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are very rare. Last year in only two instances did we have a secondary
rash and throat symptoms in a person who had had what we
had diagnosed as Scarlet Fever, on admission to hospital.
It has also been suggested that the return case may be caused
not by a continuance of the original infection, but by another
disease picked up in hospital by the patient and taken home with
him or her. The objection to this suggestion is that these patients
frequently show no other symptoms before their discharge from the
hospital. Besides patients of certain ages very rarely give rise to
return cases. An adult hardly ever gives rise to a return case;
neither does a child under 3 years of age. It is the children between
the ages of 3 and 13 years who normally give rise to return cases.
Last year only one person over 15 years gave rise to a return case,
one in 1933 and 2 in 1932. The ages of the infecting cases in 1934
were 16, 7, 4, 4|, 7, 5, and 2. In 1933, the ages of the infecting cases
were 11, 13, 12, 11 and 34, and in 1932, 10, 10, 11, 12, 12, 16 and 20.
In most hospitals the acute cases are separated from the
convalescent. In the third week the patients are usually removed
to a clean convalescent ward. The only patients who are not subject
to this regime are the adult cases and the very young children,
and these are the ones who seldom give rise to return cases.
Return cases always cause a good deal of annoyance, and
also inconvenience. Many theories have been advanced of the
cause of return cases, but no theory will fit all the conditions. The
subject has been discussed for over 30 years, and though improvements
in hospital management may have reduced the numbers,
we have not yet found out the true cause. It was at one time suggested
that return cases occurred because the quarantine period
in the hospital had been too short, and that the infection still persisted
in the patient. That the latter was correct was obvious,
but it was not so evident that the persistent infection was due to
too short a stay in the hospital. In recent years the tendency has
been to shorten the stay of uncomplicated cases of Scarlet Fever in
hospital. A few years ago the minimum stay of a Scarlet Fever
case in hospital was six weeks, or until all peeling had finished. We
now ignore the question of peeling and the hospital quarantine has
been reduced to a month. Every uncomplicated Scarlet Fever
case is now discharged at the end of the fourth week. The number
of return cases has not increased, and it has been suggested that
these cases would be reduced if the period of quarantine be lessened.
The more recent views on immunity have been responsible
for the suggestion that the sooner the case is returned from the
hospital the less is the likelihood of return cases, upon the grounds