View report page

69
of these children from school, until the house was cleansed and
disinfected to the satisfaction of the Medical Officer of Health after
recovery or removal of the patient. Where cases were removed to
hospital, the usual routine followed was fumigation, the removal of
infected bedding and clothing to the borough steam disinfector, and,
where necessary, the stripping and limewashing of the infected house
or parts thereof on the certificate of the Medical Officer of Health.
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 oi the abovenamed
complications in six weeks, whereas another mav 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.