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30
It will be observed that the return case is often not removed to the
hospital until after the expiration of the incubation period. It must, however, be
remembered that the doctor is frequently not called to see the patient for several
days. The rash may have possibly disappeared by that time, and the medical man
is not prepared to certify it for several days—in fact, not until the child has started
peeling.
Towards the end of the year I reported to the Public Health Committee the
return cases that had occurred during the latter part of the year. Some of these
were "peeling" when they were discharged from the hospital. As a result, the
Borough Council called the attention of the Metropolitan Asylums Board to these
cases. The Council also informed the Board that these cases had been discharged
while in an infectious condition. Whether the infective material was conveyed in
the desquamating skin, was not so important as the fact that the discharged patients
were the cause of propagating the disease among other children. The reply was that
the matter had received the very careful consideration of a Special Sub-Committee
of the Board, who had received a report thereon by the Medical Investigator, and
they could find no evidence to substantiate our allegation, that any of the patients
were discharged from hospital at too early a period. The letter further stated the
procedure adopted before the patients are discharged, which is as follows:—
"When the opinion is expressed by the Medical Superintendent that a
patient is fit to be discharged, a notice is sent to the friends, of the exact
day and hour, two days later, when a patient will be discharged. Before the
actual discharge takes place, the patient, after special preparation, is again
finally examined by the Medical Officer in charge, with a view of determining
whether such discharge should be effected."
Though the Council had enclosed with their letter a copy of my report on the
cases, the Board unfortunately did not forward a copy of their Medical Investigator's
report with their reply. My chief object in reporting the matter to the
Committee was that the Metropolitan Asylums Board might be asked to cause a
fair and unbiassed inquiry to be made as to the injurious agency that is responsible
for these cases, and to have it remedied if possible.
The different incidence in these two diseases—Scarlet Fever and Diphtheriais
possibly partly explained on the grounds that, whereas most, if not all, of the
hospitals of the Metropolitan Asylums Board discharge their Diphtheria patients
"culture free," such a procedure is at present impossible in the case of Scarlet
Fever, owing to the fact that, whereas the bacillus of Diphtheria is generally acknowledged
and easily recognised, we are at present in ignorance of the microbe of Scarlet
Fever.