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conditions as when the children were sitting still in class, after stamping their feet
to raise the dust and after the cleaners had swept the floor of the two rooms.
The bacterial counts showed without exception that considerably fewer colonies,
and therefore fewer dust particles, were deposited on the plates exposed to the air
of the room, the floor of which had been treated with the dust-allaying oil than on
the plates exposed in the untreated room.
(3) By Dr. Forbes on the role of the streptococcus in relation to
throat infection and the transmission of Puerperal Fever and Scarlet
Fever.
The infecting organism associated with the majority of cases of puerperal
fever has for long been recognised as a streptococcus, usually the variety known
as S. pyogenes. The etiology of scarlet fever, however, has for many years past
been the subject of much discussion and still active investigation. Even as long
ago as 1884 Loeffler had observed the abundance of hæmolytic streptococci in the
throats of severe scarlet fever cases. Klein, in 1886, attributed an outbreak of
the disease in London to streptococcal infection of the milk from a Hendon dairy
farm, supplied by cows suffering from ulcerated udders. He succeeded in isolating
a streptococcus which he named S. scarlatinæ, both from the infected milk and from
the blood of eleven scarlet fever patients, consumers of the milk.
Kurth later drew attention to a streptococcus in the scarlatinal throat which
he called S. conglomeratus. This was followed by further work from Klein, who
with Gordon claimed that this streptococcus, pathogenic to mice, was always to
be found in the scarlatinal throat and not in the normal throat. Gordon, in postmortem
examinations of fatal scarlet fever, isolated at one time S. scarlatinæ, at
another S. pyogenes and occasionally a double infection by both strains. He also
published in the L.G.B. Reports for 1903-4 an account of the grouping of
streptococci as the result of their behaviour in a series of fermentation and
cultural tests: and again in the L.G.B. reports (1910-11) on streptococci in scarlet
fever.
On similar lines in 1906 appeared an exhaustive report by Andrewes and Horder
(Lancet, September 15th, 1906, page 708 et seq.) on " The Study of streptococci
pathogenic to man," in which considerable attention was devoted to the relationship
of certain strains with both scarlet fever and puerperal fever.
At that time, as regards a specific organism in scarlet fever, the results of
cultural tests were held to be too conflicting for very definite conclusions, but the
evidence went to show that if any particular streptococcus was concerned, it would
probably be one of the hæmolytic types named " anginosus " as the more likely
causative agent, and also "pyogenes " as an important though secondary factor ; both
having been consistently found in culture from the throats of scarlet fever cases—
" anginosus " in 20 and " pyogenes " in 11, out of 33 cases investigated.
An account is also given by Andrewes and Horder of a remarkable chain of
infection linking together cases of puerperal and scarlet fever. Nurse B at a
maternity hospital, in attendance on a woman A, developed tonsilitis and three days
later scarlet fever. The patient A then developed puerperal fever and yielded
streptococcus pyogenes in culture from her blood on the sixth day after confinement.
She was transferred to the Great Northern Hospital and died three days later, but
the nurse (C) who had been attending her there developed scarlet fever, and streptoccus
anginosus was isolated from her tonsils. At the maternity hospital Nurse B
was replaced by Nurse D, who attended A for a day or two before her removal
to the Great Northern Hospital and remained well, but attended a confinement
case E in the district, which proved fatal from septicaemia on the fifth day after confinement.
Nurse B's room at the maternity hospital was disinfected and then
scrubbed by a charwoman F, who, two or three days later, developed scarlet fever
and subsequently infected her two children with scarlet fever.