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79
Nuisances that called for remedy were made the subject of
notice, and the bedding and clothing were disinfected.
Return Cases.—There were five return cases in 1910. These
are the cases which occur in a household when a scarlet fever
patient returns home from hospital, or, if home treated, when
after convalescence the ban of isolation is removed and he resumes
the position in the family he held before he was taken ill.
The original case which returns from hospital is called the
"infecting case," the secondary cases which contract the disease
from the patient recently discharged are the "return cases." It is
found that the infecting cases nearly always have a discharge from
the nose, which is generally colourless and may be profuse, or may
be so slight as only to be evident on pressing the sides of the nostrils
together. The patients may otherwise appear to be perfectly well.
This discharge is now, in most instances, considered to be the
infecting agent during convalescence from scarlet fever. It may
persist for six or seven months or even longer, and during the
whole of this time the patient is presumably infectious. It is
sometimes very difficult to cure and especially in children with
adenoids. In fever hospitals it is usual to detain the scarlet fever
patient until the discharge has quite ceased. In some hospitals
the further precaution is taken of sending the patients out for
exercise in cold and inclement weather to see whether the discharge
can be re-established. If under these conditions the
discharge recurs then the patient is kept in hospital still longer.
Cases discharged for Home.—In Finsbury every case discharged
from the fever hospital is visited soon after return home
and carefully examined. The possibility of further infection is
explained to the mother, suitable measures suggested, and a leaflet
of instruction left with her.
There was one interesting instance which showed the value
of this procedure.
A child X was notified as suffering from diphtheria in October,
1909, and removed to a fever hospital the same day. He was
discharged cured in January, 1910.