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weeks. The intervals between the return of the primary cases and the occurrence of the
secondary cases varied from one day to one month. In the majority of instances it was
seven days and under In 25 of the primary cases there is no record of any lesion
having been noticed. The statements of the friends of the patients have been taken that
at the time of return from hospital they appeared quite well. In some of these cases considerable
intervals elapsed between the time of the discharge from hospital and the time
the primary case was examined by the Medical Officer of Health. Slight lesions may,
therefore, possibly have disappeared. In the rest of the cases, 29 in number, lesions
were observed. These lesions may be classified as follows:—
Discharges from the nose in 12 instances
Discharges from nose and ears in 1 instance.
Discharges from ears in 2 instances.
Unhealthy conditions of the tonsils in 7 instances.
Discharging sores in 4 instances.
Other lesions in 3 instances.
In one of the above cases the discharge from the nose was stated to have been
accompanied by redness in the groins and spots behind the ears. This patient also had
an attack of herpes about the mouth not long after return from hospital. In another instance
the discharge from the nose was accompanied by a rough state of the skin, and in
a third instance attention was drawn to a "sore" nose. In a fourth the discharge from
the nose was associated with a red and scurvy condition of the face. In one or two
instances the patients were said to have had discharges from the nose whilst in hospital.
These had ceased when they left hospital, but came on again shortly after
their arrival home. It is noteworthy that with one doubtful exception in none of
the primary cases was there any true scarlatinal desquamation observed. Lesions such
as those indicated above afford good grounds for suspicion, but they are not conclusive
evidence as to patients being infectious.
From observation of the cases which ha ve come under notice in Shoreditch the
following appear to be the most important factors in connection with the occurrence of
return cases:
(1) The existence of lesions in the primary cases when they are released
from isolation. The lesions which are to be regarded as especially liable
to convey infection are those which are accompanied by discharges from
the nose and ears and unhealthy condition of the tonsils. Lesions may
be so slight or persist for such a short time as to be overlooked. They
may, nevertheless, have been sufficient to result in secondary cases.-
(2) The primary cases may be perfectly healthy and free from infection but
may be carriers of infection from hospital in clothing or by some other
means, the result of oversight or lack of proper care.
(3) Imlperfect measures as regards disinfection. These may result through
articles or playthings which have been handled or used by the primary case
prior to removal being put aside and forgotten when the measures as to
disinfection were taken and1 being brought into use again on the