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64
after discharge from the hospital is a morbid condition of the nose.
Such cases apparently may continue to be infectious long after
removal from the hospital environment. Consequently separate
isolation of these patients for a period of ten days before leaving
the hospital, if efficacious at all, can only be so to a limited extent.
It is further pointed out in the report that patients may continue
to be infectious for some time after the objective signs of the
complications have disappeared. A child, therefore, may be sent
home apparently quite free from infection, and yet within a short
period recurrence of the nasal discharge may take place. This is
liable to be attended by what appears to be a recrudescence of
infection and similarly the occurrence after discharge of other
complications, such as tonsillitis, may be followed by "return''
cases.
It is worthy of notice that patients discharged suffering from
otorrhcea are but seldom associated with the occurrence of "return "
cases except when a morbid condition of the nose co-exists.
Dr. Cameron considers that the discharge from the nose is not
necessarily infectious per se, but in a very large proportion of cases
its presence, especially when purulent, is an almost certain indication
that the patient is infectious. An impression has prevailed
that the duration of infectivity of scarlet fever in any particular
instance might be judged by watching the desquamation of the
skin; as long as "peeling" was taking place so long was the
patient capable of conveying the disease to others. Dr. Cameron
states definitely, however, that late desquamation cannot be regarded
as evidence of infectiousness. He concludes that in the majority
of instances the occurrence of "return" cases appears to be due to
a delay in the process of elimination of infection in the " infecting '
cases, and consequently "return" cases may be said to be due to
premature discharge. On referring to the tables, however, it will
be found that in point of time the proportions of " infecting cases "
and "all cases" discharged under eight weeks are the same. He
believes that the direct cause of the retardation is probably due