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1929
26
The death which occurred in the hospital is interesting from
the fact that it is now recognised that Scarlet Fever is only one of
the various responses to infection with the virus of hæmolytic
streptococcus. It is admitted that hæmolytic streptococci produced
many disorders beside Scarlet Fever, though all these streptococci
are not all of the same species. It is impossible to separate Scarlet
Fever from some forms of Puerperal Fever, Erysipelas and Septicemia,
either bacteriologically or epidemicologically. There are
varieties of uterine infection which are in many respects identical with
some cases of Scarlet Fever, though all uterine streptococcal infections
are not similar. The death from Scarlet Fever was that of a
woman, who after her confinement developed Scarlet Fever. She also
exhibited some signs of uterine infection which were not in any way
prominent, and the most prominent signs were those associated
with Scarlet Fever. As far as could be ascertained she had not
been in contact with .any case of Scarlet Fever. She had not, of
course, been out of the house within the usual incubation period of
Scarlet Fever, and she had been visited by no one who was suffering
from any symptoms suspicious of sore throat.
Many of the older medical practitioners were chary of
attending cases of Scarlet Fever if they expected to be called to
a confinement case, and their reluctance can be explained by the
newer findings of bacteriology. They did not have the benefit of
the present day bacteriological research, but their experience
taught them that some relationship existed between Scarlet Fever
and uterine infection.
These bacteriolgical investigations may also have an important
bearing upon our treatment of contacts, though, at the present
time it is difficult to fit in some of the conditions found with the
results of bacteriological research. One of the most constant
phenomena found in the examination of contacts is the presence
of sore throats in those who have been in contact with Scarlet
Fever cases A sore throat is of course one of the symptoms of
Scarlet Fever, but it is associated with other symptoms—fever,
rash, peculiar condition of the tongue, etc. But in Scarlet Fever
contacts, sore throat with no other associated symptoms is a very
constant and frequent condition. What is the association of
Scarlet Fever with non-specific sore throat which we constantly
see and note ? Does the streptococcus mutate with sufficient rapidity
to cause Scarlet Fever in one host, indefinite sore throat only in a
second, and Scarlet Fever again in a third? Whatever views we
may hold as to the cause of these sore throats, in Scarlet Fever
contacts we have to recognise their occurrence and their treatment
causes anxiety. On one morning I examined 12 contacts belonging
to 3 different families. Five of these had injected fauces and palate,