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75
"Metropolitan Asylums Board,
Embankment, E.C.,
17th June, 190Jf.
Sir,
RETURN CASES OF SCARLET FEVER.
The attention of the Managers has been called to the fact
that a circular letter has been issued by the Poplar Borough Council
with reference to an alleged premature discharge of a patient from
one of the Board's Hospitals. Without entering upon the merits
of the particular case referred to, I have been requested to bring
the following facts under the notice of your Council.
At the present time there is an entire want of precise knowledge
both as to the causation of scarlet fever and also as to the period
of infectivity of patients suffering from the disease, and in the
absence of definite scientific knowledge it is impossible for anyone
to assert positively that infection has or has not ceased in any
given case.
Until recently there was a consensus of opinion that the desquamation
which occurs in such cases was coincident with the
infectivity of the patient, and that the cessation of desquamation
could, therefore, be taken as an indication to determine this
latter point; but the Board understands that this opinion has
undergone considerable modification during recent years, it being
held by many of the more prominent physicians, medical officers of
health, superintendents of fever hospitals, and other medical
authorities that desquamation, especially that in the latter stages,
cannot be taken as evidence of infectivity.
The Board have long been aware that so-called return cases
have from time to time occurred, and with the object of obtaining
the fullest information as to their cause, and with the view of
adopting (if practicable) further precautions, they three years
since appointed a medical officer to conduct investigations into the
circumstances of all such alleged cases, and the report of this officer
will shortly be in print. As the result of this and other steps which
the Board are taking they trust that they may be enabled to throw
much light upon this at present obscure subject.