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were received on the same day. In the third, 2 were received on the
same day, with an interval of 8 days between the 2nd and 3rd, and
one day between the third and fourth.
In the fourth, 2 were received on the same day with an interval
of 20 days between the second and third, and 19 days between the
third and fourth. In the fifth, the third and fourth notifications
were received on the same day, four days after the second case, and
15 days after the first case in the house.
Where 5 cases had occurred the dates of the notifications were
as follows :—
1. October 13th, 24th, 29th, 29th, 31st.
2. November 2nd, 2nd, 4th, 21st, 26th.
In almost all the instances where two or more notifications were
received on the same day, one of the cases had been ill for some
time, and the others had been infected in the house. It is most rare
to find the disease simultaneously introduced into the house by
more than one member of the family. Occasionally the disease is
not diagnosed until a second member of the family has been attacked.
But even when a diagnosis has been made as early as possible, the
other children have already been exposed to infection. It has been
stated on a previous page that there is reason to believe that a
patient is infectious from the very start of the illness, and before
the rash has appeared. Very seldom is isolation practised at the
commencement of the illness, and the above instances show how
difficult it is to fulfil the most essential conditions of the spread if the
disease is to be prevented. One of the conditions is, that
the infection must not be handed on by the patient before
seclusion, but in all the above instances, in all probability, the
secondary cases were infected before the previous patient had been
removed to Hospital, or had been isolated in the home. The
difficulty of isolation in the early stages is one reason why Isolation
Hospitals have not been instrumental in stamping out Scarlet Fever
in districts where most of the cases are removed to a Fever Hospital.
There can be hardly any doubt, though, that Hospital Isolation was
in this district the means of limiting the spread of infection. In the
vast majority of instances, there was no possibility of obtaining any
kind of isolation in the homes, and the limited outbreaks in classes