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55
the fifth member of the household to succumb in turn. In onlythree
instances was the onset of the secondary case subsequent to
the removal of the primary, the intervals separating the removal
of the primary to the onset of the secondary being 1, 2 and 3 days,
the last of these cases being the mother of the original patient.
Return Cases.
There were 20 households in which return cases occurred, in
18 there being only one return case, and in two, 3 return cases.
Of the discharged patients 19 had been treated in the local
isolation hospitals, this being a percentage of patients discharged
after being treated for scarlet fever of 6.5.
8 of the discharged patients showed no abnormal signs at the
time of onset of illness of the secondary case. In 5 the interval
separating the return home of the primary to the onset of illness
of the secondary was under 1 week; in 2 instances it was over
1 but under 2 weeks, and in 1 over 2 but under 3 weeks. 12
presumably infecting patients showed some abnormality, this
being a nasal discharge in 11 and otorrhoea in one, all of which had
developed subsequent to the return home of the patient. In these
cases where the infecting patient demonstrated some abnormality,
the average interval separating the time from the return home
to the onset of the return case was longer than in those where
the infecting patients were apparently well, the intervals being
under 1 week in 4, 1 to 2 weeks in 4, 2 to 3 weeks in 3, and 3 to
4 weeks in one. In 3 instances the return case was the mother.
Of the patients who gave rise to return cases 4 were discharged
from hospital within 28 days from the onset of illness,
10 in their fifth week, 3 in the sixth, while the other 3 were in
hospital for over 6 weeks, two being detained because of otorrhcea.
Recovery Cases.
One recovery case occurred, the infected patient being the
mother of the primary case. The interval separating the onsets
of the illnesses was 29 days.
Home Treated Cases.
110 patients suffering from scarlet fever were treated in their
homes.
Most cases were uncomplicated and made uninterrupted
recoveries. The following is the percentage incidence of complications,
the figures in brackets being the incidence of
complications in hospital treated cases: adenitis 6 (14.5); rhinorrhcea
1 (6.6); otorrhoea 4 (11.1); nephritis, albuminuria (3.7)
and secondary sore throat (1.2) one each.
Cases following Operation on the Nasopharynx.
There were three cases this year in which scarlet fever followed
operative treatment of tonsils and adenoids, in all three of which
the operation had taken place in London hospitals. The intervals