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43
was missed until infection had occurred in two other members of
the household; while in three other cases the onset of illness in
the second patient led to the diagnosis of the first case. Eight
cases, therefore, occurred in which it can be assumed that they
might have been prevented had the patients been removed, at the
time of diagnosis, to hospital. In two instances the secondary case
was the mother of the first patient to whom she was acting as
nurse.
Secondary cases occurred in six households in which the
primary case was removed to hospital. In four of these, however,
the onset of illness of the secondary case preceded the date of
removal of the first case; while in the other two instances the
onset of illness of the second was the day following the removal of
the first patient, a time well within the incubation period from the
time of last exposure to infection.
Return Cases.
A return case is defined as one whose onset occurred over
24 hours but within 28 days from the return home of a patient
discharged from the isolation hospital. There were nine households
in which such cases occurred, though one was apparently
secondary to a relapse which occurred on the 9th day from the
patient's return home. In the three cases whose onset was within
the first week of the return home of the patient, there were no
abnormal signs or symptoms in the original patient. In the case
of one whose onset was on the 9th day the returned patient had
developed tonsillitis. The interval from the return home to the
onset was 24 days in one and 27 days in the remaining three cases.
Two of the returned patients were normal, but the other two had
developed a nasal discharge on return home.
There were five instances of a further case in the home on the
return home of a patient where the interval separating the date of
return from the onset was over 28 days, the actual intervals being
29, 36 , 45, 61 and 63 days. In three cases the returned patients
were well, but in the case where the interval was 61 days the patient
had developed a nasal discharge, and in the case where the interval
was 36 days, the patient had succumbed to measles after her return
from hospital.
In only one household, in which three patients were affected,
was there more than one case of illness following the return home
of the discharged patient.
The return case rate this year, which is lower than the average,
is a marked contrast to that experienced during 1935 when the
rate was well above the average though the same practice in the
administration of the hospitals and in regard to the discharge of
patients had been followed.