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The remainder of the diseases caused by the streptococcus pyogenes
are granted not the slightest epidemiological significance. They
are not notifiable, their occurrence seldom comes to the notice of the
Local Authority, and if they are treated in hospital at all, they are
admitted to the open wards of a general institution. Pursuing the
matter still further, there is now strong evidence in existence which
leads us to believe that streptococcal infection without a rash, e.y.,
aoute tonsillitis, is miore likely to be followed by serious after-effects
than the variety typified by a rash and dreaded under the
anachronistic caption of "scarlet fever!" The position is thus
illogical, indeed absurd. The remedy, unfortunately, is not
simple, although it can and should be found. Notification of all
conditions caused by the streptococcus pyogenes and the isolation of
every person suffering from siuoh infections in his or her own home
or in an Isolation Hospital, would almost certainly solve the
problem, but the expense would be considerable. Several authorities
are now tending towards the only other logical solution, the
elimination of scarlet fever as such from the list of acute notifiable
infectious diseases, at least until the whole matter can be dealt with
in a satisfactory manner. While I still personally do not agree
that scarlet fever can safely be left to its own devices, remembering
the tragic sequelae which may follow this disease, it is obvious that
the present procedure is little short of futile and touches merely the
fringe of the question. This matter has led to considerable discussion
during recent months, and it is to be hoped that some action
will shortly be taken which will rid us of this painful legacy of the
past and bring existing legislation into line with modern, scientific
knowledge.
The procedure with regard to the visiting of schools and the
supervision of cases after discharge from hospital remains unaltered,
and is still proving of the very greatest value. The
following table sets out the information collected under this
heading :
Total number of persons discharged during 1936 42
Number of persons visited after 1 year 36
(6 removed from district.)
Number of persons remaining perfectly well
throughout the year 35
(1 patient complained of rheumatism which
persisted for 9 weeks after discharge from
hospital.)
Total number of persons discharged during 1937 38
60