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Removal to hospital therefore would not he expected to limit
to any extent the number of primary cases occurring in the
district, though of course, one would expect more cases of
secondary infection amongst the home treated than amongst the
hospital treated cases. A comparison follows of the extent
of the spread of further infection in these methods of practise.
Of the 227 cases notified since April 1st, 174 were admitted
to hospital in the first place. 49 were treated entirely at
home, while 4 commenced treatment at home, but were subsequently
admitted—of the 49, 6 occurred in the earlier part of
the year when there were vacant beds at the hospital. The remaining
43, however, occurred in the latter part of the year
when there was a shortage of beds. During the same period
45 cases were admitted to hospital.
Home Treated.
Out of the 45 primary cases who commenced home treatment
there were nine secondary cases resulting from a primary
infection. In three instances the secondary infection had
occurred before the primary was diagnosed. In two cases the
mother nursing the patient was infected. Of the remainder
the onset of the secondary case after the onset of the primary
varied from 5 to 20 days. If it is accepted that each of these
was infected from the primary source and not through another
child in the house having had an unrecognised attack and
serving as a connecting link, the removal of the primary
case in these instances would probably have avoided the case of
secondary infection. The house populations where secondary
infections occurred were—over 15, 2.3, under 15, 3.0, the corresponding
figure for all houses attacked by scarlet fever being
2.47 and 2.87. In one instance a return case occurred in the
house after the freeing of a home-treated case.
Hospital Treated.
19 primary cases gave rise to 24 secondary cases of infection.
It is often doubtful where a third case arises in a house as to
whether it was infected by the primary case, or by the second
patient. When secondary cases occur at long intervals after
the removal of the primary, it is suspected that one of the other
members of the household suffered from an unrecognised attack.
In only one case was this suspicion confirmed by subsequent
desquamation, but in all cases where the onset of the second
case was delayed beyond the usual incubation period of the
disease, there were other children in the house.