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It is true that organisms have been isolated and described as such specific
microbes, notably the Streptococcus Scarlatinæ (Klein), and the Diplococcus Scarlatinæ
(Class). These have not by any means met with general recognition and
assent.
At the present time, return cases in Scarlet Fever have been ascribed to and
associated with:—
1. Coincidence.
This is, of course, possible. It is, however, improbable that so many should
occur six weeks or two months after the removal to hospital of the first patient and
within such a short time of his returning home.
2. Concealment of infectious materials by parents and guardians.
It is notorious that people most readily give up bedding, personal clothing,
especially if old or worn, books and curtains to the Sanitary Authority—yet toys and
Sunday clothes axe very often concealed and thereby escape disinfection—to be worn
and used again on the patients being discharged from hospital. This does not apply
so much to our own district, as my instructions to the disinfectors are that they
must take away all articles of clothing to be disinfected. If any particular article
is refused they are at once to report the matter to me. It is therefore not left to
the people themselves as to what shall be disinfected or not.
The patients are usually removed to the hospital at the onset of the disease
and during the acute stage. Under these circumstances, as the children are very ill,
no toys are bought for them. If any are provided they are cheap, and no difficulty
is ever encountered in having them destroyed.
The poorer people are not often blessed with books of their own. They generally
borrow from the Public Libraries. The latter are never returned to the Libraries,
but are destroyed by us.
It is curious that, in most of the return cases, I was informed by the parents,
that the children had no Sunday clothes at the time they were taken ill. New
clothes were bought a few days before their return home and were worn for the first
day on leaving the hospital.
3. Accidents and irregularities in discharging patients from hospital.
(a) Inadequate accommodation for discharging patients, so that the patient has
to be dressed in his clean clothes in a room adjacent to the ward in which other
patients are being treated.