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19
Disinfection.
Terminal fumigation was abolished early in the year. In
its place, reliance is placed on the disinfection of infected articles
by the householders. A leaflet of instructions is given by the
Sanitary Inspectors and the procedure elaborated by them. A
supply of disinfectant is obtainable at the Public Health Offices
and also a disinfectant soap. In the case of home treated patients,
stress is laid on the importance of concurrent disinfection by
which particular attention is given to those articles likely to be
infected. After the freeing of a case, or removal ol the patient
to hospital, a further visit is paid by the inspectors to ensure that
the necessary steps have been taken in regard to potentially
infected articles.
The only indication as to the infectivity of premises or articles
to be obtained in ordinarv circumstances is that they act as foci
of infection and lead to further cases. The guide therefore should
be the number of cases of secondary infection.
It is admitted even by those who see in fomites an important
factor in the spread of infection, that the chief factor is the infectious
person, either a patient or a carrier. While therefore an infectious
patient is being treated at home, there are no grounds for attributing
the source of infection of a secondary ease to fomites. Similarly,
if the onset of infection of the secondary case lies well within
the incubation period of the disease from the time ot removal of the
primary case, the secondary case can be assumed to have been
infected from the first patient. Actually the number or percentage
of secondary cases can form no guide to the extent of
infection by fomites, as, apart from these considerations, the
number is associated with the facilities available for the immediate
removal to hospital of the primary case, and also with the herd
immunity of the population to the particular disease.
As however, this is the first year in which terminal fumigation
has been abandoned and as in the same year the number of cases
of secondary infection of scarlet fever was high, these figures will
now be analysed.
Of the 89 cases, 37 were infected before the recognition of
the disease in the primary case, in some cases the primary case
being completely missed and in others the primary case not being
recognised until a medical attendant has been called in to the second
case. 20 of these were single infections; 8 cases were due to two
secondaries following a primary; and 9 cases were groups of three
secondaries subsequent to three primary cases.