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4. Imperfect, or inefficient, disinfection —
(а) By Hospital Authority.
(б) By Sanitary Authority.
5. Unknown factors.
Such are the generally accepted views as to the reason for
" return " cases, but the more experience one has the more
difficult such cases are to satisfactorily explain. It may be that
other factors (not yet ascertained) play a part in connection with
these so-called " return " cases. Personally, I am satisfied that
in scarlet fever the late stages of desquamation are not infectious,and
that, consequently, slight " peeling ' of the skin in a discharged
patient does not necessarily mean danger to those with
whom such patient may come in contact. I have never been
able to satisfy myself that a patient with late peeling after scarlet
fever had caused the disease to another or others. No patients
with discharging ears, noses, etc., should be discharged without
advising the Medical Officer of the district concerned.
The Metropolitan Asylums Board now take great precautions
before sending out their convalescents ; and about a year ago, at
the suggestion of the Metropolitan Medical Officers of Health
Society, even arranged to send previous intimation of the discharge
of all patients to the Medical Officers of Health of the
different districts concerned. This arrangement, as far as
Lambeth is concerned, is working well, each house being visited
and enquiries made as to the states of the patients sent home.
527 such cases have been visited and investigated during 1903,
and in no instance has any real cause for complaint against the
Metropolitan Asylums Board been found to exist.
Bearing all these facts in mind, the difficulties connected with
administration, the evident desire on the part of the Metropolitan
Asylums Board to do all that is possible to lessen, as far as
practicable, all cause for complaint, etc., I do not recommend the
Lambeth Borough Council to act with the Poplar Borough
Council, which alleges maladministration against the M.A.B.
The best regulated Hospitals everywhere show "return"
cases, but there is no sufficiently proved case to warrant the
assumption that a " return" case is due necessarily to the
returned patient to whom it is generally at once attributed.
Joseph Priestley.
April 18th, 1904.