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103
Report of Medical Officer of Health.
SUB-APPENDIX B.
RETURN CASES.
In each Annual Report mention has been made of the occurrence of fresh cases of infectious
disease following, at longer or shorter intervals of time, the return home from hospital of previous
patients. During the past year, such "return cases" of scarlet fever were observed in 11 families,
resulting in 15 fresh cases; and of diphtheria, in 1 family, with 2 cases. Inquiries were made
in each case, and a tabulated statement of the results of such inquiries in reference to the cases of
scarlet fever will be found on p. 110. With the exception of two instances which occurred during
the summer vacation, the inquiries were made by the Medical Officer of Health.
The results of the investigations made into the diphtheria cases were specially communicated
to the Metropolitan Asylums Board in a letter, of which the material parts were as follow:—
On January 31st, T. B., set. 6, was removed from 217, B. R., ill with diphtheria.
He returned home March 23rd.
On March 31st, F. B., set. 4 (his brother), sickened with the same disease.
T. B. after his return mixed with the family and slept with his elder brother A. B., who
had scarlet fever and diphtheria a year or two ago. F. B. was at school until March 30th.
There had been no visiting to other houses, and no visitors had called at the house.
The mother said T. B. had been well since coming home, but not so well as before his
illness.
When seen on April 3rd, T. B. had slight discharge from nose; his palate, tonsils, and
fauces were normal to the eye; and the submaxillary glands were large and hard (especially
on left side). Swabs were taken from the nose and throat. In that from the throat, a very
few bacilli were found which might be B. diphtheria. There were none in the other swab.
A further visit was paid on April 5th, to take other swabs. On this occasion a girl, L. G.,
was discovered who was working in the house. She had her neck wrapped up and spoke
with difficulty. She said she had had a sore throat since March 31st. To the naked
eye there were no indications of diphtheria, but a swab was found to contain the
B. diphtheriee. A swab from the boy T. B. gave a negative result.
Inquiry was made as to any bacteriological examination of the boy T. B. prior to discharge
from hospital. The reply was—
"It was not considered necessary to make a bacteriological examination .... prior
to his discharge. According to the notes in the Discharge Book, the throat, glands, and
nostrils were in a normal condition on the day he was removed from hospital.''

At the same time it has to be admitted that the "return cases" included in the above may
represent but a fraction of the total cases. Endeavours have been made to obtain information of
the date of return home of each patient on discharge, and until this is given, the whole circumstances
attending the occurrence of such cases will not be known. This point will be reverted to later on.
There is one factor which has, as yet, not received the full measure of attention which it