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41
In view of the findings in regard to Group A streptococci, it is
of interest to note that no case of scarlet fever had been notified
from this school in 1957, and indeed the incidence of scarlet fever
in the Borough has been unusually low throughout the year.
It is relevant to recall that during the outbreak of mild scarlet
fever at the Sidney Burnell Infants' School in 1954/5 a child, aged
five years, in attendance at that school died on the 3rd December,
1954, from a phlegmonous infection of the glottis and streptococcal
bronchitis. The cause of death was certified after a Coroner's Post
Mortem without Inquest. The Post Mortem bacteriological examination
in that case showed a Streptococcus Viridans, whereas the
scarlet fever cases were due to Haemolytic Streptococci Group A,
Type 4.
Comment:
Cases of this nature are, fortunately, very rare and appear to
present great difficulty in regard to prognosis.
The family doctor may consider a case to be either one of
spasmodic croup or of laryngismus stridulus (laryngeal tetany),
which conditions are usually not serious or fatal, although the symptoms
may be alarming.
Alternatively, the condition may be one of acute laryngitis
(Acute Laryngotracheo-bronchitis), Acute Supraglottic Oedematous
Laryngitis, Oedematous Laryngitis; Phlegmonous pharyngitis, or
Oedema of the Glottis, all of which may be rapidly fatal and for
which admission to hospital may be necessary with adequate facilities
for tracheotomy.
A recent article in the medical press (Beale, A. J., et. al. 1958
Brit.med.J. I, 302) in regard to laryngotracheobronchitis states that
this condition is common in North America, is often called croup
after the most prominent symptoms, that mortality is now negligible
owing to modern methods of treatment, but that the causation is
obscure, although the lack of bacteriological cause suggests a virus.
In the cases reviewed in this article (all of which had been
admitted to hospital) the disease was sufficiently severe to raise the
possibility of tracheotomy.
Exclusion from School on account of Infectious Illness.
During the course of the year the Borough Education Officer
circulated to all schools copies of the revised Memorandum issued
by the Ministries of Health and Education.