View report page

45
There were 24 missed cases of infection which were subsequently
diagnosed, mostly by the desquamation in the later stages, one by
the onset of nephritis, and a few by their having infected others
in the same family.
Infection of other members of the same family was very
common, both by secondary infections and by return cases.
Patients in whom the disease was missed at the onset gave rise
each to a single case in seven instances, in three of these the onset
of illness in the secondary case being within one week of the onset
of the primary, and in four in the third week from the onset in
the primary case. One missed case gave rise to a secondary case,
and within ten days of the onset of illness in this patient a further
three members of the family succumbed. In one family three
members were found desquamating, the onset having been
unrecognised in all cases. In 33 instances a patient gave rise to a
secondary case, the infected patient in four of these being the
mother. In two-thirds of these cases the onset of the illness of
the secondary case was within four days of the onset in the primary
infecting patient, the remainder occurring in the second week.
In each of three families, two other members of a household
succumbed after the primary case.
In a further six instances, a secondary case occurred in a
household in which the patient was being treated at home. In
three of these the onset of illness of the secondary patient was
within four days of that of the primary, in the other three cases
the interval being ten days. One of the six secondarily infected
patients was the mother.
One member of a family who fell ill on November 24th, was
removed to hospital on the 26th. On December 3rd another
member of the family succumbed. This, however, was not a
secondary case as the second patient had not been in contact
with the first, who had been an in-patient in a general hospital
at the time he fell ill, and had not been visited by the second
case.
There were 32 return cases. Of these 28 were single infections
following on the return home of a patient discharged from the
hospital within the month. On two occasions more than one
member of the household succumbed to infection on the return
home of the patient, and in two households three subsequently
suffered from the illness. In such cases the second case occurring
in the household may have been infected either by the returning
patient or by the first of the return cases. In one instance two
suffered with a simultaneous onset and were therefore presumably
infected at the same time by the returning patient. All except
one of the return cases succumbed within three weeks of the homecoming
of the original patient, 10 out of 20 succumbing in the first
week, 6 in the second and 3 in the third. In rather more than half,
the infecting patients, although apparently fit on their return