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59
the percentage of those who it seemed might well, or even possibly with
advantage, have remained at home was anything from 21 to 44. In very
few cases was the reason for removal the clinical condition of the patient.
The presence of young children in the home accounted each year for 15
to 20 per cent. of the requests ; the presence of many children in theihouse
from 5 to 10 per cent. The fact that there was no bedroom in which to
isolate the patient was a common reason before the war, accounting for
15 per cent. of the cases, but has been responsible for a smaller number
of requests since. Owing to difficulties in nursing them, adult patients,
though suffering from a mild type, are mostly removed, and these have
constituted about 10 per cent. of the admissions. The absence of anyone
to nurse patients at home was of course a common reason for removal
during the war years, and at times accounted for up to 6 per cent. of the
admissions.
17 per cent. of the removals were made on the 1st day of onset,
30 per cent. on the 2nd day of illness, 31 per cent. on the 3rd, 17 per cent.
on the 4th ; but in another 17 per cent. removal was not carried out until
sometime after the 4th day of illness.
Secondary Infection.
More than one case occurred in 10 households, in most of them the
first patient giving rise to one other infection, but in one instance to two.
In two of these homes two patients sickened simultaneously. Of the
remainder, the primary case was home treated in two instances, the
intervals separating the onsets of illness of the first and of the secondary
cases being two and four days. Where the primary patient was removed
to hospital, in several instances the date of onset of the secondary was
either the date of removal of the primary case or preceded removal. The
interval between the onset of the primary to the onset of the secondary
case was two days in four instances, three days in two and four days in
one. In only one instance was it more than four days, and in that case,
where it was seven, the secondary case was an adult.
A study of secondary infection is of interest from two aspects. The
first is in regard to the effectiveness of removal of patients to hospital in
preventing an attack in any other member of the household. In most
instances where a secondary case occurs, when the primary patient was
treated at home, the onset of illness of the secondary preceded the diagnosis
of the first case. This means that in these instances it was not the
failure to remove to hospital the first case that resulted in the second
contracting the infection. Again, although nearly half the primary cases
removed to hospital were at home until the 3rd day of illness and in
17 per cent. of cases were at home even over four days, only this very
small number of secondary infections occurred. It is not suggested that
there is not some increased risk to the household when a case of scarlet
fever is nursed at home ; but it is felt it should not be assumed that
because of this risk, which is slight, the proper place for the treatment of
a case of to-day's mild scarlet fever patient is the general ward of an
isolation hospital. The other point is in relation to the practice of disinfection.
The routine of fumigation and stoving of bedding and clothing
which was carried out for so many years was based on the premise that