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from infection on November 3rd and disinfected the same day. On
November 5th, a sister was taken ill and notified of Scarlet Fever
on November 6th. It is not even fair, as far as return cases are
concerned, to compare home isolation with Hospital isolation
Home isolation is usually attempted when there are no other
susceptible persons in the house, so that when the patient is released
from exclusion, there is little chance of a return case in the house.
Moreover, as is shown in dealing with the next group of
cases, Scarlet Fever displays a tendency to recur in houses and
amongst families after a prolonged period has elapsed since the
occurrence of a previous case.
But whilst contending that the return case is not solely a
hospital phenomenon, it must be admitted that a large majority of
them arise as a result of hospital treatment and administration.
The most fruitful cause probably is the overcrowding of wards and
the failure to separate the convalescent from the acute cases. It
has been pointed out to the Health Committee on several occasions
that until the proposed extension of our Hospital is completed, the
necessary separation and preparation of the patients prior to their
discharge cannot at all times be carried out. Not only is it necessary
to separate the convalescent from the acute cases, but it is desirable
that the patients should during the last week or fortnight of their
stay in the Hospital, be kept under conditions which approximate as
nearly as possible to those which obtain at their homes. In almost
all the "infecting" cases, it was found that a few days after their
arrival home, there was a history of a slight cold and a discharge
from the nose.
The causi of this is not far to seek. In the Hospital, the
wards are kept at a fairly uniform temperature, but when the
patients go home, they sleep usually in bedrooms which have no
fire. It was shown in the report for 1907, that between May and
November no return cases occurred, and last year there was a sharp
rise in November. It is generally found that the relative incidence
of return cases is less in the summer than in the winter months.
Another fruitful cause of nasal discharge after arrival home, was
the disinfecting bath, &c., on the morning of discharge, but whenever