " cases were possibly
at houses (4) (6) and (10).
At house (4) the first patient was removed on the 11th May, in a desquamating condition, and
was a young servant who had recently come from Gloucestershire, and her illness had begun and the
rash appeared about three weeks previously. This patient returned on the 3rd July, and left in two
days for another situation. The second patient was a boy aged 10 whose illness began and the rash
appeared on the 18th May, seven days after the removal of the first patient. This patient returned
home on the 4th July, the day after the young servant. The third case was a boy aged 5 years whose
illness began and the rash appeared on the 10th July. It was a mild case, and it was thought the
patient was suffering from German measles, and the case was not notified until the 20th July. On
making enquiries respecting the so-called " return " case I found that the maid servant had left two
days after her return from hospital, and that the boy who returned from hospital on the 4th July, was
quite well, with no desquamation, and no discharge from nose or ears.
At house (6) the first case, a boy aged 6, returned on the 23rd May, after staying in the
hospital nine weeks. The second case, a girl, five years, became ill on the 6th July, and the rash
appeared the following day, the 7th. The third case, a boy aged three years, was notified on the 14th
July, because he was peeling. His illness had begun a fortnight previously, and was most probably
the source of infection of the second case. The first patient on his return from hospital was quite
well, had no desquamation, and no discharge from nose or ears.
In house (10) the first patient, a boy 7 years old, was notified and removed on the 6th July,
1903, and returned from hospital on the 10th October. There was no peeling nor discharge from
the nose or ears, and the patient slept alone for three weeks after his return from the fever hospital.
The second patient, a boy 3 three years of age, began to be ill and the rash appeared on the 7th
November, on the twenty-ninth day after the return of his brother from hospital, and he was notified
and removed to hospital on the 9th November. The third case, a girl 9 years of age, was notified on
the 13th November, and probably contracted her illness from the second case.
In each of these three "return" cases there was nothing to indicate that the patients were
not free from infection either at their return from hospital or afterwards, and it is very probable that
the secondary cases at houses (6) and (10) were not really due to infection from the first case but from
other causes.
The cases at houses (2) and (3) show that secondary cases often occur many months after the
return of a patient from, hospital, and the case at house (5) many months before the return of the
first patient from hospital.
REDUCTION OF THE STAY OF PATIENTS IN HOSPITAL.
I read a paper at the meeting of the Metropolitan Branch of the Incorporated Society of
Medical Officers of Health, which was published in " Public Health " in February, 1903, in which
I prepared statistics of the average detention of scarlet fever patients in the hospitals of the
Metropolitan Asylums Board, and showed that this period was longer than in most of the provincial
hospitals and in hospitals in America and on the Continent. I then gave reasons and evidence for
the adoption of measures that, in the opinion of many experts, would reduce the average period of
detention of patients in hospital, not only to the advantage of the patients, but also of the parents, the
public and the ratepayers.