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"As the Committee are no doubt aware, it has been the practice
in Southgate to follow the second method of procedure, i.e., to
admit to hospital 70-90 per cent. of all cases notified, to detain
them for at least four weeks and to give serum only in cases of
moderate or great severity.
"In view of the changing outlook towards scarlet fever adopted
by many authorities, and also in view of the very large demand
upon our scarlet fever beds in Hospital, I have given this matter
considerable thought and have made certain investigations. I have
visited two of the foremost exponents of serum treatment in scarlet
fever and saw their work in the hospital wards. I also consulted
the Medical Officer of Health, Tottenham, and following these
interviews, together with the perusal of several recent authoritative
statements on the subject, I consider that it would be wise to change
our policy and to give serum in all cases admitted to Hospital.
''The advantages of serum administration, as held and, I consider,
proved by its sponsors, are as follows:—
(1) There is a rapid fall of temperature, oedema of the
pharynx subsides very quickly and the patients so treated
speedily experience a feeling of well-being.
(2) Complications are very considerably reduced, as are
also cross-infections in the wards, both points of vital importance.
(3) Because of the practical elimination of kidney damage
patients can be put on full diet as soon as the temperature
settles (usually within 48-72 hours), and can be got up in the
second week of disease. Nutrition and muscle tone are thereby
sustained, two very important factors in convalescence.
(4) Patients can normally be discharged from hospital with
safety at the end of three weeks.
(5) Desquamation is considerably reduced. (This is only
important from the standpoint of parental anxiety.)
''It will thus be seen that patients treated by serum make a much
speedier recovery than those untreated and are considerably less
subject to the complications which almost alone make scarlet fever
a serious disease.
"Regarding the administration of serum, there are three ways
in which this can be carried out—
(1) Intramuscularly.
(2) Intraperitoneally.
(3) Intravenously.
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