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48
secondary lead to the diagnosis of the first ease. These 19 cases
of secondary infection then, out of the 48 subsequent to a home
treated primary, would have occurred even had the primary been
removed at the time of notification.
It is questionable if all the others would have been prevented ;
as instance, on two occasions three children were infected within
six days of the onset of the primary case ; in another the onset was
two days after the onset of the primary. In the other cases the
intervals separating the onset of the second from the onset of the
primary, were 4 days, one case ; 5 days, three ; 6 days, four ;
7, 9 and 10 days, one case; 16 days, two; 19, one; 20, two;
21, one; and 23, two. In one case where the primary patient
suffered from otorrhoea, the second ease sickened on the thirty-first
day from the onset of the primary.
Return Cases.
There were 17 return cases in the course of the year, in five of
which the infectious case was discharged from one of the London
Fever Hospitals. In addition, there were four other cases which
might have been return cases or secondary to the first of the return
cases in the home. In two instances, the return case was the
mother of the infecting case.
In one instance the primary case was at home 17 days prior to
removal to hospital as an unrecognised case of Scarlet Fever. He
was then admitted on a wrong diagnosis of diphtheria and detained
in hospital 18 days. On the seventh day from his return, his
brother developed Scarlet Fever of a septic type from which he died.
In a number of other instances, the primary case was at home
some days after the onset, few being removed before the third day.
Most were apparently uncomplicated cases and were discharged
about the 28th or 30th day. In eight instances the onset of the
return case was within the first week after the return of the infecting
case; in five instances in the second week and three in the fourth.
A number of infecting cases, though apparently normal on dischargc,
developed a presumably infectious rhinorrhœa within a
few days.
Recovery Cases.
These are cases developing within the same period as a return
case but subsequent to the freeing of a home treated primary case.
Out of the seven of these cases, in two instances in whieh the
primary had not been cleared, the intervals separating the onset of