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Scarlet Fever is a variable disease, some cases being of a
most malignant form, whilst others are of a mild form. Even
in the latter type complications may arise. Some attacks are
so mild as to escape recognition altogether, thereby acting as
"carriers," and being the means whereby this complaint is
spread, which partly accounts for the difficulty and often
impossibility of tracing the source of infection. Contaminated
milk, food, water supply, overcrowding and insanitary conditions
play an important part in the spread of scarlet fever and zymotic
disease generally. It is by these mild missed cases or "carriers"
that infection is spread, especially in schools, although the
work done by medical inspection of school children has done
much to reduce one great source of infection. Complications
or sequelae may follow even in the mildest of cases: such as
otorrhoea, mastoiditis, nephritis, or albuminuria, rheumatism,
rhinitis, and secondary glandular affections forming abscesses.
As any one or more of these complications may occur in the
same patient, prolonging his recovery, the uncertainty, variability,
and treacherousness of this complaint can be understood.
Bacteriology has not as yet been of any help in defining
when a patient is free from infection, therefore the difficulties
of discharge of such cases from scarlet fever hospitals into
homes where there are other susceptible children can be
realised, especially as any eczematous condition of the mouth,
nostril, or ear is known to be highly infective. In some cases
a patient may be released who has escaped any of the abovenamed
complications in six weeks, whereas another may have
to be isolated for prolonged periods, for any one or more of
these lesions, and released even then with some risk lest a
" return " case be the result.
E