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was spent last year out of the rates which produced no public
benefit, and only saved a much smaller amount to the pockets
of persons who did not require such pecuniary assistance.
50. The reason why Hospital isolation has failed to abolish
Scarlet Fever is that this disease is now kept up mainly by
mild undetected cases, and by 'return cases.' The greater part
of the cases which go to Hospital would be isolated if left at
home ; the very mild cases cannot be isolated because they are
not detected, and the Hospital isolation is itself responsible for
frequently sending home patients supposed to be cured and
free from infection, while experience soon shows that they are
capable of giving the disease to other persons. Under the
present state of medical knowledge it is impossible to detect
such cases and prevent return cases, and it seems hopeless to
expect Scarlet Fever to be eliminated. Thus it becomes a
serious question whether so large a sum should be expended in
general isolation, when equally good results would probably be
obtained by home treatment of a large proportion of those now
sent to Hospital.
51. Duration of Isolation and return cases.—As stated above,
the duration of Hospital isolation during 1903 was 60 days.
The length of stay in Hospital has been reduced of late years,
but is still in my opinion unnecessarily long.
Most authorities are now of opinion that the later stages of
desquamation are non-infectious, and that the infection resides
in the discharges of the nose and mouth. Prolonged Hospital
isolation, besides being an unnecessary expense, seems to
increase the liability to return cases, at any rate it does not
diminish it. The following resolutions were unanimously