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14
The third case occurred in Kingswood Road. The "infecting"
case was discharged from the Hospital on November 7th. On
November 14th, a sister was taken ill, and notified of Scarlet Fever
on November 19th. The "infecting" case had been in the Hospital
for over 6 weeks, and had not suffered from any complication. I
examined him again on November 18th, and could detect no symptom
or sign which would lead one to suspect his freedom from infection.
The second case in the same house may have been merely a coincidence;
and the infection may not have been conveyed by the child
discharged from the Hospital. The following incident will illustrate
this possibility. A child living at Weston Road was a patient in the
Hospital. On November 11th, the parents were informed that probably
the child would be discharged on November 12th, but after an
examination of the child on the latter date, it was decided to detain
her in the Hospital for at least another week. On November 13th her
sister at home was taken ill, and removed to the Hospital on November
18th. If the first child had been discharged on November 12th (which
originally, had been our intention), the second one would have been
considered a return case. It is possible, in the last case, that some
article which had been in contact with the child before removal to
Hospital, had escaped disinfection, and was brought forth in the preparation
made for the reception of the convalescent. Complaints are
sometimes made that Isolation Hospitals have not been instrumental
in stamping out Scarlet Fever in districts where most of the cases are
removed to a Fever Hospital. The above instances are given to showhow
difficult it is to fulfil the most essential conditions if the spread of
the disease is to be prevented. The infection must not be handed on
by the patient before seclusion, and all infected material left behind
must be rendered sterile. Very rarely is isolation practised at the
commencement of the illness, and we have no means of ascertaining
if all the infected articles have been disinfected.
Moreover, the patient should have recovered perfectly before he
is cleansed and discharged from seclusion, but we have no means of
ascertaining whether the patient is absolutely free from infection or
not. In Diphtheria, the conditions are different; the germ has been
isolated, and a bacteriological examination can always be made before
the patient is discharged from the Hospital.