Observations of scarlet fever and its specific therapy
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1. Experimental evidence is overwhelmingly in favour of a definite haemolytic streptococcus as the causative organism of Scarlet Fever. There may be sub-groups of the Streptococcus scarlatinae which are toxigenically identical.2. Acute and chronic carriers are probably pre- ! eminently important in the method of spread of Scarlet Fever.3. The diagnosis of mild and atypical cases of Scarlet Fever remains a clinical proposition. Serological methods are seldom helpful, except that the definite change from a positive to a negative Dick Reaction during the course of the disease is proof that the condition undergoing treatment is Scarlet Fever. It is presumed, of course, that antitoxin has not been administered.4. Considerable help in the diagnosis of difficult cases would be afforded if every child were submitted to the Dick Test on entering school and periodically thereafter. Close co- operation between the School Medical Services and Infectious Diseases Hospital Authorities would then make it possible to have useful information regarding the personal history of every child suspected of having Scarlet Fever.5. Scarlet Fever is, on an average, diagnosed too late for the full benefit to be derived by the majority of seram- treated patients.6. Scarlet Fever Antitoxin is specifically antitoxic.7. The lack of a scientific method of standardising Scarlet Fever Antitoxin is a serious handicap to experimental therapy with this particular immune serum.8. The average intramuscular dose of 10 cc. of concentrated Scarlet Fever Antitoxin is a suitable one. Toxic cases should receive at least 20 cc. intramuscularly.The appropriate treatment of co- existent diseases (e.g. Diphtheria) does not detract from the value of observations on the results of the specific treatment of Scarlet Fever.9. The antitoxic treatment of the toxic phase of Scarlet Fever is valuable. The earlier the administration of the serum, the more rapid is the amelioration of the toxicity.10. The problem of sensitisation to horse serum re- quires attention. An International Scheme which would permit of harmless indelible substances being used for tattooing the site of injection would be a valuable safeguard against anaphylaxis. Accurate records of second and subsequent attacks of a particular zymotic disease would also be made possible by such a procedure, if an agreed colour represented a particular disease.11. Specific Antitoxic Therapy does not reduce the percentage of total complications appreciably, but the incidence of nephritis is definitely lessened and probably it could be entirely obviated by adequate early antitoxin treatment of Scarlet Fever. Arthritis is less evident in cases receiving early specific therapy.12. Toxic Scarlet Fever is markedly benefited by treatment with antitoxin. The treatment has no appreciable effect on cases of Septic Scarlatina.13. Antitoxin treatment lowers the case mortality by its great curative influence on toxic cases and by preventing nephritis in patients subjected to the therapy early in the toxic phase.14. The Length of Stay in Hospital is not reduced as a result of antitoxin treatment. This is ex- plained by the fact that the serum appears in- capable of preventing or mitigating septic sequelae, which are the most important causes of protracted convalescence.15. "Return" cases may be less common in Hospitals practising antitoxin treatment of Scarlet Fever, but if so, the reason for the reduction is pro- bably the early discharge of patients. By this means, massive sepsis occurring in wards is avoided. If septic complications develop after discharge, recovery is more rapid and more com- plete than is the case when complicated cases are housed in the same hospital ward.16. There is no room for argument as to the outstanding value of Scarlet Fever Antitoxin as a prophylactic. With adequate dosage, a passive immunity lasting for at least fourteen days can be guaranteed to contacts of the disease.