View report page

86
careful record was kept of all cases showing rhinorrhœa, and he finds that
while among 397 cases without complications of any kind 3.27 per cent.
caused infection on returning to their homes, among 343 cases with
rhinorrhœa only 2.62 per cent. proved infectious. Among 256 cases with
other complications only 1.54 per cent. caused further outbreaks. The
figures certainly appear to negative the suggestion that sufferers from
nasal discharges are those most likely to convey infection. On further
scrutiny of the figures there is, however, one point at least which deserves
consideration in order that we may be sure that we are not drawing
erroneous inferences. Thus it appears from the tabular statement
showing the dates of discharge of the 1,000 cases used for this inquiry
that, whereas the "return" infectivity rates for cases without complications
or with other complications than rhinorrhœa discharged after less
than eight weeks' detention were respectively 3.6 and 3 per cent., cases
with nasal discharge similiarly treated showed a percentage of over
6.6 "return" cases. The low proportion of infective cases among the
whole number of cases of rhinorrhœa may be due to the fact that no less
than 180 patients who had exhibited this complication were detained in
hospital over ten weeks, by which time the nasal infection had very
probably become attenuated. In view of these considerations it would
seem at all events premature to discard Dr. Cameron's warning as to the
special danger attaching to these cases, at all events when they are
discharged from hospital after only a short period of detention. It is to
be regretted that at present the casual organism of scarlet fever is
unknown, so that bacteriological examination cannot afford any assistance
in determining the presence or absence of infection. It is remarkable,
however, that in the case of diphtheria, in which the bacillus is easily
found, insistence on a free bill of health from the bacteriologist has not
tended to lessen the number of " return" cases arising at the institutions
enforcing this method of precaution. Another feature of this recent
report which is the reverse of reassuring is the practical contradiction of
Dr. Cameron's contention that a large number of "return" cases of
scarlet fever are pure coincidences. It thus appears that the public
danger from discharged cases of this disease is very real. On the other
hand, it must be borne in mind that at the present day scarlet fever is a
comparatively mild ailment—it has even been suggested by Dr. L. C.
Parkes that it might safely be treated as measles is, the patients not being
removed to isolation hospitals. Dr. Turner's figures do not tend to
support the belief that the mortality of "return" cases is greater than
that of other patients, a suggestion that was in any case contrary to probability
on theoretical grounds.
A somewhat curious point in which the present report is in