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is a fraction of one per cent. This decline in severity must be due to some
change in the organism responsible for the disease and is not due to any
interference by man unless, as has been suggested, the practice of admitting
to hospital the more serious cases which was carried out on a
large scale towards the end of the last century had any effect in this way.
That a decline in virulence of this sort has taken place suggests there is no
reason a reversal of the process should not occur, with resulting increased
severity of the disease.
Place of Treatment.
Sixty-six out of the 185 cases notified were nursed at home at the
election of the parents. In the case of many of those patients who were
removed to hospital, there seemed no reason that they should not have
remained at home. There are these days very few cases where admission
is necessary on clinical grounds. In a small number of cases, removal is
advisable with the object of limiting the spread of infection, or because
of some special situation at the home. So often the patient even when
removed has been at home in an infectious condition for some days, so
that it is probable that he has by then done what harm he is likely to do
in the way of transmitting infection. Too many cases are being admitted
to hospital not because the step is necessary, but because it is convenient
to the household, or because of what in many cases is an unreasonable
apprehension. Admitting such patients results in the hospitals not being
able to accept those suffering from other diseases, patients who are so
much more in need of hospital attention.
Secondary Infection.
Secondary infection occurred in six households. In four of them only
the one secondary case occurred ; in two of these the primary patient
was removed to hospital. In the first of these, removal was on the
fourth day, in the other on the fifth. The interval between the onsets
of the illness of the primary cases who were nursed at home and the
secondary cases were eight days and four days. In each of the other two
households, there were two secondary cases. In the first house, the
primary case was the mother, whose illness had been unrecognised until
a week from the onset of illness of her two children. In the other household
a child of six fell ill on the 11th December, and was removed to
hospital on the 13th ; the following day his two sisters succumbed.
Return Cases.
There was only one household in which a return case occurred. The
primary case was a girl of six who had fallen ill on the 18th June and
was removed to hospital on the 22nd. She was apparently normal when
discharged on the 10th July, and remained apparently healthy. Her
sister, aged four, developed scarlet fever on the 19th July.
Schools and Infection.
Although so many of the patients who succumb to scarlet fever are
children of school age, it is very rarely in this district that the onset
of illness is associated with another recognised case at the school. Of
course, scarlet fever is but one manifestation of the reaction of an