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population at risk of 98. In 9 houses there occurred 9 secondary
cases and one Return Case, i.e., a percentage of infection in
the houses resulting from the primary case 10.2.
Amongst the 127 hospital cases 19 houses had 24 secondary
cases, and 10 had 12 Return Cases, a total of 36 cases. The
population at risk (children under 15) of 2.87 per house in these
homes was 364, i.e., percentage rate of infection resulting from
the primary case of 9.9.
Unless therefore it is assumed that the more clinically severe
cases are more infectious from the onset than the milder cases,
there appears practically the same risk of spread in the home
if the primary cases treated at home as if removed to hospital.
If even secondary infections are not much increased by home
treatment it raises the question as to whether wholesale
removal of all cases is justifiable. An Isolation Hospital
should be utilised more as a hospital for the skilled treatment
of the infectious sick and less as premises for the segregation
of infectious persons. The prevailing type of Scarlet Fever being
so mild, selection for admission made on clinical grounds would
free beds for the reception of cases of other diseases such as
Measles or Whooping Cough which are greater killing diseases
and require skilled treatment and should have a stronger
claim on these beds than mild uncomplicated cases of Scarlet
Fever.
In spite- of the mildness of the present type however, it is
not a disease to be treated too casually. There were three
fatal cases in this district, 1 being toxic from the onset and the
other 2 Suffering from complications. Further, although mild
cases with care, recover well, 2 cases mild enough to he
unrecognised, and so untreated until desquamating, developed
nephritis.
The mildness of the disease accounts to some extent for itprevalence,
it being probable that there are many unrecognised
cases spreading infection.
Home Treated Cases.
The Health Visitors paid regular visits, the first, on learning
that the case was to stay at home. Leaflets of instructions as to
disinfection and general conduct were left on this occasion.
Another visit was paid shortly after to see if instructions were
understood and being carried out. Thereafter in favourable
circumstances at weekly intervals, the last in uncompicated cases
being in the sixth week after onset. Disinfection was carried
out about the 30th day in most cases.