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Isolation.—Of the 92 treated at home it was found possible to isolate the patient completely
in 60 instances. In many of the other cases it was found possible to minimise risk of
the spread of infection by putting the child in the parents' bedroom.
"Secondary" Cases.—There were 7 secondary cases occurring in the same family, and four
in the same house. In addition there were two "return cases" (i.e., those occurring in the
same house within 28 days of the return from hospital of the original patients.
Disinfection.—Disinfection of rooms with their contents and bedding is offered as a
routine measure in every case of scarlet fever. Where the patient is removed to hospital,
disinfection is carried out the same day that notification of removal reaches the Public Health
Department. Where a patient is nursed at home, a letter is sent to the parents giving advice
with regard to treatment and isolation. This letter encloses a form which the medical
practitioner should sign when the patient has recovered, and, upon its return to the Public Health
Department, disinfection is carried out. In 42 cases the forms were not returned and no disinfection
was carried out. Little, if any, harm seems to have followed. Of the 13 cases in which
secondary infection occurred in the same house, no disinfection was carried out in six of them
In 36 cases, therefore, although no disinfection occurred, there were no further cases in that house.
It is doubtful if disinfection has any effect in preventing the spread of scarlet fever. It is
continued because of the feeling of comfort and security it gives to many households, and
reluctance to abandon any preventive measure until it is proved entirely ineffective.
A visit is paid to every home where scarlet fever is notified to advise on disinfection,
isolation, exclusion from school and general hygiene. In 10 cases sanitary defects were discovered
and the requisite notices served.

It was only in 1950 that the notification form distinguished between paralytic and nonparalytic
cases. In 1952, of 23 cases 8 were paralytic. The Council will be aware of the Public
Health Department's concern as to this disease. It is known to be due to a virus of which there
are at least three strains, and it does not appear that the immunity derived from one strain
protects against attack by another. There is some definite evidence that the paralysis of poliomyelitis
can be prevented by the giving of gammaglobulin (a fraction of the blood serum) during
the early incubation period. The practical application of this as a prophylactic measure is,
however, difficult. Large sums of money would be involved in giving gammaglobulin to
thousands of contacts, but the vast majority of contacts do not develop a paralytic attack of
the disease and the giving of gammaglobulin in these cases would be unnecessary and wasteful.
Experiments have shown that immunity can be obtained in animals by the giving of a vaccine,
and the position for the future is not entirely pessimistic. In our own department we have
carried out investigations into certain aspects of the causation of paralysis and hope shortly to