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121
[1908
Fatality. There were 26 deaths among the reported cases, so that
the fatality was equal to 21 per cent.
Cause of Scarlet Fever.—It is very difficult to state definitely
what is the cause of Scarlet Fever, but all observers are agreed that it is undoubtedly
due to some organism. Thus Eddington ascribed it to a bacillus, and
Frankel and Freudenburg to a diplococcus, a view which Klein also supports.
On the other hand, the investigations by Crookshanks and others seem to
disprove this.
Dr. Class of Chicago holds that it is due, not to a streptococcus, but to a
microbe resembling a gonococcus. The Local Government Board's view of the
matter is probably that contained in the 30th report of their Medical Officer,
(Dr. W. H. Power) in which he summarises the researches made on behalf of
the Board by Dr. Mervin Gordon as follows:—
"Dr. Gordon infers, as a result of these and further parallel observations,
that the graver manifestations are due not to a single, but to a twofold
agency; that the infectious malady, Scarlatina, is to be referred to
Streptococcus Scarlatinae, 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.
Thus he ascertained that Streptococcus scarlatinae is the micro-organism
which is uniformly present and predominant in the mucous secretion of the
tonsils of ordinary milk scarlatina; that in the nasal discharge of the
disease this micro-organism is exceptionally, and in the ear discharge only
rarely, to be detected; and that in the blood and organs of fatal cases,
where its presence in abundance might have been anticipated, Streptococcus
scarlatinae is by no means universally found. On the other hand, Streptococcus
pyogenes was found by him to be seldom absent from scarlatina at
any stage of the disease. Frequently it was present, in association with
Streptococcus scarlatinae, in the tonsillar mucus of even uncomplicated
benign cases at a very early stage of their attack; and in the nasal and
aural discharges of the disease it abounded, to the exclusion almost of
other micro-organisms. Finally, in the blood and organs of fatal scarlatina,
Dr. Gordon found Streptococcus pyogenes commonly present—in circumstances,
indeed, and under conditions, in the majority of cases, highly suggestive
that death had resulted by the agency, not of Streptococcus scarlatinae,
but of this other and septicaemic micro-organisms."
The infection of the disease is probably taken into the system through
the inspired air, but instead of passing into the lungs, gains access to the
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