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patient, in 54 the presence in the house of children under five years
of age, 45 were adults, in 11 instances there was no one to nurse
the patient, in 19 instances there was more than one patient in the
household, and in 42 homes there were many other children. Ten
patients were removed to hospital from institutions and in nine
instances the retention at home of the patient would have entailed
the abstention from work of a wage-earner. In no instance was a
child removed primarily because of serious clinical condition,
while 91 removals were of patients in whose cases there appeared
to be no real reason that the child should not have been treated
at home.
Secondary Infections.
Secondary infections occurred in 29 households, in 25 of which
there was only one secondary case, in three there were two, and
in one there were three. In 14 of these households the primary
case was nursed at home; in 12 of these there was one secondary
case and in two of them, two. In six of these instances the
secondary infection led to the diagnosis of the illness of the infecting
patient. The secondary case occurred in the first week from the
onset of illness of the primary case in five instances, in the second
week in three, in the third, four, and in the fourth, two. Excluding
those cases where the primary case was not diagnosed until the
onset of illness in the second case and where, therefore, no
precautionary measures in the way of isolation had been taken,
the number of infections occurring in the first week from the onset
of illness of the primary case were three (of whom one was the
mother of the infecting case), in the second week one, in the third
week three (of whom, again, one was the mother of the infecting
case), and in the fourth week one.
Those infections which were secondary to cases removed to
hospital occurred within a week of removal in eight instances
and early in the second week in three (of whom two were adults).
In four instances the secondary case was diagnosed before the
removal of the primary case, and in one instance the diagnosis
in both was made at the same time. The interval separating the
onset of the first of the secondary cases in the household in which
the primary case was removed to hospital from the time of removal
of the primary case was under a week in 10 instances, and over
one week but under two in four.
Return Cases.
There were 26 households in which return cases occurred; in
23 there being only one return case, in two, two cases, and in one,
four cases. Of the discharged patients all but one had been treated
in the local isolation hospitals, most for scarlet fever, but two for
measles. Of the patients discharged from the local hospitals after
treatment for scarlet fever this constitutes a return case rate of
6.8 per cent.