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removed and that, therefore, probably no precautions had been
taken to isolate the patient or to prevent the contact of other
members of the family with him, the absence of spread to other
members of the family who later showed their susceptibilty by
succumbing as return cases is striking. More particularly is this
so when it is remembered that in most of the secondary infections,
infection took place very shortly after the onset of the disease in
the first patient. The typing of the organisms found in the throat
of the primary patient at the time of the onset of his illness, and
of the return case would be interesting.
The following cases show that not all infections occurring in
the households following the return home of a patient discharged
from hospital should necessarily be considered to have been
infected by the returning patient: An adult woman who fell ill
with scarlet fever on the 8th January was removed to hospital on
the 10th and discharged on the 5th February—on the 4th February
her child of three succumbed to the disease. On the 28th September
a child was removed to hospital and discharged on the 22nd
October—on the morning of the day the child came home the
mother complained of a sore throat and was later diagnosed as
suffering from scarlet fever
A return case has been defined as one occurring within 28 days
of the return home of a patient from hospital. In the following
cases the interval was more than 28 days:— Onset of primary case
17th January, removed 18th January and discharged 23rd
February—onset of disease in the second patient, 27th March;
onset of primary case 17th June, removal 18th June and discharged
28th August—onset of disease in other patient, 28th September ;
onset of primary case 22nd April, removal 24th April, discharged
21st May—onset of disease in second case, 19th June. In all
these instances the illness in the first patient was mild and the
disease uncomplicated, and no abnormal discharges developed,
either during the stay of the patient in hospital or subsequently.
In nine households more than one case occurred subsequent to
the return home of a patient discharged from hospital, in six,
2 being affected, in two, 3, and in one, 4. In the last case, on
the fifth day after the patient's return home one of the children
fell ill, and within another four days three more went down with
scarlet fever. In the house where the three members of the household
suffered subsequent to the return home of a patient, one child
fell ill on the tenth day after the patient's return, but the case was
not recognised, and two more were affected before the disease was
diagnosed. In the other house where three were affected, the first
fell ill on the seventh day after the first patient's return home,
was removed on the third day of his illness and two days later
another succumbed. He was removed the next day and two days
later another fell ill. In such circumstances it is impossible to
decide whether the returning patient was responsible for all the