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year. Of these, death was due in four cases to causes other than scarlet fever.
Of the two patients who died from the disease, one was a Mongolian imbecile who
had a moderately severe attack of scarlet fever and died rather suddenly. The
other, who was also suffering from a moderately severe attack, had, on admission,
hsemorrhagic nephritis and apparently had been ill with septic tonsillitis for a week
previously. This patient was not critically ill, but she collapsed suddenly.
The medical superintendent of the Brook hospital (Dr. Armstrong) has reported
as follows:—
During the year 1,518 cases were under treatment, of whom 8 died, giving a fatality rate
of -59 per cent. The cause of death in the 8 fatal cases was as follows:—
(1) L.V., female, 2 years 10 months. 20 c.c. A.S.S. (anti-streptococcal serum) on
admission. Developed measles 9 days after admission (exposed before admission) from
which she died 18 days after admission.
(2) P R., male, 11/2 years. No serum on admission. Died of nephritis 55 days after
admission.
(3) B.J., male, 4 years. No serum on admission. Admitted with mastoiditis complicated
bv septic meningitis following scarlet fever. Died 5 days after admission.
(4) J.K., male, 3 years 8 months (mentally defective child). No serum on admission.
Died of bronchopneumonia 40 days after admission.
(5) D.M., male, 18 years, 20 c.c. A.S.S. on admission. Died of tuberculous bronchopneumonia
17 days after admission.
(6) M.S., female, 6 years. 40 c.c. A.S.S. on admission. Admitted with appendicitis and
pelvic peritonitis. Died 4 days after admission.
(7) N.D., male, 12 years. 10 c.c. A.S.S. on admission. Died of infective endocarditis
(following scarlet fever) 58 days after admission.
(8) K.W., male, 7 years. No serum on admission. Admitted with purpura hæmorrhagica
after an illness at home which was almost certainly scarlet fever. Died 4 days alter
admission.
It will be seen from this list that in three cases (nos. 1, 5 and 6) death was in no way caused by
scarlet fever; whilst in two others (nos. 2 and 7) the fatal complication was established before
admission.
Apart from these cases, the type of scarlet fever admitted has on the whole remained mild,
and the practice of giving anti-streptococcal serum on admission only to those patients who seemed
likely to have an attack of more than average severity was continued. Actually about 45 per
cent, of the admissions received serum, always by the intramuscular route and in doses ranging
from 10 to 20 c.c., depending on the severity of the attack. Second doses of serum were rarely,
if ever, given. The serum cases were not segregated, each ward containing a proportion of both
serum and non-serum cases.
A series of 1,168 cases, comprising most of the admissions for the year has been analysed,
and an attempt has been made to draw comparisons between the two groups of serum and nonserum
cases. Only those cases which remained at the Brook hospital until discharged have been
included, transfers to the convalescent hospitals being excluded. The details are as follows :—
cases treated with serum, 531 (average length of stay 40-3 days); cases not treated with serum,
637 (average length of stay 46-2 days). Of these, 354 of the serum cases and 377 of the nonserum
cases were uncomplicated, and the average length of stay in both these groups was 29 days.
The remaining 177 of the serum group (33-3 per cent.) and 260 of the non-serum group (42-4
per cent.) either developed scarlet fever complications or intercurrent diseases. Of the latter
there were 44 in the serum group and 110 in the non-serum group. These cases with intercurrent
disease should really be excluded in calculating the length of stay in hospital of the
scarlet fever cases, and, by doing so, the following results are obtained :—serum group, 487
(including 133, or 27-3 per cent., with complications)—average length of stay 35-8 days ; nonserum
group, 527 (including 150, or 28-4 per cent., with complications)—average length of stay
36-8 days. It will be seen that there is no real difference in these two groups either as regards
percentage of complications or length of stay in hospital. They are not, of course, strictly
comparable, but it is interesting to note, in assessing the value of anti-streptococcal serum, that
patients in the serum group, although comprising all the worst cases, were not longer in hospital
and did not show a higher complication rate than the non-serum cases, as one might reasonably
expect if the serum had no effect at all.
The following table shows an analysis of complications and intercurrent diseases occurring
in all the serum and non-serum cases:—