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and Rural Districts, as 35 were admitted from Brentwood and
neighbourhood, the Isolation Hospital for that District being,
at that time, full. 16 cases came from the Romford Union
Workhouse and its Boarded-out Homes. The cases of Scarlet
Fever were, for the most part, of a mild type, but 'many of
the Diphtheria cases were extremely severe, necessitating the
operation of Tracheotomy in 11 instances. Of the Enteric
Fever cases, one was severe and one mild. Eight deaths were
caused by Diphtheria and three by Scarlet Fever. I should like
here to say a few words about "Return Cases," i.e., instances
where, after the return of a child to its home, another inember
of the family has been attacked, apparently infected by the
case just returned from hospital. This only applies to Scarlet
Fever, no instance of a "Return Case" in Diphtheria having
occurred. These occurrences have caused some uneasiness in
the public mind, and I have, on several occasions, been called
upon to give an explanation of what has been unjustly assumed
to be the fault of the hospital staff. I have, on these occasions,
pointed out to the Hospital Board how impossible it is in all
cases of Scarlet Fever, to say when infection is over. The
greatest precautions are taken not to discharge a patient from
hospital until the risk of infection is past. When cases are
convalescent, and apparently no longer infectious, they are
removed to the "Discharge Block," and kept there for about
a week; a separate Nurse attends to them, and there is no
communication between this block and the infectious wards.
In some cases, however, infective germs lurk in the intricate
channels of the "Naso-Pharynx" (back of nose and throat),
which, supposing the child to take cold when leaving hospital,
and get nasal discharge, at once renders it infectious to others
in close contact with it. This is the rationale of "Return
Cases," and no amount of care will prevent such cases occasionally
occurring. It happens in all Scarlet Fever Hospitals,
and I am happy to say that in our own hospital the percentage
of "Return Cases" is less than in most Isolation Hospitals
During the past year it was about 3 per cent.