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53
Of the 61 secondary infections following on a primary case
treated at home (and for this purpose the case is considered to be
home treated if, owing to delay in diagnosis or to delay in removal
owing to lack of accommodation, detention at home occurred
for sufficiently long a period for the case before removal to have
given rise to a secondary case, even though the patient was later
removed to hospital), the time from onset of the primary to the
onset of the secondary was 7 days or under in 47 instances, in the
second week in 10, in the 3rd week in two and in the 4th week in
two.
The greatest period of infectivity therefore was the first
few days, most of the damage having been done before the
recognition of the nature of the disease in the primary infecting
patient. When the extent of secondary infection occurring in the
second week after the removal of the infectious patient to hospital
is taken into account, it can be appreciated the very limited
amount of secondary infection occurring after the first week when
the primary case is treated at home. Either this is a tribute to the
efficiency of the methods of isolation practised in these homes, or
it is a further demonstration of the suggestion made following an
analysis of home treatment of scarlet fever cases in previous years,
namely, that this disease, in the case of the vast majority of sufferers,
is infectious for a very limited period of time only, possibly only
a few days, but that some patients, a small proport ion, are infectious
for weeks. The probable state of affairs is a very high percentage
of infectiousness for the first few days; by the end of the week a
sudden drop to a low level, and then possibly a gradual decline in
the proportion for succeeding weeks. This suggestion is not at
variance with the demonstration of the presence of the haemolytic
streptococci in the throats of convalescents up to the '21st day.
the high proportion of return cases compared with recovery
cases suggests infection of the patient in the wards, and presumably
continued re-infeetion, a re-infection to which the patients would
not be exposed when treated at home.
Deaths.
Two deaths were certified during the year as being due to
scarlet fever, one a boy of 5 dying from meningitis following
mastoditis, and the other a girl of one who died of pyaemia.
Dick Test.
No children were Dick-tested during the year.