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type of scarlet fever which was prevalent so long ago. Unfortunately
some of these methods result in widespread loss of time,
energy, work and schooling; and they give rise to substantial
public expenditure.
During recent years our former conceptions of the nature of
infection and epidemiology of scarlet fever have been shattered
at such a rate that we cannot afford to disregard the results of
experience of any method of dealing with the disease, however
unorthodox it may appear.
What is Scarlet Fever ?
During recent years bacteriologists have been very active in
their efforts to throw light on the nature of the infection in scarlet
fever and allied diseases. The great increase in new forms and
types of streptococci, and the ingenuity displayed in their nomenclature—well
described by Topley and Wilson as a "riot of christening"—are
sufficient to confuse the physician who is faced with
the actual clinical and administrative problems connected with
these diseases. There is conclusive evidence that uncomplicated
scarlet fever is due to infection by one or other of many different
strains of the hæmolytic streptococcus; but organisms with
the same morphological and biochemical reactions are to be found,
not only in widely varying forms of disease and in those who have
recovered from these diseases, but also in anything up to 36 per
cent, of apparently healthy persons.
The Dick test and the Schultz-Charlton Reaction may be useful
in diagnosis; but they are of limited value, and least reliable in the
very type of case in which their help is most needed. On what,
then, is the clinician to rely in trying to arrive at a diagnosis ?
Medical practitioners have always regarded the typical scarlatiniform
punctuate erythematous rash as the diagnostic feature
"par excellence," and subsequent consistent desquamation as
clinching the diagnosis; but experienced observers have always
been baffled to find patients with typical rash and strawberry
tongue who did not peel, and other patients with typical peeling
who have had no previous rash.
In a recent bacteriological investigation of 100 suspicious cases
Brown and Allison found that the incidence of rashes was almost
equal in the bacteriologically positive and negative cases; that