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42
The incidence of infection was fairly even throughout the year,
the months of February and March being those in which most
cases were notified and August the smallest number.
Places of Treatment.
The accommodation at the hospital for the ordinary cases
proved sufficient throughout the year. 176 cases were treated at
home at the election of the parents and 14 were admitted to outside
hospitals. Of these, eight were in-patients of London Hospitals at
the time of onset of illness and were removed to London County
Council Isolation Hospitals, two children were removed at the
desire of their parents to the London Fever Hospital; while four
were admitted to the isolation hospitals of other authorities as
they were, at the time, suffering from a double infection, the other
illness being whooping cough in two cases and measles and chickenpox
in one each. Seven patients were at first nursed at home but
later admitted to the hospital. In five of these the reason for the
later removal was the inconvenience found arising from the children
being at home; one was admitted because she had developed
an involvement of the mastoid, while the remaining case was
removed to hospital when she developed measles.
The commonest reason for the removal of 201 of those treated
in hospital was difficulty in nursing. Of the 55 removed on this
account, 39 were adults. The risk of spread to others owing to the
crowding of the houses was the reason in 17 instances, while in a
further 41 there were other susceptible children at home. In 8
cases only was removal requested because home treatment of the
case would have affected the employment of one of the contacts,
and 8 cases were removed either from a hospital or from a residential
school. In 70 of the cases in which the homes seemed perfectly
suitable for the home treatment of the case there appeared to be
no reason for the removal apart from the inconvenience entailed
or the still common fear of infection.
Secondary Infection.
Secondary infections occurred in 20 households, in 14 of which
there was only one secondary case, in 4 there were three affected,
and in 2, four affected.
In 14 of the households, the primary case was at home
throughout the illness. Of these homes, 7 had one secondary
infection, 2 had two and 1 had three. The time of onset of illness
of the primary to the onset of illness of the secondary, or of the
first of the secondaries where more than one was affected, was within
one week in 5 cases, between one and two weeks in 3, between two
and three weeks in 2, between three and four in 1 and over four
in 2. In 9 of these cases the onset of illness in the second was
subsequent to the diagnosis of the disease in the primary patient.
As regards the remaining instances the original patient in one case