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evidence from the tongue, temperature and pulse rate was of no
diagnostic value; and that only 40 per cent. of the positive cases
eventually showed consistent desquamation.
Even after the most thorough clinical and bacteriological
investigation, the diagnosis of scarlet fever may be beset with
extreme difficulty; and with the mild type of the disease now
prevalent it is recognised to be one of the most difficult to diagnose
of all infectious diseases. It is the busy general medical practitioner
however—with little or no time and facilities for bacteriological
and serological tests—who has the responsibility of not only diagnosing
but notifying a condition which cannot be regarded as a
specific epidemiological entity. It is therefore not a matter for
surprise that in a large percentage of patients, notified and admitted
to hospital, the diagnosis of scarlet fever is not confirmed—Brown
and Allison estimate that 39 per cent. of doubtful cases of scarlet
fever are not infectious and do not require hospital treatment of
any kind.
Notification.
In view of the acknowledged difficulties in the diagnosis of
scarlet fever, the presence of virulent strains of streptococcus
scarlatinæ in so many non-notifiable types of infection and in such
a large proportion of apparently healthy persons, it cannot be
expected that the present system of notification of scarlet fever
can result in the ascertainment of more than a very small proportion
of persons who are capable of conveying infection.
Hospital Isolation.
Towards the end of last century Isolation Hospitals, many of a
temporary nature, were built for the isolation of the infectious sick.
In the first place their function—as the name "Isolation Hospital"
implies—was "segregation" rather than "treatment." It was
difficult to persuade patients to enter them. Frequent resort was
had to the power of compulsory removal, and the element of compulsion
was ever present in the minds of infectious patients and
their relatives.
Nowadays there is a complete reversal of the position. The
modern fever hospital is—or should be—soundly constructed,
efficiently staffed and well equipped with every facility for the
effective isolation, diagnosis and treatment of all forms of infectious
disease. The difficulty one meets nowadays is not that of coaxing