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16
With respect to cases 9, 14 and 23, there is a very considerable element of
doubt as to whether the recurrences of the disease were really due to the return of
the primary cases from hospital or in any way connected with them. Excluding these
the average length of stay in hospital of the primary cases was 52.5 days or 7½ weeks,
whilst the intervals between the return of the primary cases and the occurrence of
the secondary or return cases averaged 9½ days. In the majority of instances the
primary cases presented evidence of nasal trouble, the children having discharges from
the nose which were noticed when they came home. In three instances these discharges
were not noticed until from two to six days after they reached home. It is
important to note that both discharges from the nose and enlarged tonsils are very
common amongst children, and the fact that such are present in convalescents from scarlet
fever is far from being conclusive as to their being able to convey infection. In two
instances the primary cases on their return wore clothing which had not been delivered
up for disinfection, having been put away in a drawer and overlooked. It is not
improbable that this may have been the cause of the recurrence of the disease in these
two instances.
A few instances came under notice in which recurrences of scarlet fever occurred
in houses from which cases had been removed to hospital, not after the return of
such cases from hospital, but a day or two before they came home. The following are
illustrations:—
George T——, aged 6, of No. 61, C- Street, was certified to have scarlet
fever on March 16th, and removed to hospital. The patient returned home on
June 16th. On June 15th Arthur T——, aged 8, was certified to have the same
disease, and removed to hospital.
Olive R-, aged 8, of No. 148, S- Road, was certified to have scarlet
fever and removed to hospital on October 10th, returning home on November 30th.
Stanley R-, aged 7, was certified on November 28th to have the same disease
and removed to hospital.
It need only be remarked that had the recurrences of the disease taken place after
instead of before the return of the convalescents from hospital, they would have been
included amongst the return cases. Such instances indicate, however, that careful enquiry
is necessary in connection with the occurrence of return cases before assuming
that the recurrence is due to infection from convalescents returning from fever
hospitals.
There was one instance of a return case of diphtheria, but there is a considerable
element of doubt as to whether the recurrence of the disease was due to infection
from the returning patient who was under treatment at the North-Eastern Hospital for
Children.