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1928
24
missed cases upsets any system for controlling its spread. Not
only peelers, but actual sufferers, may be found in Schools,
Omnibuses, or Cinemas. Diagnosis of the mildest forms of
Scarlet Fever may be theoretically possible, but in practice it
cannot be done. Many instances have in the recent outbreak
been brought to my notice which show the difficulty of making
a diagnosis. Among the contacts examined one morning was a
boy who had a sore throat. A doctor had been in attendance
and had been looking for a rash, but had not been able tc see
any signs. When I saw the boy, the condition of the throat and
tongue was so typical of Scarlet Fever, that I had no hesitation
in admitting the boy to hospital although there had been no
history of a rash. The case subsequently behaved like an
ordinary case of Scarlet Fever and the skin of the body peeled.
The number of sore throats in contacts of Scarlet Fever
is undoubtedly higher than that which would be found in school
children of similar ages. The question naturally arises whether
these sore throats may not be abortive attacks of Scarlet Fever.
The theory has recently been put forward that there may be more
than one species of Scarlet Fever. This of course is no new
theory. Over 30 years ago Dr. Clement Dukes of Rugby
suggested that there were at any rate two diseases included in
the term Scarlet Fever, and he suggested for one of them the
name "Fourth Disease but the suggestion of Dr. Dukes
failed to gain acceptance.
All these factors have a bearing upon the spread of
infection, especially in schools, and also upon the procedure
adopted in dealing with contacts. The difficulty with Scarlet
Fever in school control varies inversely with the severity of the
disease. Seldom dees a grave clinical condition introduce school
problems; a child who is seriously ill is not in school and gives
no further trouble there. It is the mild cases that occasion
trouble, and are frequently missed until peeling commences.
Children in whom the skin of the body and hands is peeling are
often found in school. It is possible that these did not exhibit
any rash or the rash was of so transient a character as not to be
detected by the parents. It is probable that these children did
suffer from a slight sore throat, which, of course, is one of the
earliest symptoms of Scarlet Fever. The question naturally
arises, can we, by supervision of contacts reduce the number of
these mild cases which evade detection, and does exclusion of
contacts from school attendance reduce the number of cases?
In towns, school closure as a preventive measure, has
been abandoned, and disinfection is looked upon with suspicion,
and when practised at all, done in a manner to satisfy a superstition
rather than to remedy a known ill. The modern doctrine