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1907
152
Consequently it is seen that about 95½ per cent. occur among persons under 15
years old.
3. The maximum number of cases usually occurs in October, but generally
speaking, the disease is most prevalent from the second week in September to the
last week in November.
4. It is generally agreed that the disease is caused by a micro-organism,
although bacteriologists dispute whether it is a protozoon, a streptococcus, or a
microbe resembling a large gonococcus.
A number of bacteriologists of repute, Edgington, Frankel, Freudenberg, Klein.
Gordon, Baginsky, Class, have described organisms which they believe to be
associated with the cause of the disease. But all that can be positively asserted
about the matter is that several bacteria have been found associated with the
disease, but have not been proved to be the cause.
In England Dr. Mervyn Gordon in 1897, 1898 and 3899 made an investigation
for the Local Government Board, and in his report referred the cause to a twofold
agency ; namely, that the infection is to be ascribed to Streptococcus Scarlatina,
whereas the dangerous phases of this disease, and especially its fatal tendency,
frequently result from supplementary invasion of the blood and tissues of the
patient by Streptococcus Pyogenes.
5. The poison of Scarlet Fever is probably drawn into the system with the
inspired air; it does not, however, enter it through the respiratory channels, but
rather through the pharynx and tonsils, which belong to the digestive tract.
6. The infection is considered to lie in the throat, the nasal passages, and
the skin; and that it may be contracted directly from (a) the patient, or (b) bodyclothing
and bedding, and (c) conveyed even to a distance by such articles as
letters, books, etc.
7. It is most infectious when the body temperature is highest.
8. The patient may continue in a state capable of conveying infection for
several months; and he can hardly be regarded in a non-infective state for a period
of five or six weeks.
9. The disease is not carried by water, but may be conveyed by milk, many
epidemics being due to this cause ; and, indeed, it appears to be tolerably certain
that in some cases the milk has been infected by a streptococcal disease of the teats
of the cow.
10. From an inquiry made a few years ago by Dr C. K. Millard of Leicester,
who collected the statistics of Scarlet Fever prevalence in a number of large towns,
it did not appear that those towns who had largely practised hospital isolation had
had any advantage over those not practising it, for the disease seemed to prevail
almost equally in both.
Respecting this matter Dr. Vail, formely Medical Officer of Health for
Stirlingshire and Dumbartonshire, says:—
"Prima facie it is most difficult to believe that hospital isolation is useless.
The disease is infectious and no one doubts that where a case is treated at
home the patient is best kept in a room by himself, as far away as possible from
the rest of the household, and attended by a nurse similary isolated. In this
way, as we all hold, infection may often be kept from spreading. But if that
be so, surely it is better to remove the patient right out of the house into a