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83
Again, there is not wanting evidence that the complications
of Scarlet Fever, nasal discharge and middle ear disease,
when occurring in the later stages of isolation—that is, after
the end of the second week—are not at the instance of (he
streptococcus the patients originally harboured, but are
occasioned by other types they have acquired as the result of
their association with other affected patients in the common
ward. Affections of the nose and ear in the earlier stages of
Scarlet Fever—that is, in the first fortnight—are in all likelihood,
due to the original type of organism.
What deductions is it permissible to draw from these
recent findings, first as regards protection of the community
from spread of infection and second, as regards the ideal of
protection of the patient himself ?
Take the former—there can be little doubt that the early
diagnosis and consequent facility for immediate removal to
hospital of Scarlet Fever cases, where home conditions render
adequate isolation an impossibility, affords immediate protection
for those members of the household who are not themselves
in process of incubating the malady. But what of the
risk attendant upon the return of the patient after isolation
in wards full of other cases ? The figure already quoted (80
per cent.) of streptococcal carriers in discharged patients—
and carriers, not only of their original type, but of other
types, acquired in hospital wards—looks, on the face of it,
a rather alarming one from the point of view of the home's
protection and it is somewhat remarkable that the number
of "return" cases (i.e., cases developing in the house soon
after the patient's return) is so small. This, one is inclined
to think, is evidence that invasion by streptococcus pyogenes
is not the be all and end all of Scarlet Fever and that its
presence is incidental to the activity of an unknown filterable
virus. In this connection it is pertinent to ask, if streptococcus
pyogenes be the sole virus in the causation of Scarlet Fever,
why it should usually confer permanent immunity, whereas
no permanency whatever is conferred by it when causing
Erysipelas, Tonsillitis and other affections?