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(b) Mild or Ambulatory Cases.—During both epidemic and
non-epidemic periods, these cases are discovered in the
Schools and School Clinics, or during a systematic
investigation, and such cases are undoubtedly a fruitful
source of infection as they freely mix with other
children in Schools, Cinemas, etc.
(c) Too Early Release of Convalescents.—This is certainly
a potent factor in the spread of infection. Excluding
all opinions as to whether or not the desquamation in
Scarlet Fever is of an infectious nature, it is certainly
a valuable indication of the time when it is safe to
release patients from isolation. In the great majority
of cases I have found that complications, e.g., nasal
and aural discharges, admittedly infectious, are most
likely to occur during the latter stages of the process.
Consequently, if patients are released before the
period of desquamation is complete, these complications
may develop after such release—with obvious
results. This has been clearly demonstrated during
the period under review. The official records show
that as far back as 1914, when 205 cases were admitted
to Hospital, when from my personal knowledge it was
the practice only to discharge cases from Hospital
after six weeks, or when desquamation was complete,
the return rate for cases was 3.9. In 1921, however,
when 177 cases were admitted to Hospital, and owing
to pressure on Hospital accommodation and other
factors, patients were kept for shorter periods, and
sent home while desquamating, the percentage return
rate was 7.9. Weather conditions and home conditions
naturally played an important part in causing this,
for it follows that children discharged to crowded
houses during wet cold weather are more liable to
develop infectious discharges from nose, ear or
kidneys, than those released during good weather and
to well found homes. Investigation proved this to be
the case in 1921, and the number of return cases considerably
fell immediately a systematic course of
visiting and home treatment was put into operation
for early discharged convalescents.
Too much stress, however, must not be put upon
the early discharges from an Isolation Hospital during
a marked epidemic of Scarlet Fever, for it must be