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51
Out of the 25 secondaries where the primary ease was removed
immediately, the onset of the illness of the secondary from the
time of the onset of illness of the primary was not later than the
4th day in 8 cases; not later than the 8th day in a further 12;
and occurred after the 8th day in 5. The corresponding figures in
the case of the 27 secondaries where the primary case was
immediately removed were 14, 5 and 8.
If one accepts those cases occurring within 4 days as not
preventable but those over this time as possibly preventable, it
would appear, owing to the greater number of cases in which the
onset was 5 to 8 days in the series of the home-treated primaries,
that the retention at home of the primary case resulted to some
extent in the occurrence of secondaries. An analysis of the 12
cases however shows that in at least half of them the primary case
was not diagnosed before the third day of illness, and that therefore
many of these secondaries would not have been prevented by
immediate removal of the primary infecting case.
It is not unnaturally acccpted that those secondary infections
occurring late after the onset of a home-treated primary case would
have been prevented by the early removal of the infectious patient,
so that it is of interest to note the occurrence of a number of late
cases subsequent to the early removal to hospital of the primary
case.
This analysis only confirms the findings of previous years,
that sufficient hospital accommodation to permit of the removal of
cases of scarlet fever to hospital immediately on diagnosis does
not materially affect the number of cases of secondary infection.
Return Cases.
There were 17 return cases, in addition to which there were
single cases occurring in three separate households which were
either return cases or secondary to a return case.
There was also one case in which the onset was 30 days from
the date of return home of the primary ease who had developed a
nasal discharge.
One recovery ease occurred in which the onset ol illness was
6 days after the freeing of the primary patient who had been
isolated for 28 days from the onset of illness.