SCARLATINA.
Prophylaxis.—A tendency has been showing itself of late years towards minimising the high degree of the infectiousness of the scarlatina' poison, probably because the infectivity of the desquamated epithelium had been greatly exaggerated and the comparative immunity of infants to the dis ease is now more fully realised. There are, however, few, if any, infectious diseases in which preventive measures arc so imperative, since the mor tality of the disease rises so unmistakably with the age of the child after the first year of life, though it falls after the age of eight to ten years of life. There are, moreover, good reasons for believing that if the individual can be protected during the period of childhood and early adolescence he is likely to escape the disease altogether.
These considerations are of vital importance when the question of idiosyncrasy as regards susceptibility in certain families is remembered, many reported cases showing the obliteration of a family of young children, only the grown-up members escaping.
I hence the importance of rigid isolation, and where the patient cannot be at once removed to hospital the other children should be sent away from the home without delay. The period of most intense contagiousness corresponds with the acme of the eruption and fever and not with the desquamation stage; the disease should be regarded as contagious from the time that the first throat symptoms and fever show themselves. The fact that the poison is often borne in milk has been abundantly demon strated in many epidemics, and is obviously of great importance in prophylaxis. The part played by fomites must be remembered, and the tenacity to life of the virus is most remarkable; an infected article of clothing worn during the acute stage of the disease and locked up for more than a year has often conveyed the malady in an intense form. Hence also the vital importance of a subsequent thorough disinfection of every nook and cranny in the sick-room, the repapering of the walls and the destruction of all bedding and carpets and the removal of every unneces sary article of furniture from the sick-room before the patient is placed in it.
The important question of methods of treatment which bear upon the checking of the spread of the disease from the affected to the healthy has occupied much attention of late years. The plan of early inunction of
the patient's body with Eucalyptus Oil has been, in the writer's opinion, an advance, but in the hands of many it has become a danger by leading to the practice of permitting the patient to mix too early with the un affected. The physician is wise who still maintains that complete safety can only be maintained by a period of isolation extending over at least six weeks, even when disinfecting baths, antiseptic throat applications and eucalyptus inunctions have been carried out, and this period must be prolonged considerably when any suppurative ear lesion exists.
Though the incubation stage may be a period of hours, it sometimes is prolonged to several days; hence a quarantine of 8 days for those known to have been exposed is necessary.
Vaccine prophylaxis has been tried on a large scale in Russia with most satisfactory results by Gabritschewsky, who affirms that complete im munity can he obtained by three injections of a killed culture of strepto cocci obtained from a patient suffering from scarlatina, the dose being c.c. of a concentrated bouillon culture. It is still to be determined how long this immunity will last, but it has been proved that it affords almost complete protection during an epidemic of the disease.
The treatment of the established disease will commence with the selection, preparation, heating and ventilation of the sick-room and with directions for the diet, etc. These may be taken as identical with the requirements necessary for the preliminary treatment of a case of measles as detailed in the article on Measles. A room as thoroughly isolated as possible from the other parts of the house should be chosen, and it should have an adjoining chamber or dressing-room for the nurse, who should not be permitted to wander about and infect the other parts of the house. It is unnecessary to repeat the caution already given of having everything except indispensables removed from the sick chamber before the patient's entrance into it, nor is it necessary to point out the impera tive need of a thorough disinfection of the room in which the patient first showed the symptoms of the disease in case he cannot remain there.