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35
The majority of the secondary cases followed close on the
primary notifications, and were evidently infected prior to the
isolation of the first patient, but in several instances the
secondary cases in a house occurred shortly after the term of
isolation of the first patient was completed, and were what is
known as "return cases." In nearly every one of these latter
cases there was evidence of nasal or ear discharge having
recurred a few days after the patient had returned from hospital,
or had been released from home isolation (in the case of
patients nursed at home), and the inference was that infection
had spread from this source. At the same time one must not
forget that there were other possible sources of infection, for
instance: Either intentionally or through inadvertence, some
of the child's clothing or toys may not have been handed over
for disinfection, and consequently would in all probability still
have retained infection when again brought into use.
It is especially in the case of Scarlet Fever that difficulty
arises in deciding how soon to dispense with isolation. Bacteriological
examinations as yet are no guide, and the not
infrequent recurrence of infective discharges after the patient
has apparently quite recovered, renders absolute security impracticable.
The wisest plan undoubtedly is to continue home
isolation for a fortnight after the child leaves the hospital, but
this is seldom possible. If we had a convalescent hospital to
which every child could be sent for a few weeks before returning
home, I believe that "return " cases would be of very rare
occurrence. But to efficiently maintain a convalescent hospital
on the lines needed would entail a heavy additional charge.
It is, however, a matter that should be considered when the
time comes for the provision of a local isolation hospital.
In my last annual report I drew attention to the mild
type of Scarlet Fever that appeared to have prevailed in Finchley
for many years, but at the same time noted the high case
mortality occasionally reported from various localities.