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58
Most of the cases were removed to the local Isolation Hospital,
though a number remained at home at the election of the parent.
Although one would not wish to have repeated the previous
experience of shortage of accommodation for isolation of cases
of scarlet fever, the enforced home treatment which had previously
to be carried out demonstrated that wholesale removal to hospital
of the present-day type of scarlet fever is unnecessary. It was
concluded at that time that half of the cases could well be treated
at home. It is unfortunate that the lessons are so soon forgotten,
and that, in response to a public demand, valuable hospital space
is occupied by cases which could be dealt with quite satisfactorily
at home. Actually, out of the 364 cases notified, 304 were admitted
to hospital. No eases who commenced home treatment
had later to be admitted on account of the clinical condition.
Of the cases notified, 294 were cases of primary infection,
47 secondary and one recovery case. There were 17 return cases,
plus 7 others in which the cases were either return or secondary,
in that a third case occurring in the house after the return home
of the infecting case might be either a second return case or might
be secondary to the return case.
Secondary Infection.
Of the 47 secondary cases (excluding those who might have
been return cases), 3.3 were single infections ; in three instances
there were 2 secondaries ; in two instances 3, and in one instance 4.
In four instances the primary case was retained at home; in two
of these the onset of the disease in the secondary occurred before
the disease was recognised in the primary. Both other cases
occurred in the mothers of the original patient. The intersal
separating the onset of the illness in the two patients in one case
was 30 days, and in the other 18 days. Excluding the cases
following on missed primary cases or those possibly following
first of the secondary cases occurring in a home, the onset of the
secondary case occurred on the 2nd day of illness of the Primary
in 4 instances, on the 3rd day in 6, and on the next consecuive
days in 8, 2, 4 and 3 instances. In 6 cases the onset of the secondary
was in the second week of illness of the primary, in 3 cases in the
third week, and in one case in the fourth week. In 9 cases the onset
of the secondary was before the removal to hospital of the Primary
case, and in 5 the onset was on the day of removal. In 5 instances
the onset was on the day after removal, in 3 the third day,
4th and 3 on the 7th. In 6 cases an interval of at least one week
elapsed between the removal of the infecting primary case ant
onset of the illness of the secondary case.