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In this country, among those responsible for much of the recent work may be
mentioned Drs. E. H. R. Harries of the Birmingham City Hospital, R. A. O'Brien
and C. C. Okell in London, as well as workers at the Metropolitan Asylums Board
hospitals. The work has lately been extended to include the question of artificial
active immunisation, achieved by inoculation in graded doses of the standardised
scarlatinal toxin—on the lines on which similar immunisation against diphtheria
has been employed for the past seven years in New York.
In Aberdeen, in particular, prophylactic inoculation against both diphtheria
and scarlet fever has been authorised by the authorities for the past six months,
and is being carried out under the supervision of the medical officer of health,
Dr. Parlane Kinloch, aided by the special research work of Dr. Smith, the City
bacteriologist.
There is now considerable accumulation of evidence in support of the diagnostic
value of the Dick test and Schultz-Charlton reaction, but still further experience has
yet to prove their ultimate reliability and the efficacy of prophylactic inoculation
against scarlet fever, as well as of the specific treatment of the disease by means
of scarlatinal antistreptococcal serum, which is being made use of with promising
results.
Bearing on the possible relationship between the conveyance of a specific
streptococcus in the throats of carriers and the causation of infection in both puerperal
and scarlet fever, mention may here be made of certain investigations which were
attempted in the Council's laboratory.
1. Puerperal fever.—Request was made for investigation in connection with
the occurrence of cases of puerperal fever and the suggested association with streptococcal
carriers. Cultures were taken from the tonsils and nasal mucosa of eight
maternity nurses to ascertain the types of bacterial flora present with particular
reference to the haemolytic group of streptococci. Of the eight examined, three
yielded a haemolytic streptococcus which proved on fermentation sugar tests not to
ferment mannite.
Of the three positives, one had been associated with two or more cases of puerperal
fever. From results so limited in scope it was obvious that no definite criteria
could be drawn, especially in view of the fact that hitherto by serological tests the
existence of an independent group of streptococci has not been definitely established
in connection with puerperal fever, although suggested by Gordon's results as due
to strep. pyogenes. (Type I). Moreover haemolytic streptococci are estimated to be
found in the throats of about 10 per cent. of normal individuals.
A. F. Lash and Bertha Raplan have recently published (J. A. M. A., April 17th,
1926, p. 1197) the results of observations on streptococcus hæmolyticus in its relation
to puerperal fever. Its serological and toxic characters are represented as specific
in regard to puerperal infection. But, as the investigation is limited to this condition
only and does not include corresponding neutralising and agglutinating tests
with other streptococcal strains, e.g., scarlatinal and erysipelas, their toxins and sera,
the work must be regarded as incomplete and any claim to specificity as not yet
proven. Although it is a matter of considerable doubt whether suspension from
maternity duty would be strictly justified in the case of any nurse found to be carrying
an organism not uncommonly present in a proportion of any group of individuals,
yet the possible risk of conveyance of infection from nurse to patient is one which
obviously calls for very careful consideration and cannot be lightly ignored.
2. Scarlet fever.—The occurrence of scarlet fever and a simultaneous prevalence
of sore throats in one of the departments at Harper Street School (Southwark),
provided an opportunity for bacteriological investigation with a view to ascertaining
the incidence of streptococcal throat infection among recent absentees. In the one
department there had been eight cases of scarlet fever, and sore throat had been
responsible for no fewer than 80 absentees. The proportion of sore throat to scarlet