View report page

51
Nurse B (scarlet fever)
Charwoman F
(scarlet fever)
G
H
(scarlet fever)
Patient A (puerperal
fever)
Nurse D
(not ill)
Nurse C
(scarlet fever)
Patient E
(puerperal fever).
Such a sequence of events would seem to show a close connection between
scarlet fever and the streptococcal septicaemia which characterises puerperal fever,
suggesting a common streptococcal origin.
The joint authors of the report suggested that scarlet fever might be due—
(1) Primarily to streptococcal infection, although evidence was not sufficiently
complete to indicate one specific variety of streptococcus.
(2) To a specific streptococcus (as designated by Klein, Gordon and Kurth)
within the limits of the streptococcus anginosus group.
(3) To some non-streptococcal cause which was ultra-microscopic.
Since this date much work has been carried out in recent years on the etiology
of scarlet fever, which has gone very far to prove that a hæmolytic streptococcus
is intimately associated with, if not causative of, the disease (see particularly M. H.
Gordon's work on the serological grouping of hæmolytic streptococci, in which he
distinguished the scarlatinal streptococcus as Type IIIv., B.M.J., April 30,1921). In
earlier researches Moser in 1902 in Autria, and Savchenko and Grabitewsky in 1905
and 1907 in Russia, took a leading part in the production of an immunising serum,
and their pioneer work was taken up later by the German workers, Schultz and
Charlton, and in America by George and Gladys Dick, and Dochez.
However, as Andrewes and Horder had pointed out in 1906, until scarlet fever
had been produced in human beings by infection with a pure culture of streptococcus,
no crucial proof had been furnished as to its etiological relationship with scarlet
fever. It remained for the Dicks, following up the work of Savchenko and Grabitewsky
in tracing this causal relationship, to establish the necessary proof in 1923
by the successful inoculation of volunteers with a pure streptococcus culture obtained
from a case of scarlet fever.
They further introduced the special test now well recognised by their name,
in which an individual's susceptibility to scarlet fever could be ascertained by intradermic
injection of .2 c.c. of the diluted toxic filtrate obtained from a broth culture
of the scarlatinal streptococcus. The test, when resulting in a reddened area, signified
a positive reaction, i.e., susceptibility from lack of natural protective substance in
the blood, in precisely the same manner as the behaviour of the Schick test for
diphtheria.
Schultze and Charlton in 1918 had described a diagnostic reaction, the blanching
of the scarlatinal rash, caused over a circumscribed area by a .2 c.c. injection, of the
diluted serum of a scarlatinal convalescent, or as later used, of scarlatinal antistreptococcus
horse serum, into the brightest part of the rash.
Dochez in 1924 isolated a streptococcal strain and from it by special method/
prepared the serum known by his name, now in use for the treatment of scarlet fevei
as is also a similar serum prepared by the Dicks.
The past three years have been productive of an increasing number of
observations on the application of the Dick test and Schultz-Charlton diagnostic
reaction, not only in America and this country, but in many other parts of the world.