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93
Scarlet fever being now regarded as one of the many
manifestations of the hemolytic streptococcus—this takes no
account of the possibility that true scarlet fever may be a
virus infection and that the hemolytic streptococcus plays but
a secondary part as it does in other virus infections, e.g.,
measles—it would appear an incomplete proceeding to make
elaborate isolation hospital provision for cases of this malady
as a preventive measure for the protection of the community,
when at the same time in the same community there probably
exist cases of streptococcal illness to which the label of scarlet
fever cannot be attached, such illness being possessed in all
probability of potentiality for producing in contacts recognisable
scarlet fever. This expression of opinion suggests need
for isolation of all streptococcal infections, for it may well be
asked: Why isolate scarlet fever if the various cases of clinical
sore throat due to streptococci, but from which rash is absent,
are left unisolated?
The ubiquity of this organism—the heæmolytic streptococcus—renders
impossible any scheme of isolation provision
for all its victims, but there does seem to be some reason in a
suggestion that the worst clinical cases, be they scarlet fever,
tonsillitis, otitis, dermatitis, erysipelas, puerperal sepsis and
other less clearly defined illnesses due to the streptococcus
be admitted to isolation hospitals and nursed back to health
under expert supervision.
BED ISOLATION.
It will be remembered that a system of bed isolation in a
scarlet fever block was introduced at the beginning of 1938
and in order to study the effect of this system of nursing it
was necessary to make a biological study of the organisms
associated with each case admitted to the block. The further
the investigation proceeded, with the accummulation of
material it became evident that a factor, uncountered by the
very careful techique employed, was operative.
The transference of serological types of the hemolytic
streptococcus was still in evidence, not always accompanied by
clinical complications, and the factor concerned in the