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month of the discharge of a patient from the Hospital such a
case is called a "return" case.
Nine cases discharged from the Hospital were followed
within one month by the occurrence of other cases of Scarlet
Fever in the same house. This is a great improvement on
1908 when 27 such cases occurred. Many authorities believe
that the phenomenon of return cases is essentially due to
imperfections in Hospital management, and that recent association
of discharged patients with acute cases is responsible for
most, if not all, return cases. I am convinced that, no matter
what care may be taken, "return" cases will not be entirely
eliminated under existing conditions. As throwing some
light on this matter the following case may be mentioned.
H. R. was notified of Scarlet Fever on October 17th, 1908.
He exhibited very severe symptoms probably on account of the
presence of adenoids and enlarged tonsils. Before he was
discharged from the Hospital his parents were advised to take
him to a place where convalescent Scarlet Fever cases were
admitted. No matter what care would be taken prior to his
discharge from the Hospital I felt convinced that he would
probably give rise to a "return" case. He was discharged
from the Hospital on December 7th, 1908, and was taken to
the Mary Wardell Home for three weeks. On January 2nd,
1909, P. R., his brother, was notified of Scarlet Fever. H. R.
must have infected his brother almost immediately on his return
from the Mary Wardell Home. Possibly a removal of theadenoids
and tonsils of P. R. might have obviated the return case, but
no antiseptic would ever penetrate the crypts of his tonsil.
It has been found in some districts that by placing
patients in a convalescent ward for about a fortnight before
their discharge, and systematically disinfecting the skin, nose,
auditory canals, not a single case had occurred. This statement
is probably true, but it is certain that it would not meet
the case of P. R. mentioned above, and it does not explain
everything in connection with "return" cases. "Return" cases