View report page

43
"RETURN" CASES.
(Special Report presented to the Council on April 28/A, 1904.)
When a fresh case of Scarlet Fever (or other infectious
disease) occurs in a house (previously infected) within a certain
definite time (e.g., three weeks) of a patient being returned there
from hospital convalescent from the same disease, it is known as
a '' secondary," or " return" case, and is supposed to be, in
some way or other, connected with the return home of the
previous case. Such " return " cases are known to all Health
Officers, and are attributed, generally, to maladministration (1)
of the hospital authorities in prematurely discharging their
patients, or (2) of the Sanitary Authorities in inefficiently disinfecting
invaded houses and infected clothes and bedding. The
former view is supported by Health Officers, who quote the fact
that patients are, at times, discharged from hospital with
" peeling " skins, discharging noses or ears, inflamed throats,
etc.; whilst the'latter view is supported by Medical Superintendents
of infectious Hospitals, who quote the fact that." return "
cases often occur after some garment or some article of bedding
or clothing has been brought out for the use of the particular
patients on their return from Hospital—such articles having
been put away in an inefficiently-disinfected state.
The number of " return" cases varies considerably under
different conditions, and may, even in a well-regulated, and carefully-administered
Hospital, reach as high a figure as 3 to 5 per
cent, of the total cases discharged. Theoretically, such cases
should not occur at all ; practically, they do. It is, indeed,
difficult to see how they are to be prevented, as they appear to
depend on a variety of causes, e.g. :—
1. Premature discharge of patients with discharging ears or
noses, " peeling " skins, sore throats, etc.;
2. Transference of convalescents direct from acute wards to
their homes, thereby allowing the infected air. which fills
the lungs of the returned patients, to infect others with
whom they may come into contact—mechanical carriers
of infection ;
3. Overcrowding in Hospital, leading to delayed elimination
of poison from the patients, or the re-infection of the
patients, or to other infecting conditions ;