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In discussing then the procedures which should be adopted
to prevent (a) patients carrying home multiple types of
streptococci, and (b) patients acquiring in the common ward
types of streptococci other than their own and possibly leading
to complications, a remedy immediately suggests itself
which will only be available if and when fresh hospital
accommodation becomes necessary with increase of population.
The cubicle system can combat the acquiring of types ot
organism other than the original type. The patient will still
go home with streptococci in his throat and he will still have
complications, but he will go home with only one type—
his own—and his complications, if unfortunately he should
have such, will be at the instance of his own organisms and
not by reason of those acquired in hospital and will occur
in the earlier stages of his illness, and not in the later stages,
thus unduly prolonging his stay in hospital.
In the absence of sufficient cubicles for separate accommodation
of cases of Scarlet Fever, a suggested practice is
that of the invisible barrier system of nursing. This, in effect,
is the individual nursing of each case of Scarlet Fever in a
common ward, each affected person being treated as if he
were completely detached from his fellows, as is the case in
cubicle nursing.
The transmission of Scarlet Fever by air despite experimental
evidence may be regarded as of low or even doubtful
incidence. Infection is carried almost entirely by utensils,
books, toys, and by the hands, the clothing and the air
passages of nursing staff. Also it is undoubtedly carried by
close contact of convalescent cases.
If, therefore, each case were nursed under a system
whereby contamination by any vehicle which might be expected
to carry the virus of one patient to another patient in
the same ward were avoided, the machinery for eradication
of much, if not all, of the crossed type infection would be
put in motion.