SURGICAL SCARLET FEVER.—Patients who have undergone surgical operations are unquestionably very susceptible to scarlet fever. Such scarlet fever, ever, is not essentially different from the usual disease. It is simple scarlet fever in a surgical case. It is, no doubt, true, as Osler has shown, that the eruption which has frequently led to a diagnosis of scarlet fever is nothing more than the red rash of septicmmia. It is a fact that surgical scarlet fever is much less com mon since surgical septicremia has be come less frequent.
Case of scarlatina after laparotomy and in childbed shows that one may fearlessly perform an operation that does not admit of delay (e.g., herniotomy) on a patient suffering from uncomplicated scarlet fever, and, further, that a woman so suffering may he confined, or a puer peral woman have scarlet fever, without the genitals being infected. These state ments refer to simple scarlatina, not to the traumatic form of the disease. Sip pel (Centralb. f. Oyn., Nov. 5, 'OS).
Etiology. — Among the predisposing causes age must be placed first. The disease is rare under one year, but I have seen an undoubted attack of scarlet fever in an infant of one week. Up to five years the susceptibility steadily increases and reaches its maximum; after eight years it rapidly decreases, and is slight during adult life. Sex does not influence its occurrence.
That scarlet fever is an infectious dis ease does not admit of doubt, but the specific germ has not yet been discov ered. It has, however, been fully dem onstrated that streptococci play an im portant role in the causation of many of the symptoms. It has been urged by some that streptococci are the cause of the disease itself, but this ground is un tenable. They are, however, the cause of the pseudomembranous exudations of the throat, and undoubtedly cause the otitis, and adenitis, and probably the nephritis, pneumonia, and joint lesions.
Traumatic scarlatina is an eruptive, contagions, and often epidemic disease which seems to be of the same nature as ordinary scarlatina. The infection, how ever. occurs in a wound. The disease has been called snrgical scarlatina. In 147 cases selected from the literature 117 occurred in children under 15 years of age and two-thirds of these were in boys who had suffered from traumatism.
In a number of these cases the appear ance of the scarlatina and the associa tion of the wound have been purely co incident. In a certain number, however, the scarlatina has developed in the wound. Traumatic scarlatina is less se vere in its course than the ordinary scarlet fever. The eruption makes its appearance at the wound and spreads from that point over the body. The sore throat is very much less severe and the constitutional symptoms slighter. R. de Bovis (Semaine 1ledicale, Jan. 29, 1002).
Whatever the cause of the primary dis ease may be proved to be, it is certain that streptococci are the direct cause of the secondary symptoms. They are so constant in their presence and so active in the production of the more serious symptoms and complications that they must be regarded as important factors in the production of the clinical picture which we know as scarlet fever. The disease as it commonly appears is a mixed infection, the more malignant and fatal symptoms being due not so much to the primary as the secondary infection. Staphylococci and diphtheria bacilli are sometimes found in conjunction with the streptococci.
The unsatisfactory results of careful observers in isolating a specific micro organism of scarlet fever lay with the culture-medium employed. Medium found on which it is almost invariably possible to obtain both from the scales of the epidermis and from the throats of scarlatinal patients an organism which presents characteristic features both in its morphology and its mode of growth. The specific germ of scarlet fever is a diplococcus resembling a large gono coccus. In slightly stained specimens a transverse line is noticed running through each half of the diplococcus, and giving it the appearance of a tetrad. Its size varies, but the cocci are always considerably larger than those of ordi nary pus. Specimens from pure cultures can be stained by carbol-fuchsin aqueous solution of methylene-blue, Bismarck brown, and Pitfield's flagella stain. They are decolorized by Grain's method, but less readily than the gonococcus.