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"Eetuen" Cases of Scarlet Fever.*
* The Lancet, 15th Sept., 1906.
Bather less than a year ago we commented on a report issued by the
Metropolitan Asylums Board on the subject of "return" cases of scarlet
fever and diphtheria—cases, that is to say, which arise owing to infection
conveyed by patients discharged as cured from the hospitals over which
the Board presides.* That report was drawn up by Dr. A. G. E.
Cameron on the basis of returns extending over a period of 13 months,
and embodied certain suggestions calculated to diminish risk from this
source of infection. The period of time covered by the report was,
however, obviously insufficient to allow any very certain conclusions to be
reached, and we expressed the hope that further investigations would be
made into a matter which so deeply concerns the welfare of the community.
We are glad to see that this view has commended itself to the
authorities of the Metropolitan Asylums Board and that the results of
further study of the problem are now available. The present report is
written by Dr. F. M. Turner, the medical investigator for the Board, and
is distinguished by the same industry and ability which characterised Dr.
Cameron's work. Unfortunately, although the figures for three years are
analysed, thus affording a more trustworthy statistical basis, the practical
conclusions reached are no more encouraging than those of the former
observer. Indeed, the result of the present investigation is to contradict
or neutralise some of the conclusions which the earlier series of figures
appeared to warrant.
Among the principal points emphasised in Dr. Cameron's report were
the following two—that a large proportion of so-called "return" cases
were in reality the result of mere coincidence—instances of purely
accidental outbreaks of scarlet fever in houses to which cured patients
had recently returned from hospital; and that in the majority of cases in
which infection had really been conveyed by the discharged patient
rhinorrhcea had been a feature of his attack, such nasal discharge being,
therefore, the probable means by which infection was carried. The fact
that "return" cases were most frequently met with in autumn and winter
seemed to favour this mode of infection, as suggesting that a chill with
consequent increase of coryza might have been contracted as a result of
exposure to the cold outer air. Dr. Turner has carefully tabulated
statistics of 1,000 consecutive cases at the Eastern Hospital, at which a
* The Lancet, Nov. 18th, 1905, p. 1487.