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52. The occurrence of secondary cases associated with the
cessation of isolation in private houses is exceptional, but one
such case occurred last year. The primary case was isolated
for 37 days. Six days after she was released her sister began
with Scarlet Fever. I could find no symptoms of disease or
infection when I examined her a few days later, nor were any
circumstances discovered to explain the infection.
53. Probnged Incubation.—In another instance there was
an interval of six weeks between the occurrence of the first and
second cases in one house. The primary case went to Hospital
and had not returned when the second one began. There were
no other cases in the neighbourhood, nor was any circumstance
discovered to account for infection, unless it be supposed that
incubation may be as long as six weeks. Two other cases
occurred in which the incubation period appeared to be at least
13 and 18 days respectively.
54. Although probably all the so called return cases are not
due to infection brought from Hospital, I believe most are, and
that prolonged infectiousness is to a large extent the result of
Hospital Isolation, though the way in which this acts I do not
attempt to explain. It is still the practice to give a hot bath
immediately before discharge, though this was condemned by
Professor Simpson years ago in his report to the Asylums
Board. The result is in many cases to cause a nasal discharge
which appears to act as a vehicle of infection. One child was
seriously ill with fever and rheumatic pains on arriving home;
she had walked home on a very cold day just after the hot
bath. Any personal disinfection should take place the evening
before the day of discharge.
55. The subject of Hospital Isolation in Scarlet Fever, and
its cost, was more fully dealt with in my Annual Report for
1903 (page 29).