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46
home, developed a head cold, which gave rise to a nasal discharge.
In most of those who gave rise to infection in the first week after
their return home, no abnormality was detected, but most of those
giving rise to infection in the second week, and to a less extent
those in the third, gave a history of the development of a nasal
discharge. One return case was apparently caused by an ear
discharge, which started four days after the return home of the
patient. In one case, where three of the family succumbed on the
return home of the primary patient, two sickened on the fifth day
after the return, and a third in another two days. In the other
house where three succumbed, the intervals were seven, two and
four days. In the two instances where two members developed
infection the intervals in one household were 11 days between the
return home and the onset of the first case and 17 days between
the onset of the first and second, and in the other 4 and 12 days.
There were two instances in which a return case followed on
the return from hospital of one who had himself been a return
case. One patient, who was at home 18 days as a missed case
before removal to hospital, on his return home gave rise to a case.
There were other instances of removal to hospital not having
been effected for some days from the onset of illness where, although
the patient had given rise to no secondary infections in the acute
stage of his illness, on his return home apparently infected members
of the household.
One child discharged from hospital after being treated for
diphtheria was readmitted the next day with scarlet fever, and
another patient discharged after being treated with scarlet fever
was readmitted four days later with a relapse.
Not all cases of infection occurring in a home should necessarily
be attributed to infection by the return patient. The following
dates refer to three separate groups of patients : Primary case—
Onset 26/9, removal 28/9, discharged from hospital 13/11, onset
of illness in the other patient at home 8/11 ; onset 30/9, removal
4/10, discharged 30/10, onset in other patient 26/10; onset
26/10, removal 27/10, discharged 25/11, onset in other patient
16/11. In each of these three cases the times separating the onsets
of illness of the first and the second cases were well over the usual
incubation period of the disease, and had the onsets of the illness
in each of the three secondary patients occurred after the return
home from hospital of the primary patient it would not unnaturally
have been assumed that that person was the infecting agent.
Such cases as these show that it is erroneous invariably to
incriminate the returning patient as being the source of infection
in all return cases.
Most of the patients who were treated at home progressed
satisfactorily, any complications in most being limited to adenitis
or otitis media. One patient whose onset was apparently mild was
removed to hospital on the 18th day of illness on account of her