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leagues, the swab gave practically a pure culture of streptococci
showing B.Haemolysis and other characteristics compatible
with Group A streptococci. The officer was advised to have the
tonsils enucleated and remained away from school until the
throat flora became normal. In another class, a child had a
tonsil and adenoid operation. None of the children in the
classes were found to be suffering from otorrhoea—a recognised
possibility in the cause of the spread of scarlet fever.
During the first and second quarters of 1939, only 7 and 4
cases respectively of scarlet fever have occurred at Oliver Goldsmith
school, so that perhaps the "epidemic constitution" has
spent itself.
"The classical clinical picture of this disease is now
generally accepted as a syndrome, the 'scarlet' feature of which,
an erythematous rash, is only pathognomonic in a strictly
limited sense. The 'scarlet' erythematous rash is a clinical
feature which distinguishes an infection by Streptococcus
pyogenes, in a proportion of individuals so infected. An
erythematous rash may be present or absent in diseased states
strictly comparable in all particulars and due to an infection
by the same strain of S. Pyogenes, and its appearance depends
not upon the portal of entry of the infection organism, but upon
the susceptibility of the infected individual to an erythrogenic
toxin, and the quantity of this toxin liberated by the organism.
Its appearance is no guide as to the toxicity, infectivity, or
liability to complications in any given case of infection. 'Scarlet
fever' is a term so particular in its application, yet so general
in its association with a multiplicity of diseased states, that its
retention in clinical nomenclature leads to much confusion of
thought and action." (Hobson).
The experience at Oliver Goldsmith school has given cause
for much interesting speculation, but an easy explanation of the
circumstances has not been found. Perhaps those who carry in
their throats the germs of scarlet fever are on occasion more
numerous than is generally considered, or perhaps a small
number of people who carry the germs carry them on occasion
much longer than is generally considered. In this latter regard,
a case during the year came under notice which seemed to suggest
that a child who had been very strictly and conscientiously
isolated at home for 57 days, infected her sister 21 days after
release (a usual working rule for the liberation of cases of
scarlet fever from isolation is, at the longest, 28 days).
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