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15
turn of the primary case without having been disinfected. Although
suspected on more than one occasion no evidence was obtainable with respect
to playthings. As regards clothing, however, it will be seen from
the remarks in the summary on cases 14 and 39 that clothing worn by a
patient when ill before removal to hospital may be put away and may be
brought into use again on the return of the patient from hospital without
it having been disinfected.
(4) The possibility of coincidence must not be forgotten. It is to be noted
that in a considerable proportion of the instances of return cases the
secondary cases were attending school at the time they were taken ill.
It is possible they may, in some instances, have been infected whilst at
school. Then there is the possibility of a mild case of scarlet fever in the
family having been overlooked; another member of the family not being
infected until shortly after the return from hospital of the primary case,
this is looked upon as the cause of the recurrence of the disease, though
the actual source of infection may have been the unrecognised
case. Again, it is possible for the secondary case to have actually received
infection from the primary case before removal to hospital and to
have harboured the same, the infection not taking root, so to speak, as
to produce the disease until after the return of the primary case from
hospital. Or, possibly both may have received infection from the same
source, the secondary case not developing until after the return from
hospital of the primary case. Some authorities believe it possible to harbour
the germs of a disease like scarlet fever in the throat for months
without an attack of the disease supervening.
The following cases may be quoted to show that the possibility of
coincidence ought not to be overlooked :
On December 5th., 1900, a child was removed with scarlet fever from
No. 61, C- Street. Whilst it was still in hospital another child belonging
to the same family fell ill on January 24th, 1901, and was removed to
hospital suffering from the same disease. Enquiry showed that the
measures for disinfection had been carried out satisfactorily. The
mother of the child had been particularly careful as to playthings and
clothing being destroyed or disinfected. There had been no communication
with the hospital to which the first child had been sent and no
evidence could be obtained as to any connection direct or indirect between
the two cases. There was no history of any illness indicating that there
had been any case in the family which had been overlooked. The second
child attacked was attending school until January 22nd. The interval
between the two cases was 50 days. Had the first case returned home
before the occurrence of the second case the latter would have been included
in the list of "return'' cases.
On April 27th, ,1903, Charles B-, aged 4, was removed from 41,
D- Street suffering from scarlet fever. On May 22nd following,