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cases, which are most numerous ; the proportion of the return
cases in diphtheria is a small one, viz., *5 per cent, of
the patients discharged after suffering from that disease;
and apart from the difficulty which is occasionally
experienced in respect to the recognition of the specific
bacillus, a difference of opinion exists as to the practicability
of regulating a patient's detention by bacteriological examination
alone.
4. The total number of return cases of scarlet fever was
90, giving a percentage of 1*3 of the total number discharged.
In endeavouring to arrive at a definite conclusion
as to the necessary length of detention in scarlet fever, there
are two points on which elucidation is required:
The degree of infectivity attaching to
(a.) The desquamation of the skin.
(b.) Any mucous discharge occurring during convalescence.
In respect of the infectivity of the later desquamation of
the skin in scarlet fever, it is to be observed in Dr. Simpson's
investigation that in only 2 7 per cent, was there any reason
to suspect desquamation of the skin as the cause of secondary
infection. The relatively high degree of infectivity of the
mucous discharges as compared with the later desquamation
of the skin in scarlet fever, as shown in the report, is one
which is obtaining an increasing support among those of the
profession who have had much to do with infectious diseases.
It would suggest that possibly too much importance has been
hitherto attached to the infectivity of the skin during the
later weeks of scarlatinal convalescence. The Committee
have communicated with the Authorities of a number of
hospitals in other large towns in this country and abroad, and
have ascertained that the period of detention insisted on is
of somewhat shorter duration than is practised in those of
the Metropolitan Asylums Board. Unfortunately, no corresponding
record of the incidence of return cases is available