Efforts to effect a cure in scarlet fever must be extended not only to the patient, but also to his surroundings. The well-known convey ance of the disease through the agency of a third person, and the unusual tenacity and virulence of the exciting cause of scarlet fever necessitate the immediate early and complete isolation of the patient. Ideal iso lation consists in placing the patient in an isolation hospital, as was pointed out by lieubner.
It is practically impossible to effect complete and consistent isola tion in the home. Such isolation is only a half measure, although often this is the only isolation which can be secured in many instances, espe cially in small cities and in the country. Children who have come in contact with the patient or who have been exposed to the possibility of infection in any way should be excluded from school attendance for at least two weeks, and be kept under observation.
In the case of measles it is useless to resort to isolation after the eruption has appeared, because other children in the family, as a rule, are stricken with the disease several days before the period of eruption. The same is true of all persons who have conic in contact with the patient and who have not had an attack of measles. Furthermore, another reason for not isolating these children is the well-known fact that sootier or later children acquire measles. This is not true of scarlet fever, because the majority of persons never contract the disease. The possibility of such acquisition diminishes from year t.o year, as the natural resistance of the body becomes greater.
The child should be confined in the hospital as long as is necessary, until there is no longer any danger of infection. If removed too soon, the virus is conveyed to the home, where, as is proven by numerous cases recorded in the literature, infection may occur years afterwards. The virus is highly resistant and quiescence does not imply destruction. The longer the child is kept in the home, the greater is the possibility of infection.
Even when the child is taken to the hospital early, the home should be disinfected thoroughly: Washiiig the furniture and the floor with one per cent. corrosive sublimate, or five per cent. phenol solution; destruc tion of the toys. The bedding and other linen should be washed. Cloth
ing should be disinfected with steam; all leather articles should be dis infected with formalin.
The attending physician should arrange his visit to the scarlet fever patient so that it follows the visits made to his other patients; wear a gown and wash his hands thoroughly before he leaves the house or hospital.
In spite of every precaution that may be taken, this is not a guaranty that on the return of the patient to the home, other children in the family will not become infected. The probability for such infection is, however, considerably diminished if precautionary measures are taken.
Worthy of mention in this connection are the efforts that have been made by Russian physicians to prevent contagion by means of the sub cutaneous injection of killed streptococcus cultures (Gabritschewsky).
At a meeting of the Science Association held in Salzburg, in 1909, Benjamin called attention to the peculiarly mild course of scarlet fever in children who received an injection of horse serum (diphtheria anti toxin) four to six clays before the onset of the disease. He is inclined to ascribe this mild course to the serum injection, and urges that the ques tion be made the subject of further research.
General Treatment.—In every case of scarlet fever the patient should be kept at rest in bed for four weeks. During this period no meat should be allowed.
The necessity for this prophylactic measure has not been established. I am of the same opinion as Ziegler and Baginsky, that the children who were confined in a hospital, and who were treated in this manner, did not suffer from a nephritis to the same degree as did those children who were treated in the home and who were not subjected to these measures.
Withholding meat from the diet is a prophylactic measure based on purely theoretic grounds. I doubt that we are justified in ascribing an unfavorable action on the kidney of the extractives contained in meat and meat derivatives, such as soup and beef tea. It is a matter of observa tion, however, that children do very well on a meat-free diet, and that in the mild cases there is even a distinct gain in weight..