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1929
27
in 4 of these the tongue was in the desquamative stage characteristic
of Scarlet Fever. The parents stated that the children had
had a slight sore throat but were positive that no rash of any kind
had appeared. In one of the cases the mother was a patient in
the hospital and there was no one at home to look after the contact,
who was a boy. I took him into the hospital and he peeled
profusely. In the second case the mother of the boy as expecting
to be confined very shortly, and he was also taken into the hospital.
He also peeled but not profusely, and if peeling were not looked
for it might easily be overlooked
It would simplify matters if a specific germ were isolated
as the invariable cause of Scarlet Fever. The contacts could then
be swabbed and our procedure based upon some scientific principle.
At the present time the treatment of these contacts is dependent
upon the experience of the examiner. I do not exclude from
school all contacts who have a slight sore throat, but in some
instances I do exclude and keep under observation contacts who
have sore throats but who have none of the other associated
symptoms of Scarlet Fever. Every case is treated upon its own
merits or demerits.
These considerations alone are sufficient to explain the
want of success in the stamping out of Scarlet Fever. Because
the numbers which Scarlet Fever at the present time kills or damages
are negligible, we have epidemiologists who argue that it
makes very little difference how Scarlet Fever is treated; whether
it be treated as a dangerous infectious disease with segregation in
hospital, control of contacts and clinical treatment of the most
modern kind or whether it is neglected and the sufferers"
allowed to do what they like, go where they like and receive no
treatment or inhibition whatever. The men who argue in that
way are either bacteriologists or epidemiologists, pure and simple.
They do not envisage all aspects of the disease and the part it
plays in the life of the individual and the community. The housing
problem is such that few acute diseases can be treated in the
homes and when this disease is infectious and complications can
occur weeks after the subsidence of the acute symptons, the
difficulties of nursing the patients in the home can well be imagined.
No general hospital or public institution of course will take the
cases on account of the danger of spread of the disease. Under
the present social conditions, there is no option to the provision
of special hospitals. Possibly segregation of the cases, on account
of the difficulties above enumerated and others which have been
pointed out in other reports, will not prevent the spread of the
disease, but it remains the only practical method of dealing with
it. When Fever Hospitals were instituted, the total extinction of
Scarlet Fever was devoutly hoped for, but as our knowledge of