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true cases of scarlet developed secondary rashes at the end of
the third week.
Complications:—43 per cent, of the cases were uncomplicated,
11 (8.9 per cent.) suffered from nephritis, and the
same number from rhinorrhea. The remaining cases suffered
from septic sores, onychia, rheumatism, blepharitis and other
minor infections. One child developed a diffuse erythema
multiforme in hospital, but this could not strictly be called
a complication of scarlet fever.
"Return" cases:— 10 (8 per cent.) return cases occurred
The history obtained in all these cases was similar. The
patient, on dismissal from hospital was free from all discharges,
but developed a "cold" shortly after returning
home. Six of the cases were Wimbledon cases and four were
from Kingston. This number of " return " cases is rather
high and it would almost appear as if the cases which were
mildest in hospital are more likely to give rise to secondary
cases of infection. It was observed that children with slightly
enlarged tonsils appeared to cause such return cases more
frequently than children with ear or nose discharge. It would
almost seem as if these latter cases became attenuated in
virulence after a prolonged stay in hospital, and could, safely
be dismissed from hospital although the discharge from ear
or nose had not ceased.
From these remarks it might almost be advisable to have
a consulting aural surgeon on the staff of the isolation
hospitals.
Mixed Infections.— Scarlet Fever and Whooping Cough.
Two cases of double infection were admitted, but as notification
had been given, isolation in side wards prevented any
spread.
.Scarlet Fever and Chicken-Pox.—One child was admitted
with scarlet fever who was also incubating chickenpox,
which developed eight days later. No warning was
conveyed by the notifying practitioner so that no precautions
were taken. Four susceptible children developed chicken-pox.
Scarlet Fever and Diphtheria.—One child was admitted as a
pure diphtheria case, clinically and bacteriologically. There was
no evidence of rash on admission, but as the tongue was
suspicious, " barrier-nursing " was begun at once.
The medical practitioner notifying the case was communicated
with and he stated that he had seen no evidence of
scarlet fever. Seven days later the boy in the next cot, who
had been in hospital three weeks, developed typical scarlet
fever. Further enquiries from the parents of the suspected
infecting case elicited the fact that the mother had noticed,
on the day previous to calling in the family 'doctor, a faint
rash which only lasted a few hours.
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