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removal of the primary patient to hospital; the day following
his removal, the third case fell ill but the case was not diagnosed,
and the patient was not removed for three days during which time
he had infected two other members of the household.
Apart from these cases of secondary infection there were two
instances of two patients in the same house succumbing simultaneously.
Return Gases.
In 41 instances the return home of a patient from an isolation
hospital to which he was removed while suffering from scarlet
fever was followed by the onset of a further case of scarlet fever
in the same household, the onset of the illness in the second case
being more than 24 hours from, but within 28 days of the return
home of the child from hospital. 31 of these occurred in the first
six months of the year as contrasted with 10 in the latter six months.
This heavier incidence at the time of greater prevalence of the
disease is what is usually found to occur. The actual number of
cases of scarlet fever notified in this district in the first six months
was 357 and in the second six months 159.
Of the 41 patients, 33 were treated in one of the two local
isolation hospitals, and eight in the hospitals of other authorities.
This proportion is very nearly that of the ratio of cases admitted
to the hospitals, namely, 248 to the local hospitals and 61 to outside
hospitals, the ratio of possibly infective patients to the total
number admitted to outside hospitals being one to 13.1 compared
with the ratio of one to 13.3 in the case of the local hospitals.
Where more than one case occurs in a house subsequent to
the return home of a discharged patient, unless the onsets of illness
in the patients are simultaneous or nearly so, it is impossible to
determine whether the third patient has been infected by the
patient who returned home or by the first of the return cases.
All except one of the return cases succumbed within three
weeks of the homecoming of the original patient, 19 of the 41
succumbing in the first week, 16 in the second and five in the
third. 28 of the infecting patients were free from any nasal
discharge or other complications. 13 however, though fit on their
discharge from hospital, developed some trouble, the commonest,
that of a nasal discharge, being present in nine cases. Two
developed a recurrence of an aural discharge which had been
present in hospital and which had postponed their release from
isolation, one patient having been detained 67 days and the other
56 days. Of the other complications, one was a septic finger
which developed on the return home of the patient. The other
was a case of a child who had a discharging sinus following an
incision into an abscess from a broken down tonsillar lymph gland.
After a stay in hospital of 55 days, the sinus closed, but reopened
on the patient's return home; following the occurrence of a return