928 DISEASES CAUSED BY FILTRABLE VIRUS 



panying scarlatina was so violent that it could hardly be regarded 

 as a mere secondary infection, and the writer, like many others, has 

 seen a number of cases in which severe streptococcus infection of the 

 throat, rapidly followed by general septicemia, was accompanied by 

 a scarlatiniform rash, and in such cases it is impossible to say whether 

 one is dealing with a fulminating scarlet fever case or with a violent 

 streptococcus infection with a toxic rash. The experiments of Tuni- 

 cliff u seemed to show definitely that scarlet fever blood contains 

 specific increase of opsonins for hemolytic streptococci and that strep- 

 tococci from scarlet fever cases fall into a homologous group by ag- 

 glutination reactions. Moser and Von Pirquet 18 in 1903 had claimed 

 that the blood of scarlet fever patients quite frequently agglutinated 

 streptococci and also stated that the streptococci isolated from scarlet 

 fever blood could be agglutinated specifically in most cases with 

 immune sera produced with such streptococci, while streptococci 

 isolated from other sources were rarely so agglutinated. This ap- 

 parent specificity of the scarlet fever streptococci has recently been 

 more carefully investigated by Bliss* in Dochez's laboratory, and 

 in spite of the technical difficulties of agglutination experiments with 

 this group, these workers too seemed to have found a certain amount 

 of specificity in the scarlet fever streptococcus group. In view of 

 the toxic substances which Zinsser, Parker and Kuttner 19 have recently 

 obtained from streptococcus cultures, toxic substances which are not 

 regarded as specific exotoxins and are, therefore, not to be confused 

 with previous claims of exotoxin production by streptococci, and in 

 consideration of the nature of the scarlet fever rash, we do not believe 

 it impossible that the skin manifestations of scarlet fever may be toxic 

 in nature, and that, while many features in the disease would suggest 

 a filtrable virus similar to that of measles, there is still much logic 

 in continuing bacteriological investigations. 



Epidemiology and Prevention. There seems to be no doubt about 

 the fact that the disease is transmitted by the nasal and pharyngeal 

 mucus at all stages of the disease. The disease is probably com- 

 municable from the very beginning of the onset of symptoms in 



17 Tunicliff, Jour. Infec. Dis., Journ. A. M. A., 1920, 74, p. 1386 and 75, p. 

 1339; also Journ. Inf. Dis., 29, p. 91, 1921. 



18 Moser and Von Pirquet, Cent. f. Bakt., Orig., 34, 1903, 560 and 714. 

 * Bliss, Bull. Johns Hopk. Hosp., 31, 1.920, p. 173. 



19 Zinsser, Parker and Kuttner, Proc. Soc. for Exper. Biol. and Med., 18, 

 1920, 49. 



