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101
SURGICAL WORK IN SCARLET FEVER.
With the passage of time and consequent opportunity for
prolonged investigation, fortified by availability of scientific
mechanism for bringing within vision structures hidden from
the older methods of clinical enquiry, surgery is finding fields
for activity which in past times were not available by reason
of lack of precise knowledge of existing pathological
conditions.
To appreciate some of the results of this lack of knowledge
a visit to some of the out-patient departments of ear,
nose and throat hospitals throughout the country will reveal
the lamentable effects of neglected surgery whereby long
continued otorrhœa has disorganised completely the
mechanism of the middle ear of many children whose full
earning capacity in the field of competitive labour has been
seriously jeopardised. Had those children been afforded the
full benefits of modern investigation by means of X-Ray and
other forms of scientific aids to diagnosis at the time of onset
of ear disease—often the result of scarlet fever, measles or
diphtheria—the prejudice to their earning power might have
been obviated. There is little doubt that surgery will
exercise an increasing beneficial influence in the future
administration of fever hospitals.
Opinions differ as to when surgical interference is indicated
in middle ear disease consequent upon an attack of one
of the acute infectious diseases, but it has come to be the
custom of this hospital to operate when other means of treatment
are plainly ineffective and not delay such interference
until a period when avoidance of permanent injury could not
be assured. The results of this regime have been justified,
as proved by the examination of cases on whom operations
have been performed, at periods after their discharge from
hospital.
With the increasing effectiveness of X-Ray diagnosis there
is justification for the hope that in the future by revealing
all sources of infection prior to the operation there will be a
considerable reduction of post-operative otorrhoea. That such