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37
4. In diphtheria cases, the adoption of routine bacteriological
examination before discharge has not caused any reduction
in the infectivity rate.
5. The connection between a high infectivity rate and the
weather is not close enough to permit of any notable
reduction of return cases by withholding the discharge of
patients on bad days.
6. In regard to Group C—diphtheria following discharge of
a scarlet fever case—it has been suggested that a routine
examination of scarlet fever patients for diphtheria bacilli
before discharge would abolish such outbreaks. In the
light of the very inconclusive results obtained hitherto by
bacteriology in reducing return diphtheria cases, I cannot
recommend its adoption for scarlet fever.
These conclusions as a whole are disappointing. Had a positive
result been obtained in each of the above lines of inquiry, we might
have hoped to adopt measures to seriously reduce the percentage of
infecting cases discharged.
The lower proportion at the convalescent hospitals i3 undoubted;
and past experience leads to the hope that return cases might be
reduced to about two-thirds or less of the present number by
discharging all cases from the convalescent hospitals. The experience
of the three years does not lead to any similar hope as regards further
classification or bacteriological examination. It is true that classification
has hardly had a fair trial, and other systems or a further trial
of those already in use may give better results.
I have to thank many of the Medical Officers in the Board's
service for assistance in preparing this Report. I have also to
acknowledge the help of Mr. Beresford, my clerk, in the tracing of
cases and other portions of the work.
January, 1906.