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The typg of the disease varied in severity and this will be
referred to later on, but it is the mildness of many of the cases
which is largely responsible for the increased incidence. Diagnosis
is difficult in mild cases, many are overlooked and unattended,
while the medical practitioner frequently hesitates to diagnose
Scarlet Fever on indefinite symptoms in order to avoid putting a
family to inconvenience.
For a number of years the mildness of Scarlet Fever has been
a subject of comment and the opinion has been expressed that the
danger to life of this disease has almost gone. It may be so, but
unfortunately the weight of evidence does not justify such optimism.
It is not so much the variation in the mortality of Scarlet
Fever in different countries in recent years as the past history of
the disease which suggests caution in our outlook.
In 1675 Sydenham described Scarlet Fever as "an ailment,
we can hardly call it more," and yet in the very year of Sydenham's
death it was epidemic in London and became the severe disease of
which malignant attacks were recorded. Again, that illustrious
teacher Bretonneau taught that Scarlatina, which he had formerly
heard spoken of as a dangerous malady, was then a mild infection,
and he said that from 1799 to 1822 he did not recollect seeing a
single fatal case. In 1824 an epidemic of severe type broke out
in Tours and its neighbourhood and the result was that Bretonneau
who had previously looked upon Scarlet Fever as a slight malady
now learned to regard it as equally mortal with plague, typhus and
cholera.
In 1834, Graves in referring to what he terms " the
destructive epidemic of Scarlet Fever " then prevailing in Dublin,
goes on to say that in September, October, November and December,
1801, Scarlet Fever committed great ravages in Dublin and