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for by the first attack being so mild that the patient did not
develop sufficient antitoxin naturally to confer immunity. In
the cases treated by serum, it is possible that the injection of
serum inhibited the natural development of antitoxin. The
only other explanation of such cases may be that the germ
of scarlet fever may have different "strains," producing
distinct blood reactions.
One case of scarlet fever of the mild variety (untreated
by serum), developed a petechial rash at the end of the first
week, with gastric and intestinal haemorrhages. This case
had been strictly isolated in a separate cubicle from admission.
A good recovery was made.
There were 10 "return" cases—a percentage of 6.
Serum Treatment:—During the year, 50 cases have been
treated with the new serum for scarlet fever. The cases
selected were those regarded as more severe, but no severe
toxic cases were admitted. After injection, the temperature
falls rapidly (almost by crisis), the rash fades and in the
great majority there is no further rise in temperature. In
a few cases a secondary and smaller rise occurred about the
4th day, and lasted until the end of the first week or ten days.
In these oases the dosage (10c.c.), was probably too small.
The numbers treated are probably too small to be definitely
accurate, but the following were the results observed.
Taking all complications, the percentage was the same in
treated and untreated, namely, 44%; taking the more serious
complications only, such as mastoiditis, otorrhœa, suppurative
adenitis, nephritis, rheumatism and chorea, the percentage
in the untreated was 32, as against nil in the treated. Serum
given late in the disease, appears to have no effect on the
complications. Early complications appear to be cured
quickly.
"Cross-Infection" occurred 4 times during the year—
thrice in Scarlet wards, and once in the Diphtheria block.
These outbreaks were all due to children admitted, incubating
the second disease. The outbreaks were, Chickenpox on three
occasions, and German Measles on one.
Diphtheria:—42 cases were admitted as diphtheria. 8
were not true cases—3 being follicular tonsillitis, 2 Vincent's
Angina, 2 "croup," in rieketty infants, and 1 a case of Quinsy.
Of the true cases, 33% were mild, 26% moderately severe, and
41% severe. 8 true laryngeal cases were admitted, but tracheotomy
was not required. 1 death occurred on the 8th day
from heart failure, giving a case mortality of 2.4%
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