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84
Take now the other consideration, i.e., protection of the
patient. There can be little doubt, as a result of accumulating
experience, that the nursing of Scarlet Fever patients in
common, where no barrier system exists, particularly when
there is an aggregation of cases complicated by discharges
from the nose and ears, is undesirable, however hygienic the
ward ; in fact, one is compelled to the unorthodox belief that
the nursing of uncomplicated Scarlet Fever cases in homes
capable of affording ample isolation is, in the patient's
interest, a wholesome influence.
As already stated, investigation has provided not unconvincing
proof that complications arising after the second
week of detention are at the instigation of fresh infection
acquired in the common ward. It has been experienced over
and over again in the Hendon Isolation Hospital that, notwithstanding
the excellent hygienic conditions there, given
a few cases of septic discharges in a ward, the outlook as
regards the other patients has been one of apprehension, and
when cases occur it is the practice to isolate them separately
from their fellows when accommodation for such a procedure
is available, or when multiple septic cases exist in a ward,
to arrange separate accommodation for the uncomplicated
cases. Such procedure is only possible when the number of
cases is considerably below the maximum of occupiable beds.
It may be asked what procedure could be adopted to
combat this transference of complications. Whether the
actual initial symptoms which characterise a typical case of
scarlet fever be due to the streptococcus pyogenes or not, there
can be little doubt that the complications are at the instance
of this particular organism.
In a study of ward infections, Drs. Allison and Brown in
an investigation carried out in a London Fever Hospital,
exposed plates containing nutrient media in wards when
patients were asleep, and during the day when ward activities
were at their maxima. They found that colonies of streptococci
grown on the media exposed during the night were
negligible in number and those grown during the day were
abundant, showing direct contamination induced by ward
activities, such as cleansing and making of beds.