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63
(luring the 13 months amounted to nearly 900, of which about 800
were in connexion with "return" cases of the two diseases which
have been named above. In order to avoid confusion Dr. Cameron,
in the first place, very wisely defines certain terms which are used
in the report, as the term "return" case is frequently applied both
to the patient who returns from hospital and to the individual
whom he infects after his return. Any patient who in discharge
from hospital infects, or is alleged to have infected another, is
referred to as the "infecting" case and the person infected, or
alleged to have been infected, as the "return" case. Cases occurring
in a home at intervals after the outbreak of the disease, that
is, after the illness of the first case, are called "secondary" cases.
This term, therefore, is not synonymous with "return" caae. It
would be well if this phraseology could be adhered to in future
communications on this subject.
The report is a lengthy one, and it is only possible for us to
consider certain points contained in it. We deal, therefore, on
this occasion solely with that portion which refers to scarlet fever.
As a general rule in this disease the cessation of infection is
coincident with the termination of certain clinical signs and morbid
manifestations of the disease and to a great extent the period of
detention of the patients in the hospital must depend on the duration
of these symptoms. As Dr. Cameron observes, however, their
presence is not always an indication that the patient is still infectious
and, unfortunately, their absence is not a proof to the contrary.
Nor can too much reliance be placed on the duration of the illness,
for, as the tables in the report show, after many weeks of detention
the patient may still be infectious. Each case, therefore, has to be
decided on its own merits, and in the circumstances it is not
surprising that at times it is most difficult, if not impossible, to say
when a patient has ceased to be infectious. In studying the report
one fact remains predominant and that is the "infecting" cases'
which retain their infection longest, are those which suffer from
secondary complications. The complication most frequently present