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52
two or three days from the onset, so that he will already have been home
in his most infectious period.
The North-West Metropolitan Regional Hospital Board on taking
over the administration of the hospitals, including the isolation hospitals,
decided that cases of scarlet fever would not be accepted as a routine,
but only if there were special circumstances making this step necessary.
This decision perhaps accounted for the higher proportion of scarlet
fever patients being nursed at home, the number being 212, as against 144
removed to hospital. Of these removed to hospital, most were admitted
t.o the Edgware Isolation Hospital, though limitation of accommodation,
the result very largely of shortage of staff, prevented the admission of
some patients there who were, therefore, accommodated in hospitals much
further afield.
Secondary Infection.
As scarlet fever is an infectious disease, it can be expected that
there will be some cases of secondary infection, that is, other cases
occurring in the household in which there is already one patient from
whom the infection was presumably contracted. There is no general
average frequency with which secondary infections occur, as in some years
of light incidence the proportion of these cases might be quite heavy. In
general it might be expected that in the years of heavy incidence the
proportion would be higher because the higher incidence in itself suggests
a greater invasiveness of the organism, while, too, the greater number of
cases would strain hospital accommodation and so result in a greater
proportion of patients remaining at home during the infectious period.
In 1945 when there were 270 cases of scarlet fever, secondary infections
occurred in 10 households ; the same number occurred the next year,
when there were 248 cases. In 1947 there were 4 secondary infections,
the number of notified cases being 180, and in 1948 6 households had
secondary cases in a year, when there were 181 cases of scarlet fever.
This year there were secondary cases in 16 households ; the number of
cases of scarlet fever in the district was 351. In a year, then, when a
greater proportion of those who suffered from scarlet fever remained at
home the entire period of their infectiousness, there was an appreciably
higher incidence of secondary cases. To try to determine whether the
higher incidence was, in fact, related to the greater extent of home
nursing of the scarlet fever patients, it is necessary to ascertain firstly
to what extent the primary patients were removed to hospital, and
secondly to what extent the primary case which was nursed at home
might have been a smaller risk if he had been removed to hospital on
the same day of disease as the average patient was removed. The
primary case was removed to hospital in 7 out of the 16 households in
which there were secondary cases. In another house, both patients
succumbed to the. attack of scarlet fever simultaneously. There were
then 8 instances in which a secondary case occurred in a household in
which the primary case was not removed to hospital. As the time of
the onset of the secondary case was, in each of these instances, 4 days
or longer from the onset of illness in the primary case, it is possible that,
had the primary case been removed to hospital, the second patient might