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53
"Return Cases." In part,, however, it would appear to be actual, and
to this extent is an expression of a very interesting feature - if feature
further observation should show it to be. The feature which is
suggested by the facts is that with a high epidemicity of the disease
there is a greater prevalence of Return Cases. Should more extended
observations show this to be the case it would prove a very interesting
and extremely suggestive phenomenon I associate it with a view I
have expressed elsewhere.*
"It would seem necessary, in order to account for many of the
facts in the spread of scarlet fever, to postulate carrier cases analogous
to the demonstrable passive bearers of the diphtheria bacillus and the
more recently discovered typhoid carriers. The voiding of typhoid
bacilli has been shown to be an intermittent phenomenon in one
detected carrier of the disease, and an analogous process may be
inferred in scarlet fever. There appears to be little ground for
seeking an extracorporeal habitat for the infectious material of scarlet
fever if we except the one cultural medium —milk; and a view more
consonant with all the facts would seem to be that there is continuously
diffused throughout the community the flora—if it be a flora—of
scarlatinal infectivity which under suitable seasonal and other conditions
is communicated from person to person in toxic quantity and degree,
from time to time appearing phenomenally as sporadic or epidemic
scarlet fever."
The bearing of the facts under consideration upon this view is one
which lends support to the contention.
If the normal persistent habitat of scarlet fever infection is found
to be the bodies of persons who have previously suffered from the
disease, au increase in the number of these discovered to be capable of
spreading infection at times when the infection is rife is to be expected.
Be the explanation what it may, the facts are interesting.
*"The Intermittent Infectiousness of Scarlet Fever." Proc. Roy. Soc. Med., 1909, II.,
Epidem. Sec., p. 74.