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25
1929
some years in which an uncertified death has appeared in our
returns. Usually all the deaths are certified either by a doctor or
by the Coroner.
INFECTIOUS DISEASES.
Scarlet Fever.
The total number of Scarlet Fever cases notified was
slightly less last year than that of 1928,-—235 in 1929 compared
with 243 in 1928. There was one death from the disease, and this
death was complicated by other conditions. In 1928 there was no
death.
These figures suggest the mild character of the disease, and
this in itself, as was pointed out in last year's report, constitutes
one of the difficulties in its control. Another difficulty is our lack
of knowledge of the bacteriology of Scarlet Fever, and until we
know more about it, the disease will remain one of the most
difficult to control.
A few years ago, the Doctors Dick of Chicago isolated a
hasmoloytic streptococcus which was claimed to be the cause of
Scarlet Fever. Since then at least four types of agglutinable and a
group of non-agglutinable streptococci have been isolated from
Scarlet Fever cases. Are these distinct species and are there many
different Scarlet Fevers? Clinically, of course, we have different
types of Scarlet Fever. From the same neighbourhood and even
from the same house, we frequently have the disease in varying
degrees of virulence, and this does not suggest that there is any
true correspondence between the types of the parasite found by the
bacteriologist and the types of the disease found by the clinicians.
Such variation of resulting reaction may come about by differences
in the normal flora of the throat, whether such be favourable
or antagonistic to the growth or toxity of Dicks' streptococcus or
whatever organisms may cause the disease. It is difficult to believe
that the types of organisms cause a distinct type of disease. In
spite of the varying degrees of virulence in the patients who are
admitted to the Hospital, a second attack of Scarlet Fever, whilst
the patient is in Hospital, is very rare, and multiple attacks are too
rare for the epidemiologist to believe that there is more than one
Variety.
There was only one case admitted to the Hospital last year in
which a history of a previous attack was given, and only one case
in which the patient suffered from a second attack whilst in hospital.
A patient was admitted with a definite rash, a sore throat and a
typical tongue. He peeled in the usual way, but in the fourth week
after admission, he again had a typical attack of Scarlet Fev er,
and peeled the second time. Such instances are exceedingly rare,
and would occur far more often if the clinical varieties corresponded
to the bacteriological findings.