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40 Hospital Administration.
seems little doubt, however, that an ordinary attack of nasal catarrh
can greatly increase the potential infectivity of such cases, and the
frequency with which a cold in the head follows a warm disinfecting
bath on the morning of the discharge of a patient from hospital has
led to a modification of this disinfecting procedure. In many fever
hospitals the bath is given the night before dismissal, and the
patient is quarantined till morning in a clean ward. It is interesting
to note that this alteration in method has led to a prolongation of
the average interval which elapses before the 'return case' occurs,
and at the same time the likelihood of infection is diminished.
Other precautions to be taken are the scrupulous isolation of any
septic cases in convalescent wards, the separation of convalescent
from acute cases in hospital, and care to avoid what may be called
intimate contact with susceptible persons after the patient has
returned home. For instance, a discharged patient should not
occupy the same bed as a susceptible person, should not be indiscriminately
kissed by other children, and should, if possible, have
cups, spoons, and forks reserved for his exclusive use for a fortnight
or more after leaving hospital.
Return cases occur in connection with about 3 per cent. of all
scarlatina patients discharged from our hospitals. In many
instances, doubtless, the occurrence of the second case is a pure
coincidence, but in the majority the discharged patient is responsible.
Length of detention in hospital cannot be said to affect the
number of such cases. Often, indeed, return cases occur after very
long detention."
No one who has had diphtheria is discharged from the hospital
until a bacteriological examination has shown that the throat or
nose is clear of diphtheria germs.
With regard to Scarlet Fever, patients who have made an"
uneventful recovery may be discharged at the end of five weeks
Patients with discharge from the nose or ears are kept until well,