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56
WHAT WE MAY EXPECT IN CASES OF SCARLET FEVER.
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 and 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 otorrhœa, 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 reasons,
and released even then with some risk lest a "return" case be the result.
The procedure by the Health Department for the prevention of
the spread of scarlet fever in the borough has consisted of systematic
weekly visits to the houses where cases were isolated at home, by the
Sanitary Inspector. Reports were made on receipt of each notification
to the Medical Officer of Health, as to the milk, water supply, sanitary
arrangements, drainage, school or department attended by the patient
and rest of the family, state of the house, out-buildings, number in
house, and means of isolation, these reports being entered into an
Infectious Disease Register, where the results of subsequent weekly
visits to enforce isolation are also recorded. Notices were sent to the
school where children attended from infected homes, requiring exclusion
of these children from school, until the house was cleansed and
disinfected to the satisfaction of the Medical Officer of Health, after